The placement of dental implants in posterior maxilla is often a challenge due to pneumatization of maxillary sinus. Dental surgeons have predictably overcome these obstacles by performing bone grafting proceduressuch as lateral window technique (modified Caldwell-Luc). But, mobidity has been a concerned due to postoperativebrusing, pain, and swelling. To reduce the mobidity, many internal (crestal) approaches to sinus grafting wereintroduced using osteotome, reamers, tapping drills, piezo, ISM, HSC, etc. But still, all these internal techniques forsinus grafting are difficult to predict their results because of lack of visibility when opening sinus floor and manipulatingSchneiderian membrane.
Presenting a new sinus grafting technique that is systematic and predictable. This system utilizes crestalapproach to reduce morbidity. Unlike the other crestal approaches to sinus grafting, the uniqueness of this system is thatit is not a blind technique and the result of membrane elevation is comparable to that of lateral approach.
The new systematic approach to internal sinus grafting is simple, predictable, without morbidity associatedwith lateral window technique.
Sinus, grafting, Lift, dental implants, lateral window, crestal window, internal sinus lift, crestal sinus lift,sinus elevation, osteotome, Schneiderian, sinus membrane, minimally invasive sinus surgery
The treatment of posterior edentulism has been achallenge for dental physicians due to poor bonequality and quantity (due to pneumatization of maxillary sinus). We have overcome theseobstacles by bone condensing and bone grafting intomaxillary sinus under Schneiderian membrane.
Bone grafting into sinus have produced predictableresults enabling clinicians to place longer implant formore stable prosthesis with better and long termoutcome.
However, morbidity associated withlateral window grafting procedure has beenconcerned.
5, 6, 7, 15, 17, 18
Severe brusing, swelling,and pain are the common postoperativecomplications due to flap elevation beyondmucogingival junction.
5, 6, 7, 15, 17, 18
Theintraoperative complication that arises from therupture of intraosseous branch of posteriorsuperiorior artery (branch of maxillary artery) ispanic-striken
. Moreover, the technical nature of lateral window procedure is easily accompanying thepossibility of Schneiderian membrane perforationwhile opening an window and elevating sinusmembrane. Therefore, nowadays, many internal(crestal) approaches to sinus grafting have beenintroduced such as osteotome
5, 6, 7
, piezo, ISM
, etc. Nevertheless, allthe internal techniques for sinus grafting to this dateare unpredictable for average clinicians, because of lack of visibility when opening sinus floor andmanipulating Schneiderian membrane.Standard diameter implant (4.0mm) has been a greatsolution for premolar area, but it has somelimitations in the molar area resulting pooremergence profile
, fracture of implants
, crestalbone strain
, and narrow occlusal table. Minimumof 5mm to 8mm implants in diameter willovercome poor bone quality by increasing bone toimplant contact surface as well as making superioremergence profile
. Such diameter of implants inmolar area also decreases the fracture rate of implants, crestal bone stress, and allows fabricationof natural occlusal table
.Use of wide diameter implant, which is moreappropriate for molar restoration as described above,opened a new door to sinus grafting. Crestalwindow, instead of lateral window, is made with