Crestal lift + GBR

138 Rating(s).


Posted on By UDATTA KHER In Sinus Augmentation

Case of a crestal hydraulic lift performed with Densah drills and Novabone putty. Buccal defect grafted with xenograft and collagen.

Pre op x ray
Densah drills

Intact membrane
Novabone putty


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11 Comments

Additional images

graft
membrane


Reply

Udatta, you are obviously a very experienced clinician and implant surgeon. I believe I have heard Salah talk about 3mm being a limit for OD Lift yet here I see you go much further with the addition of Novabone putty? What would suggest as a routine? for the average clinician? Thanks Maurice


Reply

I agree. Definitely not for the less experienced clinician. The 3mm limit has more to do with the need for primary stability of the implant. As far the the extent of lift is concerned its quite predictably possible with the help of hydraulic kits or the hydraulic pressure from the putty. Though the sinus lining is very fragile when you handle it, its quite tenacious when hydraulic pressure is applied. So i am not really concerned about the the extent of the lift as along as I have adequate bone for achieving stability for my implant.

Also important to note that since I've used only an alloplast, the remodelling time will be quite long. Hence, i'd wait for at leat 7-8 months before loading such a case.

Needless to say, one shouldn't start with such challenging cases. There is a learning curve. For lesser experienced clinicians, its more prudent to start practicing such procedures when the RBH is 6-7mm. Then gradually move to cases with more deficiencies.


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Great case Dr Udatta . could you please elaborate on the drilling sequence on this case with the densah Many Thanks Mathew


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Thanks. I used the 3.0mm drill to breach the sinus floor in counter clock direction. Followed by widening 0.5mm less than my implant diameter(in this case 4.6mm diameter). Placed novabone and propelled it with the last drill @100rpm. Used 0.5cc of graft.
However I wouldn't suggest anyone attempt it without understanding all principles of osseodensification and attending a structured course with some hands on training.


Reply

Udatta, I can hardly say what I appreciate more: your case management or your explanations and comments.
Keep doing and posting!
Best regards
Snjezana


Reply

Thanks Snjezana. You flatter me.
Simply being on dental XP brings the best out of me.


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Udatta. Simply fabulous execution! As we know there is a lot of advanced diagnostics needed to understand and perform this type of procedure.. On another note, as you well know, slow turnover materials are not my first choice for these circumstances. Although the physical hydrodynamic properties of Novabone putty are beneficial for membrane displacement, the remodeling properties are less than ideal. In fact the slower rate of turn over negates the efficiency of the crestal approach. One of the main advantages of the crestal approach is to shorten treatment time not to prolong it. IMO the ideal graft material would possess the physical properties of Novabone putty but have a rate of turnover of an Allograft.
Chuck


Reply

Thanks Chuck. I am aware of your affinity towards allografts. The point you make is valid and I cannot debate the fact that allografts will have a faster turnover compared to the putty. I would wait for 6-7 months in this case to load.
On the flip side, its not easy to place such a large quantity of particulate allograft through the crestal approach (though I have seen your cases and some others who do it routinely).
I choose Novabone putty for 2 reasons. The convenience of insertion of the graft due to its viscostatic nature. And the fact that we don't have a consistent supply of allografts in India and few other countries in the world. A lot of procedures and materials get chosen because of demographics and local situations. So having more than one technique is essential for a larger base of clinicians to practice these procedures.
An ideal situation would be to combine the two. Allograft putty in a cartridge.


Reply

Totally agree! We must keep moving forward


Reply

THANK YOU ALL, WHAT A GREAT CASE AND A GREAT DISCUSSION FROM SUCH PROFESSIONALS


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