Elevating the Sinus Without Grafting Materials or Membranes

By Thomas J. Greany, DDS

Originally published in "The ToothIQ Review," October 2008

When teeth have been extracted from the posterior maxilla, their replacement with dental implants may be complicated by crestal resorption and sinus pneumatization. When the amount of native bone is insufficient to house a dental implant, a sinus grafting procedure is often recommended. Traditionally, a lateral wall entry into the sinus has been recommended where less than 8mm of basal bone remained in the sinus floor. Where only a few millimeters of additional bone is required for the implant, an osteotome upfracture of the sinus floor through the osteotomy site (as described by Summers in 1994) is often performed. 1, 2, 3, 4

Most protocols which have been reported in the literature involve placement of particulate bone graft material or alloplastics such as Beta Tricalcium Phosphate, with or without a membrane. Others have demonstrated success at osseous induction using only a membrane. Many studies exist in the literature in support of concurrent osseous augmentation of the sinus and dental implant placement.

Now, an article in the July/August 2008 issue of The International Journal of Periodontics & Restorative Dentistry reports successful elevation of the sinus floor using the osteotome technique, without using graft materials or membranes of any kind. 5

In the study, fourteen implants were placed in the molar region, and 10 implants in the premolar region. Overall initial bone height under the sinus averaged just 5mm, and the mean length of implant placed was 8.6mm. The mean gain in osseous height was 3.6mm±1.4mm. Digital volume tomography was performed to evaluate 3-D generation of new bone, and compared with radiographs. The implants were allowed to osseointegrate for 6 months prior to restoring them. The patients were recalled 18 months post-operatively, and the survival rate was 100%.

Although the observation period was relatively short, the study concluded that this technique "allows for a high survival rate and a considerable amount of newly formed bone around the exposed implant surface" in the sinus.

Through personal interaction with other providers, including noted periodontist Dr. Ziv Mazor of Israel, Symbyos has become aware of other such studies, which are similar in design to the IJPRD study, and reporting similarly successful results.

In some of these studies, platelet rich fibrin (PRF), obtained by centrifugation from pre-operative blood samples is used as a rich source of pluripotential stem cells, which differentiate into osteoblasts through molecular signaling pathways following trauma to the basal bone of the sinus floor. Applied around the implants through a lateral wall approach, even greater gains in osseous height are being realized, from sinus floors as thin as 2-3mm.

The economic and patient management impacts of these findings are significant. Conservative management of the sinus floor appears to be viable in a larger percentage of patients, and will likely be performed by more general dentists with good success. Complications such as temporary or chronic sinusitis from misplaced graft materials will no longer occur. Extending the range of cases which can be treated with the osteotome technique will decrease the overall cost of treatment with dental implants, while reducing morbidity from the lateral wall approach.

Citations added to ToothIQ™ from this article

1. "A new concept in maxillary implant surgery: the osteotome technique."
Summers, R.B.
Compendium
1994 15(2): 152
Cited under Bone Grafting and Dental Implants
Read Before Treatment

2. "The osteotome technique: Part 2--The ridge expansion osteotomy (REO) procedure. "
Summers, R.B.
Compendium
1994 15(4): 422, 424, 426, 436
Cited under Bone Grafting and Dental Implants
Read Before Treatment

3. "The osteotome technique: Part 3--Less invasive methods of elevating the sinus floor."
Summers, R.B.
Compendium
1994 15(6): 698 700, 702-704, 710
Cited under Bone Grafting and Dental Implants
Read Before Treatment

4. "The osteotome technique: Part 4--Future site development."
Summers, R.B.
Compendium
1995 16(11): 1080, 1092, 1099
Cited under Bone Grafting and Dental Implants
Read Before Treatment

5. "Sinus Floor Elevation Using an Osteotome Technique Without Grafting Materials or Membranes"
Schmidlin, Patrick R., DrMedDent, et al.
The International Journal of Periodontics and Restorative Dentistry
2008 28:401-409
Cited under Bone Grafting and Dental Implants
Read Before Treatment

Comments

[Dental Expert]

Thanks for conveying such useful and resourceful message to us…good job