Crestal sinus lift: how to optimize clinical outcomes and reduce complications
This lecture will analyze the latest technical and scientific developments of sinus augmentation procedures, highlighting pros and cons of the different interventions, and hypotesizing new guidelines for choosing the more convenient surgical approach.
Insufficient alveolar bone height is a common obstacle to the placement of dental implants in the posterior maxilla. This condition results from bone loss caused by periodontal disease, from alveolar bone resorption following teeth extraction, from pneumatization of the maxillary sinus, or a combination of the above. Many techniques have been described to overcome this situation since the grafting of maxillary sinus with lateral approach was proposed in 1976 by Tatum and first published in 1980 by Boyne and James. Transcrestal sinus floor elevation (tSFE), which was first suggested by Tatum and then developed by Summers, is a minimally invasive approach to perform the grafting procedure through the residual alveolar crest: this technique allows to reduce patient morbidity and to preserve the integrity of sinus bone walls, which are the most important source for osteoprogenitor cells. Residual bone height remained for many years the criterion of choice between lateral and transcrestal sinus floor elevation. Since the Sinus Consensus Conference of 1996, five to seven millimeters of residual crestal height have been considered by many authors as a pre-requisite to perform predictable tSFE procedures: however, recent surgical advances showed successful application of this technique irrespective of the residual alveolar bone height, obtaining considerable vertical augmentation with transcrestal approach.
This lecture will analyze the latest technical and scientific developments of sinus augmentation procedures, highlighting pros and cons of the different interventions, and hypotesizing new guidelines for choosing the more convenient surgical approach, in order to obtain satisfactory regenerative results with the minimal possible invasivity in a predictable way. In particular, the use of collagenized xenogeneic bone gel as grafting material will be examined, highlighting advantages and disadvantages and giving operative tips in order to optimize the use of injectable biomaterials in transcrestal sinus floor elevation.