Sinus Elevation Site #3

With this spring extension marking the start of fourth year, I've been in the clinic 5 days a week, and getting some cool exposure to procedures we've learned about. I'll probably be writing more about procedures from this point on as we'll hopefully be doing lots of dentistry from here on out! Since I had some open appointments this week I was able to fit in observing a sinus lift in the implant clinic.

Sinus lifts are necessary in certain cases when a patient wishes to replace a tooth with an implant in the posterior maxilla. The maxillary sinus sometimes extends lower down than we'd like and to avoid placing the apical portion of the implant into the sinus, the sinus lift procedure is necessary prior to implant placement. 

Heres a couple informative graphics I found online which clearly show what's going on. This patient is also missing teeth they wish to replace in the posterior left maxilla. The sinus has undergone pneumatization which leaves the dentist with little bone to work with. Through a sinus lift procedure they were able to place three implants to restore those teeth 

[http://www.capedental.com/2013/sinus-lift-and-implants/]

[http://www.capedental.com/2013/sinus-lift-and-implants/]

The patient today however was a single 10mm x 4.8mm implant placed in site #3. The patient had nonsignificant medical history and the tooth was lost due to caries some time ago. There was 8mm of bone present and therefore needed a lift of 2mm to place the implant. 

Initially the patient was anesthetized with an infraorbital block, posterior superior alveolar injection and a greater palatine injection with 2% lido with 0.034mg epi per carpule. Once anesthetizd, the patient was draped and scrubbed extraorally with an alcohol swab, and intraorally with a chlorhexidine saturated sponge. 

The initial incisions were intrasulcular around teeth #2 and #4. The second was a crestal incision and a full thickness flap was reflected to expose the alveolar bone. The osteotomy was made using the Straumann kit drills to a depth of 7mm, and a width just shy of 4.8mm leaving 1mm of bone between the osteotomy and the Schneiderian membrane of the sinus. The sinus was then lifted using osteotomes and a mallet. Osteotomes were placed in the osteotomy site and lightly tapped to lift the sinus. Progressively larger osteotomes were used to complete the osteotomy. Two pieces of resorbable collagen membrane were placed at the apical extent of the osteotomy before the implant was placed. This membrane will resorb within 6-8 weeks. 

The implant was then placed at a speed of 35RPM into the osteotomy site to a depth of 10mm so the implant was placed at bone level. The final insertion of the implant was completed using hand wrenches rather than the motorized drill. The healing cap was placed and flaps re-adapted to the alveolar bone and three teflon interrupted sutures were placed. 

Cool experience overall. Post op radiograph looked great and hopefully all goes well with the restorative phase!