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46 Volume 2 | Issue 1/2016 Journal of Oral Science & Rehabilitation Tra n s c res ta l s in us floor e le vati o n wi th a so ni c i nstru me nt References 1. Schropp L, Wenzel A, Kostopoulos L, Karring T. Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. → Int J Periodontics Restorative Dent. 2003 Jul-Aug;23(4):313–24. 2. Sharan A, Madjar D. Maxillary sinus pneumatization following extractions: a radiographic study. → Int J Oral Maxillofac Implants. 2008 Jan-Feb;23(1):48–56. 3. Brånemark PI, Adell R, Albrektsson T, Lekholm U, Lindström J, Rockler B. An experimental and clinical study of osseointegrated implants penetrating the nasal cavity and maxillary sinus. → J Oral Maxillofac Surg. 1984 Aug;42(8):497–505. 4. Ellegaard B, Kølsen-Petersen J, Baelum V. Implant therapy involving maxillary sinus lift in periodontally compromised patients. → Clin Oral Implants Res. 1997 Aug;8(4):305–15. 5. Ellegaard B, Baelum V, Kølsen-Petersen J. Non-grafted sinus implants in periodontally compromised patients: a time-to-event analysis. → Clin Oral Implants Res. 2006 Apr;17(2):156–64. 6. Boyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. → J Oral Surg. 1980 Aug;38(8):613–6. 7. Lundgren S, Anderson S, Gualini F, Sennerby L. Bone reformation with sinus membrane elevation: a new surgical technique for maxillary sinus floor augmentation. → Clin Implant Dent Relat Res. 2004 Sep;6(3):165–73. 8. Barone A, Santini S, Sbordone L, Crespi R, Covani U. A clinical study of the outcomes and complications associated with maxillary sinus augmentation. → Int J Oral Maxillofac Implants. 2006 Jan-Feb;21(1):81–5. 9. Pjetursson BE, Tan WC, Zwahlen M, Lang NP. A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation. → J Clin Periodontol. 2008 Sep;35(8 Suppl):216–40. 10. Summers RB. A new concept in maxillary implant surgery: the osteotome technique. → Compendium. 1994 Feb;15(2):152, 154–6, 158 passim; quiz 162. 11. Toffler M. Osteotome-mediated sinus floor elevation: a clinical report. → Int J Oral Maxillofac Implants. 2004 Mar-Apr;19(2):266–73. 12. Schwartz-Arad D, Herzberg R, Dolev E. The prevalence of surgical complications of the sinus graft procedure and their impact on implant survival. → J Periodontol. 2004 Apr;75(4):511–6. 13. Pjetursson BE, Rast C, Brägger U, Schmidlin K, Zwahlen M, Lang NP. Maxillary sinus floor elevation using the (transalveolar) osteotome technique with or without grafting material. Part I: implant survival and patients’ perception. → Clin Oral Implants Res. 2009 Jul;20(7):667–76. 14. Pjetursson BE, Ignjatovic D, Matuliene G, Brägger U, Schmidlin K, Lang NP. Transalveolar maxillary sinus floor elevation using osteotomes with or without grafting material. Part II: radiographic tissue remodeling. → Clin Oral Implants Res. 2009 Jul;20(7):677–83. 15. Cosci F, Luccioli M. A new sinus lift technique in conjunction with placement of 265 implants: a 6-year retrospective study. → Implant Dent. 2000 Winter;9(4):363–8. compromise the blood supply of the region.37–40 One of the most important advantages of the present technique is, however, the presence of intact bone walls, whereas in the lateral access technique, the lateral wall is removed to a large extent, compromising bone formation. In fact, it hasbeenshownthatboneisformedfromparent bone, while the sinus mucosa does not con- tribute to such formation, at least during the earliestperiodsofhealing.25,26 Finally,inthecase of thin alveolar ridges, a split-crest procedure may be applied concomitantly, so that the width oftheridgemayalsobeaugmented. Thecrestalapproachdescribedinthepresent article also has some disadvantages, such asthe low visibility within the elevated zone and the complex learning curve. The chisels and mallet have to be used carefullyto avoid damage to the sinus membrane and discomfort for the patient. Moreover, the technique illustrated in the pres- ent article requires the sinus elevation to be per- formed twice, the implant being placed during thesecondsurgery. The sonic handpiece instrument and the micro-saw inserts used allow the operator to perform sharp and thin incisions with a clear view of the area, cleaned of bone smear and blood by irrigation. Moreover, incision with vi- bratingtoolsweakensthebonealongthelinesof the osteotomy, minimizing the use of the mallet and consequently resulting in less discomfort for the patient. Sonic instruments have been shown to produce a very low increase in temperature comparedwith ultrasonic instruments41 andvery limited soft-tissue damage.42–44 The use of sonic instrumentshasbeenproposedfortheextraction ofimpacted canines45 and successfullytested for implantplacementinananimalexperiment.46 Conclusion Thetechniqueillustratedinthepresentarticleal- lowed the placement of implants of proper length in a widely pneumatized sinus where the bone height of the floor was insufficient for im- mediate stabilization. After three years of func- tion, neithermarginalbone loss norclinicalsigns ofinflammationwereobserved. Competinginterests IAdevelopedtheSonosurgerydeviceandmicro- saw inserts used in the treatment of this case, and hence declares a competing interest. DB de- claresthathehasnocompetinginterestsinrela- tion to this study. The study was self-funded by theauthors.