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Article

Drill Device for Sinus Lift

Kitamura, Akira DDS, PhD

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doi: 10.1097/01.id.0000188467.24785.26
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Abstract

A shortage of the alveolar bone height below the maxillary sinus sometimes restricts insertion of the implant body in the upper jaw. It has been reported that the sinus lift with autogenous bone grafts or other graft materials provide sufficient bone volume for insertion of an implant.1,2 There are lateral and crestal approaches for the sinus lift operation.3 In the crestal approach, a greenstick fracture of the sinus floor is performed using an osteotome4 or with threaded implants.5 Such reports include elevation of the membrane and insertion of a longer implant.6

This is a preliminary study of an implant placed with an innovative sinus lift using a 1-stage crestal approach for implanting in a deficient alveolar height. Lifting drills elevated the discoid cortical bone of the sinus floor. The drill device consisted of the same axial diameter and different tips. Using this specifically designed sequence of drills, the clinician lifted the schneiderian membrane with a bone disk. This system allowed the sinus floor to be elevated with simultaneous bone grafting from the alveolar crest of the maxilla. The implant was installed with a less traumatic approach in an easier manner.

Surgical Procedure and Case Report

From a clinical and radiologic point of view, the patient did not have sinusitis or other inflammatory diseases in the mucosa lining of the sinus. The region was draped, and a local anesthesia with vasoconstrictor was infiltrated. The shape of the incision was designed to preserve the blood supply to the alveolar crest. After localizing the position for the implant with the template, a bur with a built-in water flow system was used to prepare the implant site until it reached beneath cortical bone of the sinus floor. A parallel pin was inserted in the prepared site. An intraoperative x-ray gave the exact length of the maxillary ridge below the sinus.

The first plastic drill having a frontal edge was pushed into the site, just beneath the sinus membrane (Fig. 1A). A check was performed of the cortical bone by using a special probe so as not to perforate into the sinus. Having the cylindrical edge smaller than the outer layer, the cutting drill (Fig. 1B) then provided the predictable bone split designated at the floor of the maxillary sinus. At this stage, the bone disc was used to incise to the floor of the maxillary sinus with mucosal lining. The cortical bone disc underlying the sinus membrane could be seen through the site of preparation. The membrane was now ready to be lifted with the bone graft. The disc did not cut the membrane. The elevator (2.9-mm width) was used to separate the bottom of the maxillary sinus (Fig. 1D). The patient breathed out against the nose with the nostrils pinched shut to check the membrane integrity.

Fig. 1.
Fig. 1.:
Drill and elevator. Plastic drill (A). Cutting drill (B). Lifting drill (C). Membrane elevator (D).

Having the smaller convex frontal design than the outer layer of the drill, the lifting drill (Fig. 1C) provided the gradual, controlled advance of the instrument, which made it possible to elevate the schneiderian membrane with unwanted tearing. The harvested bone was pressed into the site using a transfer instrument that was gently pushed. The final height of the cylindrical hollow depended on the length of the implant that was to be inserted.

The implant, which was slightly longer than the alveolar height of the bony ridge, was inserted after creating the final shape of the site. The incision was closed with interrupted 3-0 silk sutures. The mucoperiosteal flap was closed to avoid tearing and ischemia. The patient was discharged with the necessary postoperative instructions and drug prescription. Two years after the final prosthesis with this sinus lift procedure, the patient did not have any symptoms. There was no sign of infection of the maxilla (Figs. 2 and 3).

Fig. 2.
Fig. 2.:
Preoperative (A) and postoperative (B) panoramic tomography of the patient.
Fig. 3.
Fig. 3.:
Preoperative (A) and postoperative (B) intraoral radiographs of the patient.

Discussion

Implants can be inserted and stable in the maxilla when patients have ≥5-mm alveolar height. Shorter bone requires the conventional sinus lift with autogenous bone grafts and/or various kinds of surgeries from the frontal wall of the maxillary sinus to insert the implant body.7–9 There is an instrument to form a hole from the socket.10 The osteotome simplifies the surgery, but uncontrollable fracture of the sinus floor may cause laceration of the membrane and an infection of the sinus.11

The membrane integrity at the floor of the maxillary sinus is a primary condition for a sinus lift procedure and is a fundamental requirement for bone regeneration.6 Divided into 3 parts of function, the drills were presented to prevent excessive fracture and laceration at the floor of the maxillary sinus. The bone disc at the floor of the maxillary sinus allows the surgeon to place leverage for lifting. The membrane around the bone disc with mucosal lining12 was also elevated by the membrane elevator at the hole of the floor of the maxillary sinus. The risk of accidental laceration of the membrane is minimized. The crestal approach with this device gives the clinician an opportunity to accomplish the implant placement in deficient maxillary alveolar bone height. The technique is straightforward, step-by-step, and gentle.

Conclusions

This serial and sequenced disc procedure allows for the safe elevation of a maxillary sinus floor for the subsequent insertion of an endosseous implant. It is especially useful in situations in which the bone depth is <3−4 mm.

Disclosure

The author claims to have no financial interest in any company or any of the products mentioned in this article.

Acknowledgment

This work was supported by a Grant-in-Aid for Scientific Research from Nagasaki University, Japan.

References

1. Kaufman E. Maxillary sinus elevation surgery: An overview. J Esthet Restor Dent. 2003;15:272–282.
2. Krekmanov L, Heimdahl A. Bone grafting to the maxillary sinus from the lateral side of the mandible. Br J Oral Maxillofac Surg. 2000;38:617–619.
3. Woo I, Le BT. Maxillary sinus floor elevation: Review of anatomy and two techniques. Implant Dent. 2004;13:28–32.
4. Nociti PF, Albanese M, Fiore A, et al. Implant placement in the maxillary tuberosity: The Summers’ technique performed with modified osteotomes. Clin Oral Implants Res. 2000;11:273–278.
5. Brånemark PI, Adell R, Albrektsson T, et al. An experimental and clinic study of osteointegrated implants penetrating the nasal cavity and maxillary sinus. J Oral Maxillofac Surg. 1984;42:497–505.
6. Cosci F, Luccioli M. A new sinus lift technique in conjunction with placement of 265 implants: A 6-year retrospective study. Implant Dent. 2000;9:363–368.
7. Smiler DJ, Johnosn PW, Lozada JL, et al. Sinus lift grafts and endosseous implants: Treatment of atrophic posterior maxilla. Dent Clin North Am. 1992;36:151–186.
8. Boyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg. 1980;38:613–616.
9. Olson JW, Dent CD, Morris HF, et al. Long term assessment (5 to 71 months) of endosseous dental implants placed in the augmented maxillary sinus. Ann Periodontol. 2000;5:152–156.
10. Summers RB. Sinus floor elevation with osteotome. J Esthet Dent. 1998;10:164–171.
11. Doud Galli SK, Lebowitz RA, Giacchi RJ, et al. Chronic sinusitis complicating sinus lift surgery. Am J Rhinol. 2001;15:181–186.
12. Rosen PS, Summers R, Mellado JR, et al. The bone-added osteotome sinus floor elevation technique: Multicenter retrospective report of consecutively treated patients. Int J Oral Maxillofac Implants. 1999;14:853–858.

Abstract Translations [German, Spanish, Portugese, Japanese]

AUTOR: Akira Kitamura, DDS, PhD*. *A.O. Professor, Fachbereich Gesichts- und Kieferchirurgischer Wiederaufbau und funktionale Wiederherstellung, Abteilung für Entwicklungsbezogene und wiederherstellende Medizin, Fachhochschule der biomedizinischen Wissenschaften, Universität von Nagasaki, Sakamoto, Nagasaki 852-8588, Japan. Schriftverkehr: Akira Kitamura, DDS, Fachbereich Gesichts- und Kieferchirurgischer Wiederaufbau und funktionale Wiederherstellung (Division of Oral and Maxillofacial Surgical Reconstruction and Functional Restoration), Abteilung für Entwicklungsbezogene und wiederherstellende Medizin (Dept. of Developmental and Reconstructive Medicine), Fachhochschule der biomedizinischen Wissenschaften (Graduate School of Biomedical Sciences), Universität von Nagasaki (Nagasaki University), Sakamoto, Nagasaki 852-8588, Japan. eMail:[email protected]

Bohrvorrichtung zur Sinusanhebung

ZUSAMMENFASSUNG: Es wird ein Kammgelagerter Ansatz zur Implantatsetzung in Alveolarleisten mit mangelhafter Struktur vorgestellt. Eine Reihe von Bohrern erlaubt den Chirurgen dabei die Anhebung der Membran unten am Oberkiefersinus mit einer Knochenscheibe, ohne dabei Gefahr zu laufen, diese zu beschädigen. Die Plastik- und Schneidebohrer sind hierbei direkt unterhalb des Bodens des Oberkiefersinus anzusetzen. Dann wird der Hebebohrer langsam von der Höhle aus bis zu einer gewünschten Länge eingeführt. Die Implantate verfügen über eine HA-Beschichtung sowie einen Durchmesser von 3,75 mm. Die vorliegende Erfindung lässt den Schluss auf eine damit verlässliche und zuverlässig vorhersagbare Methodik zur prothetischen Wiederherstellung der hinteren Oberkieferregionen bei Vorliegen anatomischer Beschränkungen zur Implantierung zu.

SCHLÜSSELWÖRTER: Bohrersatz, Kammgelagerter Ansatz, Sinusanhebung

AUTOR: Akira Kitamura, DDS, PhD*. *Profesor Asociado, División de Cirugía Oral y Maxilofacial, Reconstrucción y Restauración Funcional, Departamento de Medicina de Desarrollo y Reconstrucción, Escuela de Graduados en Ciencias Biomédicas, Nagasaki University, Sakamoto, Nagasaki 852-8588 Japón. Correspondencia a: Akira Kitamura, DDS, Division of Oral and Maxillofacial Surgical Reconstruction and Functional Restoration, Dept. of Developmental and Reconstructive Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto, Nagasaki 852-8588, Japan. Correo electrónico:[email protected]

Dispositivo de perforación para el levantamiento del seno

ABSTRACTO: Se presenta un método crestal para la colocación del implante en crestas alveolares deficientes. El juego de perforación permite al cirujano levantar la membrana en el piso del seno maxilar con un disco de hueso sin riesgo de romperlo. Los perforadores de plástico y de cortado respectivamente se colocan apenas debajo del piso del seno maxilar. Luego, el perforador se coloca lentamente desde la cavidad hasta la longitud deseada. Los implantes estuvieron recubiertos con HA y tenían un diámetro de 3,75 mm. Esta invención sugiere que esta es una técnica confiable y predecible para la rehabilitación prostética de las regiones maxilares posteriores ante la presencia de restricciones anatómicas para la colocación del implante.

PALABRAS CLAVES: juego de perforación, método crestal, levantamiento del seno

AUTOR: Akira Kitamura, Cirurgião-Dentista, Ph.D*. *Professor associado, Divisão de Reconstrução Oral e Maxilofacial e Restauração Funcional, Depto. de Medicina do Desenvolvimento e Reconstrutiva, Faculdade de Ciências Biomédicas, Universidade de Nagasaki, Sakamoto, Nagasaki 852-8588, Japão. Correspondência para: Akira Kitamura, DDS, Division of Oral and Maxillofacial Surgical Reconstruction and Functional Restoration, Dept. of Developmental and Reconstructive Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto, Nagasaki 852-8588, Japan. E-mail:[email protected]

Dispositivo de Perfuração para Elevação da Cavidade

RESUMO: É apresentada uma abordagem de crista para colocação de implante em rebordos alveolares deficientes. O conjunto de brocas permite ao cirurgião elevar a membrana na superfície da cavidade maxilar com um disco de osso sem risco de rasgá-la. As brocas plásticas e cortantes se encaixam respectivamente exatamente abaixo da superfície da cavidade maxilar. Então, a broca para elevação é inserida a partir do alvéolo até um comprimento desejável. Os implantes foram cobertos com HA e tinham um diametro de 3,75 mm. Esta invenção sugere que essa é uma técnica confiável e previsível para a reabilitação protética das regiões maxilares posteriores na presença de restrições anatômicas para implantes.

PALAVRAS-CHAVE: conjunto de brocas, abordagem de crista, elevação da cavidade

Figure
Figure
Keywords:

drill set; crestal approach; sinus lift

© 2005 Lippincott Williams & Wilkins, Inc.