Dental Asia March/April 2019

User Report
initial drilling channel must be inferior to
that of the first osteotome used. Thus,
the addition of bone substitute is only
required to further increase the volume of
sinus floor obtained. If the residual bone
height is between 4 and 6 mm, it may be
necessary to first place a bone substitute
in the drilling channel before inserting the
first osteotome, which will, in this case,
have a convex end.
Before implantation, an X-ray is taken to
view the arch obtained. Bone substitutes,
like xenografts and β-TCP, seem to be as
effective as autogenic bone to increase
an atrophic maxillary ridge with the sinus
floor elevation technique. 9-11
Advantages and disadvantages
A transcrestal sinus floor elevation
osteotomy is an approach most dental
practitioners use because of its benefits
namely:
• it is considered a low invasive
surgery with minimal postoperative
follow-ups 13
• it does not require end drilling, thus
better bone/implant interface with
lower risk of heating
• only a very small enlargement of the
alveolar crest is made with an improved
peri-implant bone density 14-15
• simultaneous implant placement is
possible
• reduced treatment time, as implant
integration occurs at the same time
as bone filling consolidation (3 to 6
months, according to residual bone
height)
• lower in cost because it is a single
surgery with a smaller amount of
biomaterial used, as the implant
contributes to increase the volume of
the sinus floor.
Despite all of its advantages, a transcrestal
sinus floor elevation osteotomy is not
without its drawbacks as it is a blind
technique – sinus membrane is not
visible 12 , patient feels discomfort due
to the shocks caused by the osteotome
hammering technique and it is not suitable
for treatment of extensive defects.
Conclusion
The essential factor to enable
simultaneous implant placements seems
to be the residual bone height of the
sinus floor before filling. The minimal
value stated varies between 4 and 6 mm,
according to studies. 1-16 However, more
than this value, primary stability is one
of the key conditions of success, hence
the importance:
• of the site preparation technique with
an atraumatic condensing osteotomy
• of the ability to compact the filling
material
• of the design of the implant itself.
Although this is a blind technique
that carries the risk of perforating
the Schneiderian membrane, in very
specific cases, transcrestal sinus floor
elevation osteotomy represents the most
cost-effective solution for the patient.
This article will focus on two clinical
cases which illustrate a new transcrestal
sinus floor elevation technique with
Osteo Safe ® , the automatic impactor
developed by Anthogyr (Fig. 1).
Fig. 1: Osteo Safe ® kit
Calibrated impactions enable a more
precise and homogeneous progression
into the bone, thereby minimising the risk
of perforating the sinus membrane, while
also being synonymous to higher surgical
comfort for the patient.
Case 1
A 59-year-old male smoker patient
presented preoperative X-ray (Fig. 2)
showing a sinus floor bone thickness
of 4.5 mm, where we will use concave
end osteotomes. As the crestal width
is favourable, we placed an Axiom PX
self-drilling implant measuring 4.6 mm in
diameter and 10 mm in length after bone
tissue development.
In a standard case, drilling is initiated with
a Ø2.0 mm drill up to 1 mm of the sinus
floor (Figs. 3-4) but, if bone density is
higher, it is preferable to place 0.5 mm,
resuming the drilling in order to use a
moderate impaction force, resulting
in a more comfortable experience for
the patient during bone perforation
(Figs. 5-6).
Fig. 2: Preoperative X-ray
Fig. 3: Depth gauge in place.
Fig. 4: Follow-up
X-ray with depth
gauge in place.
MARCH / APRIL 2019 DENTAL ASIA 57