Never tear another sinus membrane
In a previous article, “Sinus Augmentation Without Sinus Membrane Exposure”, we described a method of performing a sinus augmentation without contacting the sinus membrane. That case discussed a minor sinus elevation (sinus bump). Today, we are using the same technique that allows the graft material to flow through the bone and lift the sinus membrane but with the ability to graft the sinus with any desired amount of graft material.
The sinus presents with a septum (blue arrow) separating the sinus in two compartments. The patient wanted only one additional implant placed.
A pilot drill is used to approach the floor of the sinus until an increase in bone density is felt through the handpiece. (Yes, even a periodontist can see the caries).
The osteotomy is enlarged until the final drill. The osteotomy stops short of penetrating into the sinus.
The osteotomy is prepared short of the floor of the sinus.
BioDensification is formulated to spread into bone to regenerate poorly mineralized bone and improve implant integration. In this case, those characteristics are used to flow through bone and lift the sinus membrane.
The osteotomy is filled with BioDensification.
The osteotomy is filled with graft material that will flow through the bone and lift the membrane hydraulically.
The implant is used to push the graft material through the floor of the sinus and elevate the sinus membrane. We repeated this step two times to increase the elevation of the membrane off the floor of the sinus.
The sinus membrane is elevated approximately 3 mm, which was accomplished without entering the sinus. With the membrane raised, the osteotomy is completed with the final drill into the sinus.
After the sinus is prepared for grafting, Sinus Graft is used to hydraulically raise the membrane to the desired level.
Sinus Graft is packaged with two different sterile tips. The tips are designed to be cut to the desired length to fit into the osteotomy and create a seal.
Sinus Graft was injected into the sinus to hydraulically lift the sinus membrane and fill the lower sinus with graft material. Sinus Graft contains 2 cc of graft material.
50% of the graft material is injected, and a radiograph is taken to check the augmentation.
With 1 cc injected, the graft material is short of the septum dividing the sinus. While this is adequate for the current implant, the remaining 1 cc of Sinus Graft was injected in the direction of the septum to fill the space for a future implant.
After the full 2 cc of Sinus Graft, the anterior compartment of the sinus is filled and ready for implant placement.
Day of implant placement. Note the graft material is contacting the sinus wall. Because Sinus Graft is a biocement, it binds to the bone allowing regenerative cells to enter the graft.
Implant placed
Two-week post op. The progression of mineralization shows regenerative cells and vascular supply enter the graft material along the border of the floor of the sinus that has become radiolucent. This band of radioleuency will mineralize and become radiopaque as mineralization progresses. As the band of vascularity and regenerative cells move deeper into the graft, the radiopacity will move deeper into the graft. Because SteinerBio graft materials are the only grafts that produce integration to the implant surface, the implants are always placed at the time of grafting, and loaded in 3 months.
A 3D view of the graft site at 2 weeks post op shows the anterior compartment of the sinus filled and the peripheral border of the graft being resorbed as mineralization proceeds inward from all of the bony walls. Cortical bone has a paucity of regenerative cells; however, in this image, the buccal cortical bone is seen contributing to bone growth in the sinus.
Today, many methods are available for sinus augmentation. However, any method of sinus augmentation will have instances of sinus membrane tears when the sinus membrane is manipulated. In this technique, the sinus membrane is gently lifted off the floor of the sinus as BioDensification flows through the bone. At SteinerBio, we have been using hydraulic pressure to lift the sinus membrane for 15 years and have never ruptured an intact sinus membrane with this method. With this current technique of elimination of contact with the membrane, tearing the sinus membrane is now a thing of the past.
MEMBER:
American Society for Bone and Mineral Research (ASBMR)
Tissue Engineering and Regenerative Medicine International Society (TERMIS)
American Academy of Implant Dentistry (AAID)
