A maxillary sinus floor augmentation procedure (sometimes known informally as a sinus-lift or sinus procedure) is a surgical procedure performed by an appropriately trained dentist or dental specialist, to augment bone mass in the top jaw (maxilla), which increases the likelihood of successful placement of dental implants. Bone from another part of the body, such as the iliac crest, a human or animal donor (from an accredited tissue bank), or artificial bone grafting material is grafted into the bone (endosseous) above the floor of the maxillary sinus. In the upper jaw the amount of bone is reduced by the presence of the sinus.
A sinus lift is done when there is not enough bone in the upper jaw, or the sinuses are too close to the jaw, for dental implants to be placed. There are several reasons for this:
* Many people who have lost teeth in their upper jaw — particularly the back teeth, or molars — do not have enough bone for implants to be placed. Because of the anatomy of the skull, the back of the upper jaw has less bone than the lower jaw.
* Bone may have been lost because of periodontal (gum) disease.
* Tooth loss may have led to a loss of bone as well. Once teeth are gone, bone begins to be resorbed (absorbed back into the body). If teeth have been missing for a long time, there often is not enough bone left to place implants.
* The maxillary sinus may be too close to the upper jaw for implants to be placed. The shape and the size of this sinus varies from person to person. The sinus also can get larger as you age.
Sinus lifts have become common during the last 15 years as more people get dental implants to replace missing teeth.
CLINICAL CASE
Surgeon: Dr Vo Van Nhan
Patient: a 50 years old man patient, healthy was in good and non-smoker. The missing teeth on upper jaw had been absent for 10 years therefore the bone resorption became serious. After a consultation on treatment options, the patient requested an implant-retained fix restorative solution within 6 months because he had to return to his country as soon as possible.
Taking an exmination
Because he had been missing teeth for a long time, jaw bone was lost therefore we had to perform sinus lift and bone graft before implant placement.
| You can observe position of missing teeth and infection teeth next to space |
To evaluate retain high bone, we took x ray and according to the result we made a suitable treatment plan.
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| According to the x ray, we can obsreve missing teeth and loss of bone |
Two phrases of treatment was planned:
- First: we extracted some infection teeth and treated infection carefully because it was a risk factor which caused implant complication. After extraction 5 days, sinus lifts, augmentation and implant placement were performed at the same time.
- Second: 6 months later, restoration with all ceramic bridge on the implants was performed
TREATMENT PROCEDURE
Extraction and infection treatment
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We treated infection with antibiotic before im
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plant placement to prevent failure implant
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After that, it is important that we take CT scan to determine retain high bone and position of implant placement. If we hadn't known this information, we woudn't have chosen suitable implant to be successful result.
According to x ray, the sinus was extended more widely and retain high bone (RHB) was very thin that's why we had to sinus lift and augmentation before implant placement.
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| RHB of tooth14 |
RHB of tooth15 |
RHB of tooth17 |
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| RHB of tooth 24 |
RHB of tooth26 |
RHB of tooth 27 |
This was a difficult case because RBH of those teeth were very thin and it was a challenge for surgeon to have a successful implant procedure.
Augmentation and implant placement
We used external sinus lift technology for bone grafting and implant placement. In this case, a small lateral window to the maxillary sinus is created. The bone substitute material is inserted through this window. A reconditioning of the bone substitute material with autologous body cells or growth factors is not necessary.
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| The right maxillary sinus windows |
The left maxillary sinus windows |
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| Removing the right maxillary sinus windows |
Removing the left maxillary sinus windows |
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| Augmentation and implant placement |
Augmentation and implant placement |
| Using resorable membrance helped the bone substitute material stabilize and the healing wound period be faster. |
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| The incision was stitched closed |
The healing wound after 1 week |
It was necessary that we take an x ray to check implants immediately after surgery to make sure they were in right position.
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| Checking positon of implant by x ray |
Restoration
After surgery 6 months, patient came back to our clinic to have final restoration with all ceramic bridges.
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After 6 months the wound healed completely, at that time, there was no comlication had reported by patient
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After we had checked the healing wound, an incison was performed to expose implants so that we could repair restoration. Next, the healing cap were placed and the tissue was colsed with a suture to create natural tissue.
After that, we took the copy impression and then gave it to the technicians in the laboratory. They made restoration which were both beautiful and correct in every detail by using CAD/CAM system. And finally, after we had tried the all ceramic frames and took x ray to make sure everything was correct, the restoration were fixed with abutment which connected implant and restoration.
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| According these picture, we could |
observe that implants were well integrated |
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| The healing cap were placed and the tissue was colsed with a suture to create natural tissue |
| Although the frames were made by CAD/CAM system, we wanted to check a tight frame again by taking an x ray |
To Be Continued
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