Dennis G. Smiler (DDS, MScD)
Private practice, Encino, California. USA.

The sinus lift operation continues to be one of the most successful graft procedures in the surgeon’s armamentarium. Loss of posterior teeth with subsequent atrophy of the alveolus and increased pneumatization of the sinus results in the decrease of available bone for implant placement. The surgical procedure to elevate the sinus membrane with simultaneous grafting can produce sufficient bone for the placement of endosseous implants. A 39-year-old woman presented for implant consultation. The evaluation revealed a severely resorbed maxilla secondary to missing posterior teeth on both the left and right. The amount of bone between the sinus and the crest of the bone ridge on both the upper right and left side was radiographically shown to be very thin (< 4 mm) with loss of both height and volume. The patient was treatment planned for bilateral sinus lift surgeries.

SURGICAL PROCEDURES.

A crestal incision was made from tuberosity to canine fossa with a vertical relaxing incision in the area of the canine fossa. The mucoperiosteal flap was reflected, exposing the malar buttress region of the infratemporal fossa and the area of the canine fossa. A No. 8 round bur was used to create a quadrilateral window on the outer maxillary wall (Fig. 1). The osteotomy exposed the Schneiderian membrane. The membrane was elevated with the lateral wall in a superior position. At the superior osteotomy site, a molt curette was inserted to elevate the membrane 5 mm higher than the superior bone cut (Fig. 2). The procedure was exactly the same on the contralateral side. The left sinus lift surgical site was grafted with a mixture of 60% by volume anorganic bovine material (ABM) (OsteoGraf/N-300, CeraMed Dental, LLC, Lakewood, CO) and 40% by volume decalcified freezedried bone allograft (DFDBA) (Allo- Gro, CeraMed Dental, LLC) (Fig. 3). The right sinus lift site was grafted with a 60% by volume ABM/P-15 (PepGen P-15, CeraMed Dental, LLC) and 40% by volume DFDBA (AlloGro, CaraMed Dental, LLC) (Fig. 4). Both sides were covered with a BioMend (Sulzer Calcitek, Carlsbad, CA) resorbable collagen membrane (Fig. 5).

Fig. 1. A, quadrilateral windows left;
B, quadrilateral windows right.



Fig. 2. Elevation of Schneiderian membrane.



Fig. 3. Graft placement (OsteoGraf/N-300, AlloGro).



Fig. 4. Graft placement (PepGen P-15, AlloGro).



Fig. 5. BioMend (Sulzer Dental, Inc., Carlsbad, CA) membrane positioned.