Dental Seminar Training Sinus Lift Grafting Procedure Perforation Repair
Michigan Dental Seminars

Ara Nazarian, DDS
Sinus Perforations
1857 East Big Beaver Rd
Michigan Dental Center
Troy MI 48083
(248) 457-0500

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Perforated Sinus Lift Surgery during Implant Dentistry

Sinus Lift Bone Augmentation
Sinus Floor Assessment
Perforations of the sinus cavity floor can have many different causes, including root canal treatments, re-excavation of deep fillings, crown and veneer prep, extractions and especially implant dentistry.

Dentists and specialists alike who perform numerous implant placement surgeries routinely assess the quality and thickness of the sinus cavity floor.

X-rays for this patient indicate that the sinus cavity floor is presently too thin, suggesting that implant placement will cause an unwanted communication between the oral cavity and sinus cavity.

Thin Sinus Floor
Tooth Replacement: Implant Site Preparation
Traditionally, dentists and specialists would create a window through the buccal or anterior surface of the upper jawbone, between the root area of the affected tooth, just below the sinus cavity floor.

Once the "window" is created, the sinus membrane is gently lifted while bone grafting products are injected into the treatment area. The actual lifting of the sinus membrane is performed manually with a specially designed instrument or with a balloon device.

Once fully healed, the new bone mass can be prepared for implant placement.

Windowless Sinus Lift

No Flap Perio Punch
Minimally Invasive Perio Punch

Atraumatic Intercrestal Protocol

Today's latest developments in bone graft products and special instrumentation now permit implantologists to perform a sinus lift through the implant site directly.

A sinus lift protocol that is gaining popularity with many dentists and specialists alike, the Atraumatic Intercrestal Sinus Lift procedure impacts the healing process dramatically.

The need for the traditional perio flap is eliminated. Instead, a minimally invasive tissue punch is used to remove soft tissue that matches the diameter of the needed access point.

Sinus Lift Instruments
Successful Sinus Entry
Next, a motorized handpiece with a specialized bit functions similar to a hole saw, simultaneously creating a pilot hole and predetermined diameter of bone tissue removal that provides the accuracy needed for assuring the least invasive protocol possible.

Depth and diameter precision are controlled by the selection of appropriate bit size, determined by the measurements obtain from the x-rays or scans.

Minimally Invasive Features

Exposed Sinus Cavity
Successful Sinus Entry
The adjacent photo aptly demonstrates the minimally invasive features of the Intercrestal Protocol, as compared to the traditional sinus lift surgery.

Minimal, if any, bleeding and no flap surgery.

Root structures of adjacent teeth are protected by the use of a properly sized bit that takes the best advantage of direct and best access to the sinus cavity floor.

The next photo shows the insertion of a GTR membrane that separates the sinus membrane from the new bone graft material.

GTR Membrane Insertion
GTR Membrane Insertion
Particulate based bone graft material is specifically prepared to promote optimal regeneration of bony tissue for a thick sinus cavity floor.

Optimizing Tissue Regeneration

The particulate size is larger than what is commonly used for injectable types of bone graft material.

The material is manually inserted into the opening, using a quantity that corresponds with the need for thickness and breadth of sinus floor augmentation.

Insertion New Bone Particulate
Particulate Material Layered Above Membrane
Calculations for needed volume are based upon measurements obtained from x-rays and/or scans.

The adjacent photo shows how the graft material is packed up to a level that corresponds with the bone height at the adjacent teeth.

To assure optimal predictability, the graft material is totally saturated with blood before implant placement begins.

Implant Selection and Placement

Sinus Implant Selection
Implant Selection
The selection of implant type and design is based upon the characteristics of the implant site, depth of augmented bone and type of abutment that will be used to create a tooth replacement that provides an ideal treatment outcome.

The use of a manual insertion tool provides the best control for placement. The use of a motorized handpiece is not needed.

The texured surface characteristics and implant thread design is selected to assure fully successful osseointegration as the new bone material regenerates around the implant and into what will become a thickened floor of the sinus cavity.

Sinus Floor Repair Xray
X-ray Confirmation

Confirming Treatment Success

Immediately subsequent to implant placement, x-rays or scans are taken to confirm treatment success that addresses depth, width and breadth of the sinus floor augmentation along with proper dispersion of bone graft material surrounding the implant.

Notice, in the adjacent photo, how the graft material completely fills in the deficiencies in thickness of the sinus cavity floor and extends beyond the tip of the implant.

Implant Healing Cap
Healing Cap

Healing and Osseointegration

A healing cap is placed on the implant that is appropriately sized to what the diameter of the new implant abutment will be.

Once healing is completed (2-3 months) and osseointegration has been safely and accurately tested (Ostell Mentor) the implant abutment and new crown can be placed.

Multiple Sinus Lifts and Implants Example

Multiple Implant Treatment Plan
Sinus lift implant planning xray

Multiple Sinus Lift Grafting and Implant Placements
Sinus lift implants post op x-ray

Questions and Details

Dr. Nazarian can be most easily contacted via our on-line email Contact Form. He will respond to you directly with the answers you seek to unique questions or questions about the activities of the Reconstructive Dental Institute.

Michigan Dental Seminars
Ara Nazarian, DDS Seminar Leader
1857 East Big Beaver Road
Troy MI 48083
(248) 457-0500 - Fax: (248) 457-0501

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