The transalveolar sinus elevation,

often called closed or also osteotome technique

is based on a technique developed by Summers

and published in the early 90s.

Summers used a set of sharp osteotomes

of increasing diameter in order to

create a controlled fracture of the sinus floor and

consequently push bone debris from the sides of the osteotomy

to an apical direction,

creating the space necessary under the sinus membrane

in order to place implants.

Ever since the publication of Summers however,

there has been so many modifications and changes

introduced to the transalveolar technique

that today it is difficult to identify a single standard.

The basic principle however remains the same:

the creation of a controlled fracture of the sinus floor

and the creation of a space under the membrane

with or without the use of grafting material.

There is a wide variety of osteotomes available today,

either as generic instruments

or specific to certain systems and techniques.

Nevertheless, some critical elements of osteotomes have to do with

the type of the edge and the shape

of the engaging part of the instrument.

A concave edge is more aggressive

and will concentrate more force on a smaller surface.

It is indicated in cases of harder cortical bone,

but will require precise control.

When using this type of instrument

after the preparation of the osteotomy,

the force is gathered at the margins of the osteotomy

and often pushes the fractured segment of the sinus floor

to an apical direction.

A convex edge of the osteotome is less

aggressive and safer to use in cases of softer bone.

Such an edge is more likely to create

a less defined dome-like fracture of the sinus floor

and it is usually safer than the concave edge.

Furthermore, the engaging part of the osteotome

can be either parallel or tapered.

A tapered instrument will condense the bone laterally

at the same time as advancing

in an apical direction.

This can be beneficial in cases of soft spongious bone.

Now let's take a quick overview of

how this could be applied in a typical patient case.

Our patient is going to receive two implants

in a segment of his posterior maxilla.

After the three-dimensional radiographic assessment,

we have calculated that

the bone height to the sinus floor

is 6 and 4 mm, respectively.

Let's see the implant in the 6 mm site first.

Here we are looking to generate

two more millimetres from the sinus.

To start with, we identify the place of the osteotomy

and then, we continue preparing the osteotomy

stopping short of 1 mm to the sinus.

That is drilling for 5 mm.

After the final drill, we place the osteotome.

Gentle knocking with the mullet will be enough to create

a small, controlled fracture of the sinus floor

and give us two additional millimetres

for implant placement.

Let's now move to the 4 mm site.

In this case, we need to elevate the sinus floor

for another 4 mm.

To achieve this without perforating the membrane,

we often have to use some grafting material.

Again, we mark the osteotomy and

continue preparing to the last drill,

stopping short of 1 mm from the sinus floor.

After the final drill, we place again the

osteotome and create a controlled fracture,

adding another 1 to 2 mm to our preparation length.

We would then use our grafting material

to gently elevate the sinus floor

for the last remaining 2 mm.

Attention!

At this stage, please remember the gentleman

who just popped out!

This is the famous Renaissance anatomist Antonio Valsalva

and I'm sure you're all familiar with

the Valsalva manoeuvre!

Remember, the sinus membrane is like a balloon

with only one narrow opening high at the ostium.

If this opening gets blocked,

and the sinus can no longer drain through the nose,

chronic sinusitis and major problems can follow.

Loose biomaterial in the sinus can

quickly accumulate and block the ostium.

It is crucial therefore to ensure that the membrane is intact

before you place any biomaterials in the sinus.

After a negative Valsalva sign,

we can place grafting particles in the osteotomy

and with gentle moves of the osteotome,

gradually push them apically under the membrane

creating the 4 mm required

for the placement of our implant.

The transalveolar sinus elevation technique

is widely practised today and most research

points to a high survival rate of the implants placed this way.

Prevalence of membrane perforation is reported around 4%,

while other complications include

tinnitus and low prevalence of nausea,

post operative infections of the surgical wound or the sinus.

Nevertheless, it is a technique that allows no visual inspection

and no margin for errors.

Rare but dangerous complications have also been reported,

such as the case of a patient with a severe bleeding

which required hospitalisation.

As with everything, careful patient selection and plan

as well as good preparation

and education of the operator is the key to success.

上颌窦内提 (*新增内容)

口腔种植学（Implant Dentistry）

Conoce a los instructores

上颌窦内提 (*新增内容)

口腔种植学 （Implant Dentistry）

Conoce a los instructores

口腔种植学（Implant Dentistry）