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ePaper created 2015-10-15, 17:20:52 | version 1.38.0
science & practice 11ICOI World Congress XXXII Introduction Implant placement in the atrophic posterior maxilla is a challenge. Bone augmentation (si- nus floor elevation) is very often indicated.1 When the subantral residual bone height is very limited, open sinus lift surgery or lateral window Caldwell–Luc antrostomyistheconven- tional therapy used by most dentists.2 This is a traumatic invasive sur- gery with several postop- erative complications for the patient and long term recovery.2–6 Chen was the first to introduce a hydraulic si- nus lift technique,7 dur- ing which the surgeon lifts the Schneiderian membrane from the si- nus floor using the hand- piece and by spraying a liquid. The newly formed space is filled with bone grafting material and fol- lowed by implant place- ment. The present case will demonstrate a novel ap- proach to the hydraulic sinus lift technique util- ising the iRaise implant system (Maxillent). The implant design includes an L-form internal chan- nel leading to the apical portion of the implant, which allows for saline and bone grafting mate- rial to be injected into the sinus cavity. A sterile 0.9% NaCl solution is in- jected through the im- plant’s internal channel in order to detach the Schneiderian membrane from the sinus floor. As- piration of the saline is then followed by injec- tion of bone grafting ma- terial (in gel form) through the same im- plant channel, thus fill- ing the space between the sinus floor and the membrane. In the last step, the entire im- plant body is placed into the aug- mented bone. The hydraulic lift of the sinus membrane is performed through the alveolar crest. Once the implant has been fully in- serted, the internal channel is closed by the bone and there is no communication with the implant prosthetic platform, preventing penetration of bacteria from the oral cavity to the bone graft after implant placement. Case presentation A40-year-oldhealthyfemalepa- tientpresentedtothedentaloffice. Clinicalandradiographic examination revealed that tooth #15 was miss- ing (Fig. 1). The residual alveolar ridge height was 5mm.Thetreatmentplan included placement of an endosseous implant fol- lowed by an implant-re- tained crown. In order to be able to realise this plan, a sinus augmenta- tion was required. The iRaise implant was used in this case, which allowed placing of the implant and hy- draulicelevationofthesi- nus membrane simulta- neously. Prior to the sur- gery, 1,000mg amoxi- cillin was prescribed as a prophylactic treatment and a full-thickness mu- coperiosteal flap was raised. The exact point of im- plant placement was marked in region #15. Special drills were used to engage the cortical bone of the sinus floor. A diamond bur was then used to cross the cortical bone. The use of a dia- mond bur prevents rup- ture of the Schneiderian membrane. An iRaise im- plant of 4.2mm in diame- ter and 14.5mm in length was inserted halfway. Theorificeoftheinternal channel reached the bone and was placed fac- ing the buccal side. The implant connector was attached to the implant orifice, and 2ml of NaCl was injected through the connector in order to detach the sinus mem- brane by equal hydraulic pressure. The Valsalva manœuvre test was per- formed to confirm mem- brane integrity. Aspiration of the saline followed, and a mixture of saline and blood appeared in the sy- ringe, indicating that the Schneiderian membrane had de- tached and become elevated and thebloodcapillarieshadruptured. The next step was injection of 2ml of a synthetic bone grafting mate- rial of tricalcium phosphate and hydroxyapatite in gel form (MBCP Gel, Biomatlante). The connector was removed and the implant in- serted to its full length, to crest level. ACBCTscanwastakenimmedi- atelyaftertreatmentandshoweda beautiful four-layer creation of air, water, bone grafting material and the residual alveolar ridge (Fig. 2). The integrity of the Schneiderian membrane and a healthy sinus were also observed. The internal channel of the implant had been completely filled with the injected bone. The surgery ended with closure of the flap by conventional sutur- ing. The patient found the surgery easily tolerable and immediately returned to her everyday routine. No side-effects, such as swelling, painorhaematoma,werereported. Follow-up examinations at three and six months postoperatively were performed, and the periapi- cal radiographs showed calcifica- tion,whichisassociatedwithbone formation (Figs. 3 & 4). Discussion TheiRaisesinuslifttechniqueis easy to perform. Two separate sur- geries are combined in one short surgery to create a minimally inva- sive procedure that is well toler- atedbythepatientandallowsfora quick return to normal life, as op- posedtoothersinusliftsurgeryap- proaches, such as the open lateral window technique, which have been shown to cause substantial side-effects, such as swelling pain and haematoma, and require longer recovery. The present mini- mally invasive hydraulic sinus lift techniqueislikelytobecomearou- tineprocedureinprivatepractices and hospitals. Editorial note: A list of references is available from the publisher. Minimally invasive sinus lift with iRaise A case report.By Prof.Gabi Chaushu,Israel Prof. Gabi Chaushu is the Director of the De- partmentofOralandMaxillofacialSurgeryat the Beilinson campus of the Rabin Medical Center in Petah Tikva in Israel. He can be con- tacted at gabi.chaushu@gmail.com. Fig. 1: Pre-op panoramic radiograph. Fig. 2: Immediate post-op CBCT image. Fig. 3: Treatment outcome at three-month follow-up. Fig. 4: Treatment outcome at six-month follow-up. 1 2 3 4 1234