Osseodensification facilitates Sinus Autografting in steep floor anatomy

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Posted on By Salah Huwais In Sinus Augmentation

Patient presented for implant placement in area of #12. Area revealed localized Maxillary sinus pneumatization with steep floor angle post extraction. Osseodensification was utilized to autografting the sinus and 4/11.5 mm fixture was placed. No allograft was used.

Pre-op
Densah Bur autografting the sinus

Post Placement
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8 Comments

Salah. Nice looking lift. Could you please describe your drill sequence and final size drill utilized? Thank you for sharing. Chuck


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Salah; Ditto what Chuck asked. Very impressive. I have just initially started with these drills at my office but not yet for internal sinus augmentation. regards Dr. Salama


Reply

Drs. Schwimer and Salama:
thank you for your remarks. Please find below the step by step protocol to do a case with steep sinus floor.
The Densah burs are not end-cutting in densifying mode (CCW rotation at 800-1200 RPM). With irrigation and bone slush, they create a hydrodynamic pressure wave that helps lift up the membrane ahead of the tip.
in this specific case:
I measured the lowest point of the sinus floor which was 7 mm and was located distally. Let us call it the distal point. then I measured the highest point which was 10 mm in the mesial, let us call it the mesial point. Regardless of the slope difference, I always follow the lowest point to determine the opening level of the sinus floor. Finally, as a rule, I do not penetrate with the Densah bur more than 3mm from the lowest point of the sinus floor:
1- Pilot osteotomy to the depth of 6 mm (1 mm short of the distal point) with traditional 1.7 mm pilot drill rotating at 1200 RPM in CW cutting mode.
2- I used Densah Bur VT1828 which has an average diameter of (2.3) mm in densifying mode at 1200 RPM rotating CCW to a depth of 8 mm (1 mm passed the floor) modulating pressure with a gentle pumping motion to advance past the sinus floor. Maximum advancement past the sinus floor at this stage must not exceed 1.0 mm. Bone will be pushed toward the apical end and will begin to gently lift the membrane, autograft and compact patient's own bone
3- I used next the Densah Bur VT2838 which has average diameter of (3.3)mm in the same mode to the 10 mm depth line with gentle pumping motion to achieve additional vertical depth and total maximum membrane lift of 3.0 mm.
4- I then finished my preparation with Densah bur VS3238 which has an average diameter of (3.5) mm in the same densifying mode to 10 mm depth. I am still at only 3mm in the sinus.
5- 4.1/11.5 Zimmer fixture was placed with 60N/CM. The implant tip would push the autogenous bone deposit further while it was seated.
As you see, I usually do not factor the higher point (in this case the mesial point) in determining the sinus entry level because the Densah bur tip is designed not to cut apically in reverse mode, which makes it safer to enter the sinus even in two different level points. Basically, The bur did the job predictably. Please try them and let me know your thoughts.


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Salah. Thank you for the explaination. I look forward to trying these burs. Your description of your protocol is appreciated. Best regards. Chuck.


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Salah,

Nice work and successful lift.
After your presentation, I'm looking forward to using Oseeodensification kits.
One question.
How about the height in sinus lift can we gain with this kit?
Is there any limit?

Thanks for your sharing.

Best Regards, Vincent


Reply

Dear Vincent:

You can lift and autograft up to 3mm without allograft utilizing only the compaction auto-grafting. If you need an additional lift, then you might incorporate an allograft as follow:
1- prepare your osteotomy to the final width and length including the additional 3 mm lift with the autograft (patient own bone)
2- fill up the osteotomy with your preferred allograft material, then use your last used Densah bur in CCW densifying mode at low speed 100-500 rpm to pump the allograft up into the sinus. The more particulate the allograft the higher speed you need. Please use slow irrigation at this point. You might repeat filling up the osteoltomy and pumping up the allograft several times. 5 mm fill will give you 2-3 mm lift. You can achieve up to 7 mm lift with the allograft densification. Dr. Neiva's team has showed great success lifting up to 9 mm with allograft utilizing the the densifying mode of the densah Bur. Please watch our sinus graft video, it has several example cases. http://versah.com/versatility/
3- The minimum ridge height to do the Versah Sinus Autografting in my hands is 4 mm. Any case with less than 4 mm I tend to utilize the lateral widow technique.
I hope this help. Please also review our surgical instructions at
http://versah.com/wp-content/uploads/2015/01/Maxillary_Sinus_Autograft.pdf
Salah


Reply

Salah,

Thanks for your comprehensive and detailed reply:P
Forgive me for another question.
I'm quite interested in sinus lift. In current available techniques of sinus lift, the elevated and augmented areas are usually soft.
How about the bone quality in the apical area after autograft with Densah kits?

Best Regards, Vincent


Reply

Vincent:

The Autografted bone that is usually pushed up and deposited during the Densah Lift posses the same quality of the original host bone. It is not soft or (mushy), it does establish a new roof for the fixture. Please see image (1)
Our Data is showing that this autograft does mature and maintain its integrity over time. Please see image (2)
We are planing a histological in-vivo study to look at the time line healing of this autograft in sheep maxillary sinus.
Great question!!

Clinical view of the Densah Sinus Autograft


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