ABSTRACT
BACKGROUND: The sinus augmentation procedure has facilitated dental implant treatment in the posterior maxilla where there is insufficient bone for implant placement. A modified Caldwell-Luc, lateral window technique can be applied in most cases needing sinus augmentation in order to create a larger bone volume. However, treatment morbidity can be a concern, especially in the form of postoperative swelling due to surgical trauma. Vertical augmentation using osteotomes has also been selected as a choice of treatment due to less invasive surgery and less postoperative trauma. Although the osteotome technique enables the surgeon to raise the sinus membrane internally through an implant osteotomy site, the quantity and predictability of bone augmentation can be limiting due to the elasticity of the Schneiderian sinus membrane, difficulty of the membrane to separate from the floor as well as the inability to have direct tactile access to "peel" the membrane off of the floor. PURPOSE: The objective of this report is to present a new, minimally invasive sinus augmentation technique, called the Internal Sinus Manipulation (ISM) procedure, which has been developed to facilitate sinus floor augmentation while reducing treatment morbidity and yet have direct tactile access to raise the membrane off of the sinus floor. SURGICAL TECHNIQUE: Access to the Schneiderian sinus membrane is achieved without perforation of the membrane through a conventional osteotomy drilling procedure alone or combined with osteotome technique, followed by reflection of the membrane utilizing special ISM instrumentation and bone graft procedure laterally and vertically through the osteotomy site. A planned implant is then placed. CONCLUSION: The Internal Sinus Manipulation procedure can be used as an alternative treatment modality for sinus augmentation as compared to the external lateral window technique while reducing postoperative morbidity for the patients who need implant treatment in posterior maxillary areas.
Subject(s)
Alveolar Ridge Augmentation/methods , Maxilla/surgery , Maxillary Sinus/surgery , Adult , Aged , Alveolar Ridge Augmentation/instrumentation , Bone Matrix/transplantation , Bone Substitutes/therapeutic use , Dental Implantation, Endosseous , Dental Implants , Equipment Design , Female , Follow-Up Studies , Humans , Male , Middle Aged , Minerals/therapeutic use , Minimally Invasive Surgical Procedures , Mucous Membrane/pathology , Osseointegration/physiology , Osteotomy/instrumentation , Osteotomy/methods , Postoperative Complications/prevention & controlABSTRACT
PURPOSE: Bone density was evaluated in designated implant sites using a novel volumetric computerized tomographic device. Those measurements were then compared with traditional quantitative computerized axial tomography and subjective bone density evaluation. MATERIALS AND METHODS: Sixty-three potential sites for implant placement in jaws from 9 human cadavers were used. Indicator rods 2 mm in diameter were placed in all sites. Radiographic images representing 1-mm buccolingual slices immediately mesial and distal to the rods were selected. Bone density in Hounsfield units was assessed using quantitative cone-beam computerized tomography (QCBCT) and quantitative computerized tomography (QCT) in a standardized implant area superimposed on the images. Bone density was also subjectively evaluated by 2 independent examiners using the Lekholm and Zarb classification. RESULTS: The QCBCT bone density values were generally found to be higher than the corresponding QCT measurements. The correlations between the QCT and QCBCT values, however, were very high in spite of this systematic difference between the 2 methods. The Lekholm and Zarb ratings for the 2 examiners showed correlation coefficients ranging between 0.46 and 0.60 for the relationships with the QCBCT values. For each of the scores used for the subjective classification, however, a wide range of corresponding QCBCT values was observed. DISCUSSION: High dosage has been the major impediment to the utilization of CT in implant dentistry. The development of a reliable volumetric CT alternative with reduced radiation should provide an effective method for the assessment of both bone quantity and bone density. CONCLUSIONS: Access to objective radiographic bone density values should constitute a valuable supplement to subjective bone density evaluations prior to implant placement. QCBCT could be considered an alternative diagnostic tool for preoperative bone density evaluation, especially since the reported radiation dose is minimal.
