{"id":3673,"date":"2015-10-25T08:58:19","date_gmt":"2015-10-25T08:58:19","guid":{"rendered":"http:\/\/biomedpharmajournal.org\/?p=3673"},"modified":"2020-04-25T09:30:37","modified_gmt":"2020-04-25T09:30:37","slug":"indirect-sinus-lift-in-immediate-placent-of-implant-a-case-report","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol8octoberspledition\/indirect-sinus-lift-in-immediate-placent-of-implant-a-case-report\/","title":{"rendered":"Indirect Sinus Lift in Immediate Placent of implant \u2013A Case Report"},"content":{"rendered":"

Introduction<\/strong><\/p>\n

Implant placement in compromised \u00a0posterior maxilla is more demanding and essential \u00a0\u00a0with available \u00a0bone quality and quantity for the functional chewing and speech .1-5\u00a0 the presence of\u00a0 maxillary sinus floor above the maxillary alveolar bone after the extraction limits the\u00a0 implant placement\u00a0 and as the implant perforate the sinus lining and complicate the successful osteointegration of the implant . so various treatment and approaches are available for elevating the sinus floor and lining\u00a0 to achive excess height\u00a0 and primary stability for the placement of root form implants the widely performed two techniques\u00a0 for sinus floor elevation are lateral window\u00a0 approaches 6-8 and .to increase the amount of bone in the atrophic maxilla the sinus lift procedure and subantral augmentation procedure are performed and developed\u00a0 at the mid 1970\u2019s( 7)\u00a0 creastal bone approaches(9-14) .the most commonly used technique for maxillary sinus floor\u00a0 lifting through a lateral window which was first presented by tatum in 1977,and was first published by boyne and james 1980. (14-16). This bone augmentation Is considered as the time consuming\u00a0 invasive and expensive procedure when compared to the minimally invasive methods .summers in 1994 introduced the a less aggrasive procedure for sinus floor elevation with immediate placement of implant known as the osteotomy sinus floor elevation (OSFE)(17). Creastal approach\u00a0 was very widely performed rather than lateral window approach followed by osteotome for elevation of the membrane and floor of the sinus and immediate placement of the implant.at the same time graft mayor may not be placed<\/p>\n

This procedure is less invasive\u00a0 compared to the lateral window approach ,less time consuming , mii al trauma to the underlying structures and post operative complications is less and prognosis of the treatment is similar to the usual conventional technique\u00a0 (18)<\/p>\n

Materials and Methods<\/strong><\/p>\n

Our study was performed inbetween the age group of 25 to 50years irrespective of genders having poor prognosis of maxillary posterior teeth including root stumps\u00a0 and that are opted for extraction. patients with chronic sinusitis and smokers, long standing chronic nasal obstruction, pregnant patients and psychologically ill patients are excluded from the study.<\/p>\n

A preoperative evalution of bone height and bone width are measured\u00a0 clinically and with the help of intro oral \u00a0radiograph.<\/p>\n

1<\/sup>Antibiotic prophylaxis is was initiated a day before surgery<\/p>\n

2<\/sup>Under local anaesthesia\u00a0 tooth was extracted , and the surgical curratage done and socket irrigated with betadine solution.<\/p>\n

3<\/sup>Drill upto 1 mm away from the floor was was continued with1.1,2.8 ,3.3 drills were used till the final preparation.then the expansion osteotomes are used<\/p>\n

4<\/sup>light tapping with a mallet carefully collapse the sinus floor into the sinus cavity elevating the schneiderian\u00a0 membrane.<\/p>\n

5<\/sup>elevation of the sinus membrane performed using the 3# osteotome,that was used previously\u00a0 to force the graft head of its tip to achive fracture the sinus floor up fracture.<\/p>\n

6<\/sup>implant of dimension of (13 x 4.2 mm) was placed.primary stability was assessed by finger pressure the implant showed primary stability .stability can also be increased by the threads or by placing the implant deeper.<\/p>\n

7<\/sup>abutment was positioned over the implant and the occlusal height \u00a0was adjusted , implant was loaded with temporary restoration.<\/p>\n

8<\/sup>post operatively, patient was adviced\u00a0 to rinse the mouth with twice a day with 0.12% of chlorohexidine solution\u00a0 for two weeks after surgery. antibiotics \u00a0wera priscribed for next 7 days.<\/p>\n

9<\/sup>After a healing period of 4 months , patient was recalled , and rehabilitated with fixed prosthesis.<\/p>\n\n\n\n
\"figure<\/td>\nFigure 1: Pre Operative <\/strong><\/p>\n

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\"Figure<\/td>\nFigure 2: Post Operative<\/strong><\/p>\n

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\"figure<\/td>\nFigure :3\u00a0 Pre Operative \u00a0<\/strong><\/p>\n

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\"figure<\/td>\nFigure 4: Post Operative<\/strong><\/p>\n

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 <\/p>\n

Discusion<\/strong><\/p>\n

The elevation of the maxillary sinus floor was first reported by the boyne in 1960, after fifteen years later boyne and jame reported elevation of the maxillary sinus\u00a0 floor in largely pnuematized sinus cavities in preparation of the placement of the\u00a0 bladed implants. always the decreased bone height in the posterior maxilla limits the placement of the implant , so the problem can be solved by elevating the maxillary sinus and achieving excess height for the placement of implant and so the implant \u00a0enters into the space occupied by the sinus floor and the ridged fixation is achieved and osteo integration takes place .\u00a0 these authors proposed two different techniques for the easy way to approach the sinus floor without disturbing the integrity of the sinus lining the various two methods that was currents performed are lateral window approach and crestal approach, both the approaches have their own advantages and disadvantages, either with or without placement of the grafts here in this study we a practicing only the easy and the recent approach of crestal approach\u00a0 , because the procedure is invasive ,\u00a0 a traumatic and less time consuming procedure , here the alveolar bone that is present in between the sinus floor root apex\u00a0 acts as the readymade graft and it tents the sinus floor so the enough space is created in between the floor and the prepared site so that the root form implants enters the sinus cavity behind the bone\u00a0 , this procedure is widely practised and there is no much complications post operatively, in direct sinus lifting surgery\u00a0 piezo instrument is used to create the window , whereas in crestal approach osteotome is used to elevate the sinus floor the advantage of this procedure is avoidance of the invasive surgery and permitting treatment with a single stage, to achive excellent primary stability in the cases of sinus floor lifting followed by immediate extraction cases use of osteotomies are more useful than using the drills , by compressing the sinus floor slightly by indirect approach with osteotomies can condense the bone laterally dense interface is created in between the sinus and the implant\u00a0 19. Improving the initial bone to the implant contact\u00a0 20. Commonly the complications happens if the schneiderian membrane \u00a0is perforated by the instrumentation and implant and the filling material can move into the sinus cavity and can cause sinusitis 21 and 22, proper case selection\u00a0 and\u00a0 anatomical site preparation can overcome these problems.<\/p>\n

Conclusion<\/strong><\/p>\n

Implant placement in in the posterior maxilla that are atrophied\u00a0 with less height in between the sinus floor and\u00a0 the alveolar ridge can be greatly extended by the indirect sinus lift procedure through the crestal osteotome approach as the procedure is very easy and invasive and\u00a0 the time consumption is less and the apical bone themselves acts as the bone graft and that tents the sinus lining and crestal \u00a0sufficient primary stability for the implant placement with less post-operative complications. It also allows the treating the compromised posterior maxilla with reliable results.<\/p>\n

Referenses<\/strong><\/p>\n

    \n
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  22. pikos MA MaxillARY Membrane repair. Update on technique for large and compete perforations , implant dent 2008:17:24-31.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

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