Journal of Oral Implantology June 2014 - (Page 281)

CLINICAL Safe Sinus Lift: Use of Acrylic Stone Trimmer to Avoid Sinus Lining Perforation Prashanth Konatham Haribabu, BDS, MDS, MSD1* Krishna Kumar Raja, BDS, MDS2 Shankar Iyer, DDS, MDS3 Iatrogenic injury to the maxillary sinus membrane is a common complication during direct sinus lift procedures. The most common cause is perforation of the Schneiderian membrane using a tungsten-carbide round bur no.6. We propose a safe technique in which an acrylic stone trimmer is used to create a window in the maxillary antrum thereby minimizing the risk of injury to the delicate sinus membrane. Key Words: direct sinus lift, Schneiderian membrane perforation, acrylic stone trimmer, bovine bone graft, collagen membrane, dental implant INTRODUCTION T he sinus lift procedure was introduced by Boyne et al1 in early 1980s to overcome the anatomic limitation and gain vertical bone height in atrophic areas of the posterior maxilla to facilitate placement of dental implants.1,2 This procedure has significantly contributed towards the application of the dental implants. Even though sinus membrane elevation is a relatively safe pre-prosthetic surgical procedure, there are some potential problems associated to the technique. The most prevalent intraoperative complication is iatrogenic perforation of the Schneiderian membrane (11%-56%).3 The Schneiderian membrane of the maxillary antrum is a thin membrane that consists of periosteum covered with respiratory epithelium, which is delicate, friable, and easy to perforate. Disruption of sinus membrane leads to loss of graft material, early implant failure, and interuption of normal sinus physiological functions.4,5 The literature shows that 30% of sinus membrane perforation occurs with the 1 Department of Diagnostic Science, New Jersey Dental School, University of Medicine and Dentistry of New Jersey, Newark, NJ. 2 Department of Oral & Maxillofacial Surgery, SRM University, Ramapuram, Chennai, TN, India. 3 Center for Reconstructive Dentistry, Smile USA, Elizabeth, NJ. * Corresponding author, e-mail: prasan777000@hotmail.com DOI: 10.1563/AAID-JOI-D-12-00037 use of rotary instruments and drills before the membrane is elevated.3 It is very difficult to repair a tear or perforation in the sinus membrane by suturing because of its inaccessibility and the friable nature of the sinus lining membrane.6,7 The main purpose of this report is to demonstrate a new technique in which an antral opening is created using an acrylic stone trimmer, which is commonly used for prosthodontic laboratory purposes. This tool helps the clinician perform an atraumatic and safe sinus lift procedure to augment the posterior maxillary sinus floor using bovine bone graft. CASE REPORT A 68-year-old woman reported to the Oral & Maxillofacial Surgery Unit at SRM Dental College, SRM University, Chennai, India, for implant rehabilitation of the edentulous upper right maxillary molar region (#1-#4). Radiographic examination (panoramic view) showed insufficient bony support as a result of severe alveolar bone resorption and pneumatization of maxillary sinus. The patient had no history of medical or surgical contraindications to undergo the surgical procedure. Therefore, a lateral sinus lift procedure was planned to augment the bone in the posterior maxillary sinus with subsequent placement of root-form dental imJournal of Oral Implantology 281

Table of Contents for the Digital Edition of Journal of Oral Implantology June 2014

Controlled Early Inflammation and Bone Healing—Potential New Treatments
Zygomatic Implants: The Impact of Zygoma Bone Support on Biomechanics
A Comparative Study on Microgap of Premade Abutments and Abutments Cast in Base Metal Alloys
Topical Simvastatin Improves the Pro-Angiogenic and Pro-Osteogenic Properties of Bioglass Putty in the Rat Calvaria Critical-Size Model
Assessment of the Correlation Between Insertion Torque and Resonance Frequency Analysis of Implants Placed in Bone Tissue of Different Densities
Benefits of Rehabilitation With Implants in Masticatory Function: Is Patient Perception of Change in Accordance With the Real Improvement?
A Method for Fabrication of Implant-Supported Fixed Partial Dentures
Safe Sinus Lift: Use of Acrylic Stone Trimmer to Avoid Sinus Lining Perforation
The Effects of Sinus Membrane Pathology on Bone Augmentation and Procedural Outcome Using Minimal Invasive Antral Membrane Balloon Elevation
Cellular Responses to Metal Ions Released From Implants
A Two-Stage Surgical Approach to the Treatment of Severe Peri-Implant Defect: A 30-Month Clinical Follow-Up Report
Eight-Year Follow-Up of a Fixed-Detachable Maxillary Prosthesis Utilizing an Attachment System: Clinical Protocol for Individuals With Skeletal Class III Malocclusions
Active Implant Peri-Apical Lesion: A Case Report Treated Via Guided Bone Regeneration With a 5-year Clinical and Radiographic Follow-up
Flapless Implant Placement: A Case Report
Active Implant Periapical Lesions Leading to Implant Failure: Two Case Reports
A Review of Platelet Derived Growth Factor Playing Pivotal Role in Bone Regeneration
LETTER TO THE EDITOR
REVIEW OF CURRENT LITERATURE

Journal of Oral Implantology June 2014