The document discusses the indirect sinus lift technique for implant placement in the posterior maxilla with limited bone height. It describes how the technique involves using osteotomes to elevate the sinus floor by at least 5-6 mm without membrane perforation. This creates space for grafting material and implant placement with high survival rates of 93.5-100%. The technique offers a minimally invasive alternative to the lateral window approach with advantages of avoiding membrane visualization and permitting treatment in a single stage.

1. Indirect sinus lift technique
PRESENTED BY:
DR.P.VENU SAMEERA, MDS,
ASSISTANT PROFESSOR,
DEPT OF OMFS,GDC VIJAYAWADA.

2. INTRODUCTION
• An important requirement for the correct placement of the implant is the
presence of an adequate quantity and quality of residual bone .
• In 1994 Summers introduced the sinus lift technique with the use of
osteotomes combined with graft material around the implant.
• This technique is a well-validated surgical option for situations with
limited residual bone height; ≥ to 5-6 mm .
• The survival rate of implants placed simultaneously with indirect sinus lift
with bone graft material ranges between 93.5% and 100% .

3. • In the beginning, the osteotome technique was used for congesting the relatively
soft bone tissue of the upper jaw primarily.
• This improved the primary stability of the implants - a guarantee for success.
Subsequently, using the elasticity of the bone ,Summers started FLOOR
DILATATION OF THE SINUS, thus increasing the length of his implants.
• The disadvantages of this technique are its limited indications - the height lack
of 1-2 mm and the absence of direct visual control of the state of the membrane.
• Summers developed his technique, using the fractured sinus floor as an
osteotome and putting the grafting material through the osteotome hole. Later,
Summers’ technique was modified and the original concave, cutting osteotomes
were replaced by convex and rounded ones .

5. This technique is normally performed when the sinus floor needs to be lifted less
than 4 mm. The osteotome technique is performed by flapping back gum tissue and
making a socket in the bone within 1–2 mm short of the sinus membrane.
The floor of the sinus is then lifted by tapping the sinus floor with the use
of osteotomes.

6. The modified
Summers’
osteotomes.

7. • Another technique with crestal access is the balloon sinuslift.
• This is an elegant minimum invasive technique, using an elastic catheter.
• Forcing saline in the catheter, we swell the balloon and push out the
membrane.
• Aside from its higher costs this technique is accessible and with
predictable results.

9. • Additional advantage of this method is that we know in advance the free
space volume and the graft material volume we need.

10. RAISING THE FLOOR OF THE SINUS DURING EXTRACTION is a two-stage
technique.
It’s borrowed from classic Summers’ technique, but it has limited
indications.
Raising the floor of the sinus through fracturing the interroot septum of
upper molar after its extraction is possible, but relatively risky technique.

11. THE HYDROPNEUMATIC SINUSLIFT IS A CRESTAL ACCESS TECHNIQUE, introduced in 2008
by Troedhan, A. Kurrek, M. Wainwright.
The essence of this technique is that after the osteotomy with the pilot bur, reaching 2 mm
from the sinus cavity, the hole is expanded to the sinus floor using calibrated diamond tips.

12. Then, using a tip, called “Trumpet” , with a diameter equal to the diameter of the last instrument that
expands the hole,
a cooling solution is inserted from the piezosurgery unit and its hydrodynamic pressure pushes out the
Schneider membrane.
The grafting material is placed in the free space through the osteotome hole with the help of the
“trumpet” and then the implant.

13. Osteotome Sinus Floor Elevation Technique Without Grafting Material and Immediate
Implant Placement in Atrophic Posterior Maxilla: Report of 2 Cases Rabah Nedir, DMD,*
Nathalie Nurdin, PhD,† Serge Szmukler-Moncler, DDS, IEP, PhD,‡ and Mark Bischof, DMD§
• According to several authors, small quantity of grafting material mixed
with blood from the operative field is sufficient to maintain the required
volume.
• There are authors who do not recommend the placement of any such
material, relying entirely on the blood clot. The osteotome sinus floor
elevation procedure, although technically demanding with an RBH of less
than 5 mm, was minimally invasive.
• Because the Schneiderian membrane can support elevation in the sinus
cavity of 4 to 8 mm, the required elevation of the sinus floor could be
obtained.

14. Osteotome Sinus Floor Elevation Technique Without Grafting Material and Immediate Implant
Placement in Atrophic Posterior Maxilla: Report of 2 Cases Rabah Nedir, DMD,* Nathalie Nurdin,
PhD,† Serge Szmukler-Moncler, DDS, IEP, PhD,‡ and Mark Bischof, DMD§
• The osteotome sinus floor elevation procedure described by Summers
involves a grafting material that is condensed in the osteotomy site to
elevate the sinus membrane.
• If the Schneiderian membrane is perforated, the filling material can
migrate into the sinus and lead to inflammation.
• The present protocol, by avoiding use of a grafting material, has
completely eliminated this risk.
• With this technique, undetected perforations are likely to remain
uneventful because the membrane can reform around 4 mm of protruding
implants

15. • To enhance the primary stability in low-density bone, the use of
osteotomes is more relevant than the use of drills.
• By compression, the osteotomes can laterally condense bone and create a
denser interface at the placed implants,17 improving the initial boneto-
implant contact.

16. Indirect Sinus Lift in Immediate Placent of Implant - A Case Report VIJAY EBENEZER,
R.BALAKRISHNANand SENTHIL NATHAN
• Most of the surgeons rely on crestal approach , because the procedure is
invasive , atraumatic and less time consuming procedure ,
• here the alveolar bone that is present in between the sinus floor root apex
acts as the readymade graft and it tents the sinus floor so the enough
space is created in between the floor and the prepared site so that the root
form implants enters the sinus cavity behind the bone ,
• this procedure is widely practised and there is no much complications
post operatively

17. Indirect Sinus Lift in Immediate Placent of Implant - A Case Report VIJAY EBENEZER,
R.BALAKRISHNANand SENTHIL NATHAN
• ADVANTAGES: In the direct sinus lifting surgery piezo instrument is
used to create the window , whereas in crestal approach osteotome is
used to elevate the sinus floor the advantage of this procedure is
avoidance of the invasive surgery and permitting treatment with a single
stage,
• To achive excellent primary stability in the cases of sinus floor lifting
followed by immediate extraction cases use of osteotomes are more useful
than using the drills ,
• By compressing the sinus floor slightly by indirect approach with
osteotomes, can condense the bone laterally & dense interface is created
in between the sinus and the implant

18. CONCLUSION:
• lateral antrostomy allowed for a greater amount of bone augmentation to the
atrophic maxilla but required a larger surgical access. The crestal approach is
minimally invasive but permits only a limited amount of augmentation .
• Implant placement in in the posterior maxilla that are atrophied with less height
in between the sinus floor and the alveolar ridge can be greatly extended by the
indirect sinus lift procedure through the crestal osteotome approach as the
procedure is very easy and invasive and the time consumption is less and the
apical bone themselves acts as the bone graft and that tents the sinus lining and
crestal sufficient primary stability for the implant placement with less post-
operative complications.
• It also allows the treating the compromised posterior maxilla with reliable
results.

19. References:
• ALTERNATIVE SINUS LIFT TECHNIQUES Literature review Metodi
Abadzhiev Prosthodontic Department, Faculty of Dental Medicine, Medical
University – Varna
• Osteotome Sinus Floor Elevation Technique Without Grafting Material and
Immediate Implant Placement in Atrophic Posterior Maxilla: Report of 2
Cases Rabah Nedir, DMD,* Nathalie Nurdin, PhD,† Serge Szmukler-
Moncler, DDS, IEP, PhD,‡ and Mark Bischof, DMD§
• Indirect Sinus Lift in Immediate Placent of Implant - A Case Report VIJAY
EBENEZER, R.BALAKRISHNANand SENTHIL NATHAN