Original study - ZZI 04/2012

Clinical application of piezo-surgical hydrodynamic sinus lift procedures in combination with augmentation and implantation

G. C. Scheiderbauer

Introduction: The aim of this retrospective study was to assess the success of hydrodynamic sinus lift using a piezo-surgical instrument with simultaneous augmentation and implantation and compare it with alternative techniques.

Materials and method: Between December 2007 and July 2009 109 hydrodynamic sinus lift procedures were performed in 100 patients using the TKW-5 trumpet, a piezo-surgical instrument, accompanied by augmentation with autologous bone.

Results: The study involved placing 130 implants in the atrophic posterior maxilla. The initial bone height was between 2 mm and 10.2 mm. The sinus floor was augmented with autologous bone grafts from the maxillary tuberosity and from the retromolar mandible, where necessary. The hydrodynamic sinus lift procedures were successful in 82 cases. Perforation of the maxillary sinus membrane was observed in 27 cases; these were repaired through a lateral window, covering the perforation with an absorbable collagen membrane (Resorba: “Kollagen-resorb”). Augmentation and implantation were then carried out. There was no association between perforation and the average bone height.

The second surgery was performed six months after implant placement, and healing caps were inserted with 20 Ncm. All 130 implants were osseointegrated. Patients were instructed to use the superstructure carefully for three months. Radiographic follow-up of the implants and regenerated situation took place one year after prosthetic restoration.

Conclusion: The advantages of the hydrodynamic sinus lift procedure using the TKW-5 trumpet include less time required for surgical treatment, fewer post-surgical problems, less swelling, no lateral window in the maxilla, and a good prognosis for osseointegration. This technique is an alternative to the lateral window technique for sinus floor augmentation but is not a substitute if the sinus membrane is perforated.

Keywords: hydrodynamic sinus lift procedure; maxillary sinus membrane; augmentation; implantation

Introduction

Implantology has found the ideal path from placement in residual bone to placement in the ideal prosthetic position. The bone height in the posterior maxilla is often reduced so that augmentation of the ridge and/or sinus lift is required prior to implant-based restoration.

This study investigates hydrodynamic sinus lift with a piezo-instrument, combined with simultaneous augmentation of the sinus floor in the implant axis, having regard to the risk of perforation [10] of the sinus membrane. Membrane elevation was performed hydrodynamically.

Several procedures are employed to augment the sinus floor prior to prosthetic placement:

  • Direct sinus lift according to Tatum [33, 29, 13] employs a lateral approach to the sinus floor. The lateral sinus wall is weakened by a circumferential line, and this cap is pressed in and dissected inwards and upwards with the sinus membrane. The resulting cavity is filled with autologous bone, bone allograft, synthetic bone substitute or a mixture of bone substitute and autologous bone. This results in bony thickening of the maxilla. Implantation takes place in a second procedure after a period of several months to one year.

 

  • In hydrodynamic sinus lift (Intralift) as described by Kurrek et al. [14], access to the membrane on the sinus floor in the implant axis is achieved by ultrasonic surgery. The membrane is elevated with ultrasound-activated water pressure and the space obtained is filled and an implant is inserted.
  • Other techniques are described in the literature: elevation of the sinus membrane with hydraulic pressure [3, 23, 32], water pressure from a handpiece [4], endoscopically controlled sinus lift [6, 19], intrusion of the alveolar bone into the sinus floor [34] and manual mucosal elevation through a crestal access to the sinus floor [28].

 

The listed techniques have been investigated scientifi-
cally; they differ in surgical complexity and patient discomfort.

Piezo surgery [22, 27, 31] spares the soft tissues and has simplified sinus membrane elevation, reducing the risk of perforation [8, 24]. In hydrodynamic sinus lift (Intralift), the use of piezo surgery allows atraumatic elevation of the membrane by hydraulic pressure in the implant axis through a minimal access.

The aim of this study was to analyse the prognosis of hydrodynamic sinus lift with regard to implant healing and the risk of sinus membrane perforation. A single-stage procedure – augmentation and implantation – was chosen because of the long-term prognosis, which has been confirmed in the literature [20].

 

Materials and method

In this retrospective study, data were analysed from 100 consecutive patients who underwent hydrodynamic sinus lift between December 2007 and July 2009 with the TKW-5 trumpet attachment (Satelec, Aceton, Intralift set) [14]; 52 of the patients were women and 48 were men. Eleven patients were smokers and all smokers reported that they smoked fewer than 20 cigarettes daily; 89 subjects were nonsmokers.

Treatment followed a standard protocol with the “Piezotome“ (Aceton, Mettmann, Germany). The patients were informed of the planned treatment and gave written consent. 130 implants were inserted at the same time as augmentation was performed.

All procedures were performed after operation planning with a digital panorex (fig. 1), digital bone height measurement and laboratory-fabricated drill templates for pilot drilling. Local anaesthesia was given with Ultracain Dental forte (Sanofi-aventis, Paris). An incision was made in the alveolar ridge, the mucosa was dissected bluntly from the ridge and the position of the implant was determined with the sterile drill template. The first drill was used to drill the alveolar bone in the implant axis (fig. 2); the last millimetre was drilled in reverse direction to protect the sinus membrane. The drill hole was then widened within the ridge with the next drills (fig. 3, 4) of the same implant system. The TKW-5 trumpet was pressed into this bony funnel (fig. 5, 7) and the piezo-instrument was used intermittently. The procedure was successful when it was possible to press the trumpet tightly into the bony funnel. Progress was checked with a blunt probe every 30 seconds (fig. 6) until a depth of at least 12 mm from the ridge was obtained (fig. 8).

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