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Dental Tribune Middle East & African Edition Jan.-Feb. 2015

26 DENTAL TRIBUNE Middle East & Africa Edition | January-February 2015implant tribune Sinus lift with simultaneous implant placement By Dr. Peter Hentschel O ral rehabilitation has been paid notice for a long time to regain masti- catory function and for aesthetic reasons. Implant placement in the maxilla is often limited due to missing height of the alveolar process, this can be solved by ex- ternal Sinus Graft (Boyne 1980). The alveolar crest can be built up to 8-15 mm by Sinus Eleva- tion. The function of the sinus is not touched by the reduced vol- ume, the success rate is between 85 to 96 % after 15 years. The lower success rate often comes along with an intra-operative perforation of the Schneiderian Membrane (Incidence 25-40%), failures are based on the in some circumstances following Piezosurgery offers the patient a gentle treatment with less complications and time saving benefits. Fig. 1. Autologous Bone Fig. 2. Pre-clinical situation Fig. 3. Piezosurgical Preparation Fig. 4. Release of Sch- neiderian Membrane Fig. 5. Preparation of Implant Tunnel Fig. 6. SL-Implant In Situ complications. In opposite of app 25% perforations with bone milling devices the use of piezo- surgical devices can lead to per- foration rates of 5%. At external elevation and sinus augmentation a second surgical can be avoided by simultaneous implantation in case of 5 mm bone height. During the Eleva- tion of Schneiderian Membrane with sandwichtechnique autolo- gous bone and bone substitute materials are used (Kamikawa et al. 2006).To resist the respira- tory pressure non-resorbable bone substitute material (eg. CompactBone B, bovine Bone) or the cranial bone lid are placed next to sinus membrane. The during the procedure gained autolougous bone can be placed alone or in combina- tion with a bone graft material (eg. Compact Bone S, biphasic Calciumphosphate) around the placed implant. Sinus Eleva- tion with simultaneous implant placement is indicated with up to 97.9% survival rate in after years (Peleg et al. 2006). Guided Bone Regeneration (GBR) as state of the art method for bone grafting uses in most cases bioresorbable Mem- branes. Resorbable membranes offer several advantages beside the easy handling , as no need for a second surgical procedure for removal or minimization of complications, e.g. soft-tissue dehiscences. Fig. 7. Bone Protect Membrane In Situ Fig. 8. Grafting with Bovine Bone Fig. 9. Covering of Sinus Membrane with Bone Protect Membrane Single tooth rehabilitation with implant is the appropriate meth- od instead of conventional use of bridge. In the reported case the situation is aggravated by the lowered sinus and lateral limi- tation by intact adjacent teeth. For lateral one-stage sinus lift we are using the special de- signed Sinus-Lift implant for increased primary stability (SL Implant; Dentegris, Germany). The improved stability is based on micro threads with increased contact in neck area. The au- tologous bone is gained during surgical procedure within piezo based window preparation and drilling process (Fig. 1). Dr. Peter Hentschel Clinic of Implantology Essen Martin-Luther-Str. 122 45144 Essen, Germany info@zahnarztessen.de www.zahnarztessen.de Contact Information Fig. 11. 12 month Post-OP Fig. 10. X-ray Post - OP For filling of horizontal-cranial space and stabilization of bone lid a bovine bone graft is used (Compact Bone B; Dentegris, Germany). Bovine bone has been used in dental surgery for decades and is well known for stable and reliable results. To ensure the barrier and to stabilize the particulated bon- egrafting material a pericar- dium membrane with a resorb- tion time of 16-24 weeks is used (Bone Protect Membrane; Den- tegris, Germany). The pericardi- um membrane offers very good handling properties in combi- nation with a prolonged barrier function. Case Study The patient (36 y, f) was showing an alio loco lost tooth in 15 (Fig. 2). Patients request was aesthet- ic and masticatory rehabilitation which was suggested by one- stage lateral sinus elevation. Based on diagnostic planning pi- ezosurgical window preparation in 15 (Fig.3) was performed after local anesthesia and periostal flap. By choosing a round-oval lid design sharp edges can be avoided which reduces the risk of perforation. After release of the sinus mem- brane (Fig. 4) the implant tunnel was prepared (Fig. 5) and the Implant (SL Implant; Denteg- ris, Germany) placed (Fig. 6). Simultaneoulsy the surrounded space was covered with a re- hydrated Collagen Membrane (Bone Protect Membrane; Den- tegris, Germany) as protections of the Schneide’rian membrane (Fig. 7). Autologous bone was mixed with Compact Bone B and placed in the sinus for stabiliza- tion (Fig. 8). After control of primary stabil- ity particulate materials was filled laterally and covered with pericard membrane according to GBR standards (Fig.9). The flap was readapted and closed, control by X-ray shows axial po- sitioning and augmentation of sinus maxillaris (Fig. 10). Reentry after five months was accompanied by full ceramic crown and results in aesthetic and harmonic rehabilitation (Fig. 11).

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