IMPLANT DENTISTRY / VOLUME 21, NUMBER 5 2012
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Sinus Bone Grafting Technique Using Special Reamers and Microelevators Young-Kyun Kim, DDS, PhD,* and Su-Gwan Kim, DDS, PhDâ€
inus bone grafting is a procedure that is commonly performed in maxillary molar areas with insufďŹ cient bone volume, and it shows good clinical outcomes. However, sinus membrane perforation is the most common complication during sinus bone grafting, and it may occur during the formation of the lateral window.1,2 Here, we introduce a special technique for performing successful sinus bone grafting that minimizes the risk of injuring the maxillary mucosa through the use of a special reamer and a microelevator.
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TECHNIQUE Sinus bone grafting using the sinus lateral approach (SLA) instrument (Neobiotech, Seoul, South Korea) was performed in a 62-year-old male patient. The right maxillary second molar was extracted, a ap was lifted, and the maxillary bone was exposed. Using a C-reamer (diameter, 6.5 mm and length, 3.0 mm), a lateral round window was formed in the ďŹ rst and second molar area, removed, and stored. The lateral window of the second premolar area was removed using the identical method. Nonetheless, the bone wall was thick, and thus, a bone window was formed by the *Associate Professor, Department of Oral and Maxillofacial Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea. †Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwang-Ju, South Korea.
Reprint requests and correspondence to: Su-Gwan Kim, DDS, PhD, Dept. of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, 375, SeoSuk Dong, Dong-Gu, Gwangju, South Korea 501-759, Phone: 82-62-220-3819, Fax: 82-62-228-7316, E-mail: sgckim@chosun.ac.kr ISSN 1056-6163/12/02105-387 Implant Dentistry Volume 21 Number 5 Copyright Š 2012 by Lippincott Williams & Wilkins DOI: 10.1097/ID.0b013e31826a56c3
When residual bone height is insufďŹ cient in the maxillary posterior area, the maxillary sinus elevation and implant placement with lateral approach are oftentimes used. However, the risk of sinus membrane perforation, or tearing, is high for this procedure. This
article introduces a technique that uses a special reamer and a microelevator to minimize sinus membrane injury. (Implant Dent 2012;21:387–389) Key Words: maxillary sinus elevation, microelevator, reamer, sinus membrane injury
additional use of the LS reamer. The sinus membrane was elevated through the use of a microelevator, bone graft materials were ďŹ lled, and the removed bone window was repositioned. During the procedure, perforation of the maxillary mucosa did not occur, and successful sinus bone grafting outcomes were obtained (Figs. 1–5).
membrane does not cause negative long-term effects on sinus bone grafts and dental implants. Regardless of the controversies in the potential effect of membrane perforation on postoperative complications and implant failure, this potential for an intraoperative complication absolutely increases the surgical difďŹ culty and lengthens surgical time. Therefore, it is preferable to prevent the occurrence of a membrane perforation.4 To minimize perforation during the generation of the lateral window, various techniques and instruments have been recently developed and applied frequently in clinical practice. Wallace et al9 have reported that the perforation rate with piezosurgery was lower than with traditional rotator instrumentation during the formation of the maxillary lateral window. Sohn et al10 have reported that a bony window osteotomy could be performed in 2 to 7 minutes through the use of erbium and a chromium:yttrium-scandiumgallium-garnet laser. Nonetheless, in cases with a thick lateral wall of the maxillary sinus, it may take too long to form a bony window using a laser, piezoelectric device, or the like. Herein, the SLA instrument was used to remove the bone wall safely
DISCUSSION The incidence of perforation of the maxillary mucosa has been reported with various rates ranging from 14% to 56%.1–3 The height of the residual bones, a large edentulous area, the septum, the thickness of the maxillary lateral wall, the thickness of the maxillary mucosa, the presence of cystic lesions in the maxillary sinus, and previous allergy involving the maxillary sinus have been reported as factors increasing the risk for perforation. In addition, sinus membrane injury occurs during the process of lateral window formation via the use of surgical burs and/or drills in many cases.2,4–6 It has been reported that perforation of the maxillary mucosa adversely affected the prognosis of sinus bone grafts and dental implants.3,7 However, Oh and Kraut8 suggested that perforation of the Schneiderian