Crestal Approach Sinus Elevation with Osteotomes

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Posted on By Maher Walid In Sinus Augmentation

a young male patient presented to clinic with missed #3.
pre-surgical evaluation showed 6 mm of bone height.
the case was planned for crestal approach sinus elevation with Osteotomes and Osteobiol Putty bone graft, and placement of 5.0X11.5mm Nobel Active Implant.
4 months after submerged implant healing, a cement retained PFM crown was placed. first recall was doen after more than 6 months, CBCT was performed to show result and healing of implant and sinus graft

Sinus grafting

Implant placement

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Maher; Grea result and no denying the success you achieved with this approach. With the advent of other more minimally invasive approaches like Hydraulic Sinus elevation, Osseodensification, Piezo HIPSE approach, would you consider this approach similar in risk?? Additionally, with the risk of VERTIGO present with the hammering and fracture of sinus floor is this technique not becoming "outdated" relatively speaking? Thanks for sharing. Dr. Salama


Hi, Dr S. you suggested osseo-densifiacation as an alternative to fracturing sinus floor with osteotome .From whatever i read on this site regarding this technique it doesn`t seem to be a safer technique, (in my mind atleast..) . There seems to be is a bigger risk of bony particles entering the sinus via tear (albiet small) and causing post op complications. Besides is there a way to prefom a Valsalva maneuver when we are just pushing bony particles toward the sinus and get an idea about grafting a whole\torn membrane ?
in the case presented the sinus floor and most likely will fracture easily sinse floor is flat .So vertigo might be less of an issue here.

I would love to hear your thought and experience on the subject and why you feel alternative are better than the `classic crestal sinus lift`.


thank you Dr. M.Salama for your note. yes I totally agree with you that hammering is an outdated technique for sinus lifting with all the new available techniques. at the time of this surgery, this was the only instruments available for me. although the surgery was stressful for me and the patient ( who is also a dentist), it was finally accomplished in a nice way regards


KLS Martin
Nobel Biocare