Safe, accurate, simplified sinus lift technique for general practitioners, Part 1: Crestal sinus approach innovation

This technique quickly became popular, known as the “Summers osteotomes intracrestal sinus lift” technique. In the next decade, many prominent clinicians, such as Jaime Lozada, Eduardo Anitua, Leon Chen and others have developed variations of the Summers crestal lift and proved scientifically the validity of this technique. As a result we can now perform a crestal lift using the balloon approach lift, drilling systems by various implant manufacturers and hydraulic sinus condensing technique.

The purpose of this article is to introduce an innovative sinus lift that can be mastered by the general practitioner in a safe, predictable and simple manner.

This technique utilizes a crestal sinus approach (CAS kit by Hiossen, Philadelphia) (Fig. 1). The specific indication for the CAS lift is when a patient has 4 mm to 7 mm of residual (Fig. 2). It is important to point out that patients with more atrophic ridges with 3 mm or less must be treated with a lateral window technique.

The CAS lift uses Dr. Anitua's biological drilling protocol of 50 RPM and special CAS drills designed to push (not cut) the sinus (Fig. 3). The initial drilling sequence is done 2 mm short of the sinus and verified radiographically.

The length of the CAS drill is increased until the cortex of the sinus floor is broken (Fig. 4). At this point, we stop drilling and use a 3 cc syringe filled with saline fluid, which is injected slowly over a period of three minutes; each cc of saline will elevate 1 mm of sinus membrane. The saline creates hydraulic internal pressure that causes the membrane to lift without the need of curettes, thus creating a safe, simple and accurate technique.

This technique has proven to reduce the percentage of sinus perforations. The objective is to safely lift 3 mm to 5 mm. Once this objective is accomplished, we pack the site with 0.5 cc of synthetic bone (Osteogen by Impladent). Figure 5 shows a lift on the site where the implant will be placed. Now we are able to place a taper 4 mm x 10 mm implant (Hiossen, USA) (Fig. 6). Most research studies have shown that elevating the membranes past the 10 mm mark increases the chances of sinus perforations.

A retrospective study is being performed by myself and Dr. Jae W. Chang, analyzing 250 intracrestal hydraulic lifts that were performed by general dentists from the United States in seven-day, intensive, live-surgical training.

The dentists learned innovative implant techniques while operating on patients under direct supervision of board certified oral and maxillofacial surgeons who are professors at Georgia Health Science University. The study's initial result are interesting in that we are seeing less than 5 percent of sinus lift perforations using this technique. Studies performed by University of Michigan and Loma Linda implant departments show 10 to 20 percent of perforations using other proven techniques.

Virgilio Mongalo, DMD, is a general practitioner in private practice exclusive to implant dentistry in South Florida since 1991. He is a pioneer in the field of implant education, introducing live surgical courses to U.S. dentists. He is an associate professor of implant surgeries at Georgia Health Science University, department of oral maxillofacial surgery. For more information on the Mongalo Implant Institute and live implant surgery courses, visit www.liveimplants.com.

Editorial note: This article was published in Dental Tribune U.S. Edition, Vol. 7 No. 11, November 2012 issue. Dr. Mongalo is developing a computer-guided hydraulic lift that will be the focus of Part 2 of this article.