Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2016-09-20, 16:58:27 | version 1.38.0
Journal of Oral Science & Rehabilitation Volume 2 | Issue 3/2016 09 M i n i m a l l y i n v a s i v e s i n u s l i f t i m p l a n t s y s t e m Introduction Intheposteriorsextantsofthemaxilla,toothloss is generally associated with alveolar bone loss andsinuspneumatization.1 Inaddition,poorbone qualitymayhave a negative influence onthe sur- vival rate of implants.2 There is no consensus on treatmentforthe atrophic posteriormaxilla,with the dilemma ofwhetherto place short implants3, 4 ortilted implants5, 6 orto augmentthefloorofthe maxillary sinus.7, 8 In a recent review of the liter- ature, Pjetursson et al. reported that the place- ment of dental implants in combination with maxillary sinus floor elevation using a lateral ap- proachisapredictabletreatmentoptionshowing highmedium-termimplantsurvivalratesandlow incidences of complications.7 However, the lat- eral approach to the sinus entails elevation of a large mucoperiosteal flap that affects postoper- ative recovery of the patient and the additional expenseoftheaugmentationprocedure.9 Schnei- derian membrane perforations, nose bleeding, postoperative pain and swelling could be consid- ered major risks.10 The elevation of the maxillary sinus floorthrough the alveolar crest (transalve- olar)wasfirst described byTatum11 and modified by Summers.12 Subsequently, various modifica- tions to the original technique have been report- ed, in order to improve the predictability and safety, such as the use of atraumatic lifting drills,13 membrane elevationvia inflation ofa bal- loon catheter,14 andthe use ofhydraulic15 orneg- ative pressure.16 The aim ofthis clinical report was to present a novelself-tapping endosseous implant system (iRaise, Maxillent, Herzliya, Israel) developed for sinus augmentation. The advantage of this sys- tem isthe abilityto perform majorsinus lift aug- mentation via a minimally invasive transcrestal approach and to simultaneously place an im- plant,with minimalpatient discomfort and shor- tened treatment time. Case presentation A63-year-oldfemalepatientpresentedwithcom- promised fixed dental prostheses supported by failing teeth in her posterior maxilla (Figs. 1 & 2). The patient reported esthetic concerns and im- pairment of her masticatory function; conse- quently, she desired replacement ofthe prosthe- ses.Acone beam computedtomography(CBCT) scan was performed to evaluate the amount of residual bone. On the right side, conventional implantplacementwasplanned.However,onthe left side, the distance from the maxillary crest to thesinusfloorwas3.2mm,requiringaboneaug- mentationprocedure.Afterdetailedconsultation, various treatment options were discussed with the patient. Closed major sinus floor augmenta- tionwithatranscrestalapproachusingtheiRaise implantsystemwasplannedforthemaxillaryleft first molar position to support a screw-retained fixed dental prosthesis. An adjunctive implant was planned for the maxillary left first premolar position. The day before the implant placement, the patient underwent intranasal spray therapy (thiamphenicol glycinate acetylcysteinate, 810 mg/4 mL) b.i.d. One hour before surgery, a single dose of antibiotic (2 g of amoxicillin and clavulanic acid) was administered prophylacti- cally. A 0.2% chlorhexidine mouthwash was administered for 1 min priorto the implantation procedure. Localanesthesiawas administered (articaine with 1:100,000 epinephrine) and a small full-thickness mucoperiostealflapwas elevated. A 2 mm diameter round bur was used to mark the implant site. The osteotomy was prepared with a 2 mm twist drill 1 mm below the sinus floor. A periapical radiograph with a depth guide was performed in order to verify the drilling angle and depth, as well as the distance to the sinus floor. The implant recipient site was wide- Figs. 1 & 2 Fig. 1 Preoperative panoramic radiograph. Fig. 2 Alveolar ridge before implant placement (occlusal view). Volume 2 | Issue 3/201609