Sinus membrane perforation is the most common complication of sinus augmentation surgery. Dealing with the sinus membrane is also one of the most stressful parts of sinus augmentation surgery. This post describes a stress-free method of elevating the sinus membrane for predictable sinus augmentation.
Sinus Augmentation Without Sinus Membrane Exposure
Tooth #4 presented with the medial distal fracture of the crown. A periapical lesion was present with loss of bone opening into the maxillary sinus. Swelling of sinus membrane and opacity of the sinus is evidence of sinusitis.
When the sinus is infected, it is advised that the patient begin antibiotics 3 days prior to surgery to control bacterial infection. Normal bone will not grow in an area of infection and sinus infections are a cause of ridge preservation graft failures.
The tooth was sectioned medial distal, and the individual roots were removed a-traumatically. A sinus perforation was present. To treat the communication, the socket was grafted with Socket Graft Injectable using the suture-less membrane technique.
6 months after extraction and grafting, the patient returned for implant placement. The sinus infection is resolved with solid regenerated bone on the floor of the sinus. Due to restorative fractures and fractured teeth, it was clear that the patient exerts a heavy load on his dentition and the decision was made to augment the sinus to place a full-size implant.
Pilot drill confirming good position of the implant.
This method of sinus augmentation involves drilling to the floor of the sinus with the final drill. Precise measurements are not required as it is easy to sense an increase in bone density at the floor of the sinus. As soon as an increase in bone density is felt, drilling is stopped short of drilling into the sinus.
BioDensification is formulated to be injected into implant osteotomies to stimulate bone formation. BioDensification is an FDA designated drug/device and is used when poor bone quality is noted during drilling. The implant osteotomy is filled with BioDensification, and the implant is placed. As the implant is driven into the filled osteotomy, the graft material flows into the surrounding bone. This stimulated bone formation is commonly used for improving integration of ceramic implants, used in the posterior maxilla for titanium implants and any area of poor mineralization. In this case, Biodensification is placed in the implant osteotomy, the implant is driven into the site, and the graft material flows through the bone on the floor of the sinus, and lifts the sinus membrane without exposing the membrane. After the graft lifts the membrane, the implant is removed, and the final drill is used to drill though the floor of the sinus. The osteotomy in this case was then filled with BioDensification again to get more graft material into the sinus and the implant was placed.
A 4.2 X 11 mm implant was placed.
Day of surgery. The graft material in the osteotomy will flow through the bone on the floor of sinus and lift the sinus membrane. The graft material will set hard in approximately 30 minutes which maintains the graft site dimensions. Over time, the graft will be fully resorbed and converted into newly regenerated vital bone. At that time, the graft site will remodel until the apex of the implant is reached, at which time the resorption of the material will stop where load is sensed.
This technique can be used for predictable sinus bumps as in this case or for a full sinus augmentation. After the membrane is raised and the sinus is entered with the drill, rather than using BioDensification to fill the osteotomy, Sinus Graft can be injected into the sinus to raise the height of the membrane in relation to the amount of graft material injected.
For anyone interested in this technique, please contact SteinerBio at contactus@steinerbio.com. Also, for anyone interested in a greater understanding on bone biology and bone graft biology, please check out our free 2-hour AGD Short Course on Bone Science.
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American Society for Bone and Mineral Research (ASBMR)
Tissue Engineering and Regenerative Medicine International Society (TERMIS)
American Academy of Implant Dentistry (AAID)