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ePaper created 2017-05-12, 09:42:21 | version 1.38.0
| case report Sinus elevation with short implant Authors: Prof. Dr Mauro Marincola, Prof. Dr Dr Rolf Ewers, Prof. Giorgio Lombardo (University of Verona) & Prof. Miguel Simancas Pallares (University of Cartagena), Austria/Italy/Colombia Introduction An upper posterior edentulous maxilla with dimin- ished bone height usually represents a challenging situation for clinicians when dental implantation is the solution for tooth absence. Bone decrease is the result of a reduction in both height and width of the alveolar process due to the maxillary sinus pneuma- tisation.1 Two main options have been proposed to lift the Schneiderian membrane and then create some space to place implants: the lateral approach that increases treatment-related costs, postoperative morbidity and also surgical time, and the osteotome sinus floor elevation (OSFE) firstly introduced in 1986 by Tatum. Then in 1994 Summers introduced the maxillary sinus lifting internal sinus lift (ISL) technique by the use of osteotomes, in which bone is added to the apical part of the implant to improve implant primary stability.2,3 This technique was shown to be less invasive, less time consuming and reduces postoperative discomfort to the patient. ISL is indicated when residual bone height (RBH) is between 5 and 7 mm. Other authors perform ISL in RBH extreme conditions such as ≤ 4 mm.4 There’s an increasing debate whether a bone graft is needed into the elevated area to maintain the space for new bone formation in the future. According to Summers’ original report, autogenous, allogenic or xenogeneic grafting materials are often placed.5 Re- cently Nedir et al. showed no differences (P > 0.05) between ISL procedures performed with or without bone graft on the apical portion.6 However, the main clinical challenge arises when a bone graft is placed and the bone around the implant-abutment interface needs to be maintained. Rammelsberg et al. performed ISL but without bone graft in a retrospective study in 66 patients with 101 dental implants in 2015. By using X-rays, they determined bone changes over the time.7 They further obtained results that mesial and distal mean apical bone gain (initial-final bone height) were 0.5 mm and 0.4 mm respectively, thus recommend- ing that implants placed in combination with ISL without graft material would have bone gain. Likewise, Nedir et al. compared dental implants plus ISL placed in combination with and without bone graft in 2013. They concluded that, although more bone is observed when the grafting material is Fig. 1: Pre-operative patient assess- ment: a) X-ray of the edentulous space showing maxillary sinus pneumatisation; b) diagrammatic scheme representing the patients clinical scenario and how the RBH can fluctuate along the ridge. On the desired site of implantation, to replace tooth #16, a ~4 mm RBH was encountered. Fig. 1a Fig. 1b 20 implants 2 2017