Vijay Ebenezer ¹, R. Balakrishnan²,Senthil Nathan³

¹Vijay Ebenezer, Head of the Department, Department of Oral and Maxillofacial Surgery, Sree Balaji Dental College and Hospital, Bharath University, Pallikaranai, Chennai - 600100 ²R.Balakrishnan, Professor, Department of Oral and Maxillofacial Surgery, Sree Balaji Dental College and Hospital, Bharath University, Pallikaranai, Chennai - 600100 ³Senthil Nathan, Reader, Department of Oral and Maxillofacial Surgery, Sree Balaji Dental College and Hospital, Bharath University, Pallikaranai, Chennai - 600100

DOI : https://dx.doi.org/10.13005/bpj/733

Abstract

The posterior maxilla is always  considered as the difficult  site for the placement of implant than the mandible  due to the presence of various anatomical land mark such as maxillary sinus ,            these anatomical structures  often makes every dental implant surgeons a challenge task in placement of endosteal implants in the chronic atropic maxilla and difficult in osteointegration  and  further functional and aesthetic  implant supported prosthesis.various techniques  in sinus lifting procedure enables the additional anchorage and stability in implants placed support in maxillary segments in with atropic ridges and pneumatic  sinuses.

Keywords

Atropic maxilla; sinus floor; crestal approach; osteotome; endoseous implants

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Copy the following to cite this article: Ebenezer V, Balakrishnan R, Nathan S. Indirect Sinus Lift in Immediate Placent of implant –A Case Report. Biomed Pharmacol J 2015;8(October Spl Edition)

Copy the following to cite this URL: Ebenezer V, Balakrishnan R, Nathan S. Indirect Sinus Lift in Immediate Placent of implant –A Case Report. Biomed Pharmacol J 2015;8(October Spl Edition). Available from: http://biomedpharmajournal.org/?p=3673>

Introduction

Implant placement in compromised  posterior maxilla is more demanding and essential   with available  bone quality and quantity for the functional chewing and speech .1-5  the presence of  maxillary sinus floor above the maxillary alveolar bone after the extraction limits the  implant placement  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  to achive excess height  and primary stability for the placement of root form implants the widely performed two techniques  for sinus floor elevation are lateral window  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  at the mid 1970’s( 7)  creastal bone approaches(9-14) .the most commonly used technique for maxillary sinus floor  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  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  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

This procedure is less invasive  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  (18)

Materials and Methods

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  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.

A preoperative evalution of bone height and bone width are measured  clinically and with the help of intro oral  radiograph.

¹Antibiotic prophylaxis is was initiated a day before surgery

²Under local anaesthesia  tooth was extracted , and the surgical curratage done and socket irrigated with betadine solution.

³Drill 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

⁴light tapping with a mallet carefully collapse the sinus floor into the sinus cavity elevating the schneiderian  membrane.

⁵elevation of the sinus membrane performed using the 3# osteotome,that was used previously  to force the graft head of its tip to achive fracture the sinus floor up fracture.

⁶implant 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.

⁷abutment was positioned over the implant and the occlusal height  was adjusted , implant was loaded with temporary restoration.

⁸post operatively, patient was adviced  to rinse the mouth with twice a day with 0.12% of chlorohexidine solution  for two weeks after surgery. antibiotics  wera priscribed for next 7 days.

⁹After a healing period of 4 months , patient was recalled , and rehabilitated with fixed prosthesis.

Figure 1: Pre Operative Click here to view full figure

 

Figure 2: Post Operative Click here to view full figure

 

Figure :3  Pre Operative   Click here to view full figure

 

Figure 4: Post Operative Click here to view full figure

 

Discusion

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  floor in largely pnuematized sinus cavities in preparation of the placement of the  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  enters into the space occupied by the sinus floor and the ridged fixation is achieved and osteo integration takes place .  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  , because the procedure is invasive ,  a traumatic and less time consuming procedure , here the alveolar bone that is present in between the sinus floor root apex  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  , this procedure is widely practised and there is no much complications post operatively, in direct sinus lifting surgery  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  19. Improving the initial bone to the implant contact  20. Commonly the complications happens if the schneiderian membrane  is 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  and  anatomical site preparation can overcome these problems.

Conclusion

Implant placement in in the posterior maxilla that are atrophied  with less height in between the sinus floor and  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  the time consumption is less and the apical bone themselves acts as the bone graft and that tents the sinus lining and crestal  sufficient primary stability for the implant placement with less post-operative complications. It also allows the treating the compromised posterior maxilla with reliable results.

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