Surgical Solutions - March-May 2017 - 27

CRESTAL CRESTAL
SINUS LIFT
SINUS
- INTRALIFT™
LIFT - INTRALIFT™

PROSPECTIVE MULTICENTRE STUDY ON 404 PATIENTS,
SURGICAL UNITS
446
SITESHYDRODYNAMIC
AND 637 INSERTED
IMPLANTS
THE SINUSLIFT
TRANSCRESTAL
ULTRASONIC
CAVITATIONAL
SINUSLIFT:
RESULTS
OFB.AFischak-Treitl,
2-YEAR
A. Troedhan, A. Kurrek,
M. Wainwright,
I. Schlichting,
M. Ladentrog
PROSPECTIVE
MULTICENTRE STUDY ON 404 PATIENTS,
Open Journal of Stomatology, 3, 2013
446
SITESHYDRODYNAMIC
AND 637 INSERTED
IMPLANTS
THE SINUSLIFT
TRANSCRESTAL
ULTRASONIC
CAVITATIONAL
SINUSLIFT:
RESULTS
OFB.AFischak-Treitl,
2-YEAR
Keywords
A. Troedhan, A. Kurrek,
M. Wainwright,
I. Schlichting,

Transcrestal,
Hydrodynamic
sinuslift, Bone
Augmentation,
Implants,
Ultrasound
M. Ladentrog
PROSPECTIVE
MULTICENTRE
STUDY
ON 404
PATIENTS,
Surgery,
Maxillary
Sinus.
Open Journal of Stomatology, 3, 2013

446 SINUSLIFT SITES AND 637 INSERTED IMPLANTS

Introduction:
Keywords
Troedhan,
A. Kurrek, M. Wainwright,
I. Schlichting,
B. Fischak-Treitl,
InA.2006
an ultrasound-surgery-based
method
to hydrodynamically
detach the sinusTranscrestal,
Hydrodynamic
sinuslift,
Boneeffect
Augmentation,
Implants,
Ultrasound
membrane
utilizing
the ultrasonic
cavitation
- the tHUCSL
- was developed
and
M. Ladentrog
Surgery,
Maxillary
Sinus.
a Open
surgical
protocol
established. The
aim of the study was to determine the indicationJournal
of Stomatology,
3, 2013
range and success-rate of this novelty procedure.
Introduction:
Materials and methods:
Keywords
In 2006 an
ultrasound-surgery-based
to hydrodynamically
detach
sinusBetween
2007
and 2009, 404 patientsmethod
were treated
by 6 oral surgeons
ofthe
different
Transcrestal,
Hydrodynamic
sinuslift,
Bone
Augmentation,
Implants,
Ultrasound
membrane utilizing
the the
ultrasonic
cavitation
effect
- the 637
tHUCSL
- was developed
and
experience-levels
with
tHUCSL
in 446
sinus-sites.
implants
were
inserted
Surgery,
a surgical
protocol Sinus.
established.
The aim
the studyand
wasdocumented
to determineuntil
the indicationand
thenMaxillary
prosthodontically
treated
andof
observed
December
range The
and subantral
success-rate
of this
procedure.
2011.
space
wasnovelty
augmented
via the 3 mm transcrestal approach with
Introduction:
an
augmentation
volume of 1.9 ccm (+/- 0.988 ccm) and an augmentation height of
Materials
and methods:
In 2006
ultrasound-surgery-based
to hydrodynamically
detach
sinus10.7
mman
(+/2.85
Between
2007
andmm).
2009, 404 patientsmethod
were treated
by 6 oral surgeons
ofthe
different
membrane utilizingwith
the the
ultrasonic
cavitation
effect - the 637
tHUCSL
- was developed
and
experience-levels
tHUCSL
in
446
sinus-sites.
implants
were
inserted
Results:
a surgical
protocol established.
The aim
of
the studyand
wasdocumented
to determineuntil
the indicationand
then
prosthodontically
treated
and
observed
December
Within the survey-period 15 (2.35%) of the 637 inserted implants were lost, mostly
range The
and subantral
success-rate
of this novelty
procedure.
2011.
space
augmented
via the 3and
mmnon-osseointegration
transcrestal approachinwith
before implant
loading
duewas
to postsurgical
infection
the
an
augmentation
volume
of
1.9
ccm
(+/0.988
ccm)
and
an
augmentation
height of
Materials and methods:
augmentation
site. 1 implant was lost after implant loading and
prosthetic treatment
10.7
mm
(+/Between
20072.85
andmm).
2009, 404
were treated
by 6functional
oral surgeons
of different
within
1 year
after
loading.
Thepatients
overall success
rate with
implants
in site is
experience-levels
with
the
tHUCSL
in
446
sinus-sites.
637
implants
were
inserted
97.65%
were
Results:evenly distributed among the participating surgeons. 86% of the patients
and
then
prosthodontically
and
observed
documented
untillost,
December
observed
no postsurgical
swelling
87%
noand
postsurgical
pain.
Within
thewith
survey-period
15treated
(2.35%)
of and
the
637 inserted
implants
were
mostly
2011.
The
subantral
space
augmentedinfection
via the 3and
mmnon-osseointegration
transcrestal approachinwith
before
implant
loading
duewas
to postsurgical
the
Discussion:
an
augmentation
volume
of
1.9
ccm
(+/0.988
ccm)
and
an
augmentation
height of
augmentation
site.
1
implant
was
lost
after
implant
loading
and
prosthetic
treatment
The results suggest the tHUCSL to be a safe minimal-invasive alternative to traditional
10.7
mmyear
(+/- 2.85
mm).
within
afterand
loading.
The overall
success sinuslift-procedures
rate with functional implants
in site
is
lateral 1approach
transcrestal
osteotome
applicable
to all
97.65%
evenly
distributed
among
the
participating
surgeons.
86%
of
the
patients
were
Results:
anatomical situations.
observed
no postsurgical
swelling
no postsurgical
pain.
Within thewith
survey-period
15 (2.35%)
of and
the 87%
637 inserted
implants
were lost, mostly
before
implant
loading
due
to
postsurgical
infection
and
non-osseointegration
in the
Discussion:
augmentation
site.
1
implant
was
lost
after
implant
loading
and
prosthetic
treatment
The results suggest the tHUCSL to be a safe minimal-invasive alternative to traditional
within
year afterand
loading.
The overall
success sinuslift-procedures
rate with functional implants
in site
is
lateral 1approach
transcrestal
osteotome
applicable
to all
97.65%
evenly
distributed
among
the
participating
surgeons.
86%
of
the
patients
were
anatomical situations.
observed with no postsurgical swelling and 87% no postsurgical pain.
Discussion:
The tHUCSL-INTRALIFT-procedure can be trained with a small investment of time by
The
resultsand
suggest
the tHUCSL
be a safe
towith
traditional
the dentist
be applied
by everytodentist
withminimal-invasive
a basic training in alternative
implantology
almost
lateral
approach
and
transcrestal
osteotome
sinuslift-procedures
applicable
to all
the same success-rate as long-term experienced oral surgeons as the study results suggest.
anatomical
situations.
The standardized hydrodynamic pressure described in the surgical protocol combined with

A. Troedhan et al

the ultrasound cavitation effect distributes the detaching forces equally between the sinus
membrane
and the bony antrum of the sinus.
The tHUCSL-INTRALIFT-procedure
can be trained with a small investment of time by
The
tHUCSL-INTRALIFT
is compatible
to all
implant
an implant diameter
of
the dentist
and be applied
by every dentist
with
a basicsystems
trainingwith
in implantology
with almost
more
than
3 mm andas
most
of all applicable
tooral
all anatomical
of the suggest.
alveolar
the same
success-rate
long-term
experienced
surgeons asconditions
the study results
crest
and the maxillary
sinus which
can be
considered
a major
advantage.
The standardized
hydrodynamic
pressure
described
in the
surgical
protocol combined with
A. Troedhan
et Journal
al. / Open
Journal of Stomatology
3 (2013) 471-485
Troedhan
et al. / Open
of Stomatology
3 (2013) 471-485
474 474
the
ultrasound A.cavitation
effect
distributes
the detaching forces equally between the sinus
membrane
and the bony antrum of the sinus.
The tHUCSL-INTRALIFT-procedure
can be trained with a small investment of time by
The
tHUCSL-INTRALIFT
is compatible
to all
implant
an implant diameter
of
the dentist
and be applied
by every dentist
with
a basicsystems
trainingwith
in implantology
with almost
more
than
3
mm
and
most
of
all
applicable
to
all
anatomical
conditions
of
the
alveolar
the same success-rate as long-term experienced oral surgeons as the study results suggest.
crest
and the maxillary
sinus which
can be
considered
a major
advantage.
The standardized
hydrodynamic
pressure
described
in the
surgical
protocol combined with
the ultrasound cavitation effect distributes the detaching forces equally between the sinus
membrane and the bony antrum of the sinus.
The tHUCSL-INTRALIFT is compatible to all implant systems with an implant diameter of
Figure 6. Preparation
of3
the mm
2.8 mm receptacle
the cylin- of all applicable to all anatomical conditions of the alveolar
more
than
andwithmost
drical diamond
coated
TKW 4-tip-schematic.
Figure Insertion
7. Insertion of
of the
the hollow
3.03.0
mm mm
TKW TKW
5-tip and deFigure 6.
Preparation
ofof
thethe
2.8 2.8
mm mm
receptacle
with the cylinPreparation
receptacle
hollow
Final widening and smoothing of
Application of bone graft with a
tachment of Figure
the sinus-membrane
by
of ultrasonic
osdrical
diamond
coated
TKW
4-tip-schematic.
crest
andwiththethe
maxillary
sinus
which
can
considered
major
advantage.
7.be
Insertion
of injection
the
hollow
3.0 mmaTKW
5-tip
dethe
diamond
coated
detachment
of the
sinustheand
transcrestal
canal to 3.0 mm
common bone applicator. The
cillating5-tip
salineand
solution
creating a cavitation
effect-schematic.
After checking
snugcylindrical
fit of the TKW
5-applicator
in

Figure 10. Final widening and smoothing of the transcrestal
A. Troedhan et al. / Open Journalcanal
of Stomatology
3 (2013)for
471-485
to 3.0 mm diameter
smooth application of bone graft. 475

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17

Figure 12. Intrasurgical x-ray
check of augmentation extension:
0.5 ml
bone graft with
applied.
Figure 11. Application
of bone
a common bone apFigure 10. Final widening and smoothing of the transcrestal plicator. The amount of bonegraft applied depends on the neccanal to 3.0 mm diameter for smooth application of bone graft. essary extension of the subantral augmentation.

tachment of the sinus-membrane by injection of ultrasonic osTKW
4-tip-schematic.
membrane
by injection of ultrasonic
diameter for smooth application
the receptacle
hydrodynamic
cavitational
cillating saline solution creating a cavitation effect-schematic.
After the
checking
the snugultrasonic
fit of the TKW
5-applicator in
oscillating saline solution creating a
of bone graft.
detachment
of the sinus
had to be
performed
the receptacle
themembrane
hydrodynamic
ultrasonic
cavitational
at a power
setting
of
the
Piezotome
at
mode
D3
with
a
detachment of the sinus membrane had to be performed cavitation effect-schematic.
flow rate of 30 ml/min for 5 seconds. At these settings
at a power setting of the Piezotome at mode D3 with a
the sinus membrane will be completely detached from
flow rate of 30 ml/min for 5 seconds. At these settings
the entire sinus floor and provides a possible augmenthe sinus
membrane
will be
completely
detached from
tation volume
of 2.5
ccm. (Figures
7 and
8)
entireofsinus
floor and provides
Thethe
integrity
the sinus-membrane
had toabepossible
check- augmentationand/or
volume
2.5 ccm. (Figures
7 and
8)
ed visually
by of
Valsalva-test.
In case of
a perforaThesinus-membrane
integrity of thethe
sinus-membrane
to be checktion of the
surgeon had to had
decide
and/or
by Valsalva-test.
In case
of a perforawethered
to visually
proceed or
interrupt
surgery for wound
closure
depending
of the perforationthe
when
visible.had to decide
tion on
of the
thesize
sinus-membrane
surgeon
After
widening
of the ortranscrestal
trepanation
with closure
wether
to proceed
interrupt surgery
for wound
Figure 8. TKW 5-tip inserted into the receptacle: this tip seals
TKW depending
3 (Figure 9)
TKWof4the
diamond
coatedwhen
ultra-visible.
on and
the size
perforation
the approach canal like a sealing ventile and enables by it's
sound tips (Figure 10) synthetic, xenogenic and/or autooscillations the cavitation effect.

Orders

1 3 0 0

6 5

8 8

2 2

of bonegraft
type,amount
prior maxillary
sinus surgery applied
on sinuslift side y/n,
chronic
sinusitis y/n,
medication (type);
depends
ongeneral
the necessary
extension
Amount of anesthetic applied in ml, crestal mucopeof the subantral augmentation.
riostal flap approach or gingiva-punch (f/p), mucoperiostal thickness at approach site in mm, dental socket
number of INTRALIFT-approach-site, real subantral alveolar crest height measured intraoperatively, surgeon's
subjective rating of bone quality (D1-4);
Perforation of the sinus membrane detected y/n, commercial name of inserted bone graft, amount of bone
graft inserted in ccm, resulting subantral augmentation
height in panoramic x-ray/CAT-scan/CBCT, additional
C

Figure 13. Intrasurgical x-ray
check of augmentation extension: 1 ml bone graft applied.

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Table of Contents for the Digital Edition of Surgical Solutions - March-May 2017