Crestal approach sinus elevation without bone graft

263 Rating(s).


Posted on By narayan tv In Sinus Augmentation

72 y old Male, failed bridge 25-28 (FDI) and 24 extracted. Implants placed in 26 & 27 regions with the crystal approach using the SCA kit, PRF with no bone graft. 25 was extracted and socket filled with PRF before primary closure

Pre-op Clinical & CBCT.-5-6 mm RHB sub antral in 26 & 27 regions. Periapical lesion on 25 precluding the possibility of RST
Flap reflection, intraop with paralleling pins just short of the sinus floor and of the c reamer breaching the sinus floor

After completion of 27 osteotomy, with the 26 site sinus floor still intact
condensing PRF into the 27 osteotmy site


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21 Comments

Very nice case, please continue to follow it up. Thanks for sharing.

Ehab


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Thank you for your appreciation Ehab. Will update after Ramadan, when he comes back for restoration.


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Great Dr. narayan! just saw d pics today. why was the lifted area not grafted with bone?


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Thanks Amol. I've increasingly started moving away from using graft materials in the sinus other than PRF. I've found tenting the membrane alone to be effective enough.


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Nice case! Minimally invasive approach with minimal risk of infection.Well done. Thank you for sharing. Chuck


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Great case and it's management Narayan, compliments.


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Thank you Dr. Schwimmer & Ashok for your kind words


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Dr N
I learn by seeing not reading. Beautiful Photos
This is not a good case... Its a real good case

Thanks

Rocco Mele


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Thank you Dr.Rocco. That's high praise indeed.


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Great job Narayan. It will be nice if you could take a post loading cbct to see the bone fill around the implant. I have no doubt that if the lining is intact, you are certain to get good bone all around.


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Thanks Udat,and I am planning to get that cbct. Trying to document a series with post op cbcts. Just feel ethically challenged asking for the post op cbct.


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Very nicely done.thanks a lot for sharing ..dr. narayan tv did younused trephine initially instead of drills?


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Works best with 2 osteotome sites. See my video on XP. http://www.dentalxp.com/video/internal-hydraulic-sinus-lift-procedure-1052082.aspx?locale=


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Mo. That was my initial thought as well. However, after attending Dr Sohns course, he explained HPISE works best in more confined sites. In confined sites fluid pressure is higher, therefore membrane elevation is greater. A V- shaped sinus is an advantage or even the presence of septum can facilitate elevation. In a flat sinus or with "side by side" sites the hydraulic pressure effect will be diminished. Chuck


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Chuck; Look at Dr. Salama's video. He clearly displays the movement of water and lift from one osteotomy to the other. Often, there can be too much pressure with a single confined site that can lead to perforation even with just water?
Band


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Brand. I viewed the video by Maurice, and yes he clearly lifted the membrane between the osteotomies with hydraulic pressure. However, once the water pressure was released through the adjacent osteotomy site, no further hydraulic membrane lift can occur. The second site acts as a pressure release valve. Therefore, vertical augmentation may have been limited. Had he implemented the hydraulic pressure prior to the second osteotomy, he would have increased the likely hood of vertical membrane displacement. At least, I believe this principle to be true for Piezo use. Chuck


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Narayan, perfectly done. Congrats.
However, in our 11 years experience of sinus elevation with only PRF (crestal or lateral) the only one factor of decision to use PRF alone or with bone graft is the bucco-palatal distance. If the sinus is too wide, or if the sinus floor is too plate, we prefer to add bone graft. (the schneiderian membrane is much better stabilized)
If we respect this condition, we can expect close to 100% success.
In your case, the distance is short and the indication is completely respected.


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Thanks for your appreciation and your inputs Dr. Choukroun. I have a fair series now of sinuses with only PRF or no grafting. This patient was seen by me this week, and on the rig things look great. Have asked him for a cbct at the end of the month, and then will update.


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Great job Doc N, what torque did you achieve for the 26/27 Implants?


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Thanks Jayanto, both >35 NCm


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gud work narayan


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Henry Schein