Minimally invasive techniques
Other minimally invasive techniques for sinus augmentation have been introduced over the years. Modified trephine/osteotome technique was described in 1999 was modified by the simultaneous insertion of implants. The implant site is prepared using a 3 mm exterior diameter trephine bur at a distance of 1-2 mm from the sinus floor. Bone cylinder is then pushed apically to a depth of 1 mm less than the one made with the bur, using an osteotome of the same diameter as the trephine bur. The final preparation of the implant site is carried out using osteotomes of increasing diameters, always inserting them to the same depth. The implants are inserted at a speed of 30 rpm, causing controlled lateral movement of the bone cylinder inside the space created by the movement of the sinus membrane.[30]
Antral membrane balloon elevation procedure was given by Soltan et al. in 2012. This technique uses inflatable balloon to elevate the sinus membrane. The Zimmer sinus lift balloon was designed to lift the sinus membrane gently and evenly. This technique has been shown to reduce the chance of sinus membrane perforation.[31,32] There is a metal shaft with a tip connected to a latex balloon which has the inflation capacity of approximately 5 cm.[3] For lateral window approach, angled design of balloon and for a crestal approach, the straight design balloon is used. There is popular micro-mini design also available which can be used for either of the approaches. Before the balloon is inserted, the osteotomy is enlarged to 5 mm. Osteotome of 5 mm is used to break the sinus floor after the addition of bone. The sleeve of the balloon is then inserted 1 mm beyond the sinus floor. The saline is injected slowly from the syringe into the balloon so that the balloon would inflate progressively. The desired elevation is determined by deflating the balloon and the process is again repeated till the desired sinus elevation. One cubic centimeter of saline is expected to raise 6 mm of the membrane.[33]
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Minimally invasive transalveolar sinus approach (MITSA) elevation technique was given by Kher et al. 2014. In this procedure, calcium phosphosilicate putty is used for hydraulic sinus membrane elevation.[34] Drilling is done 1 mm short of the sinus floor and osteotomy completes till the last drill. Concave 3 mm osteotome is used to in-fracture sinus floor. Novabone gun cannula fits snugly in prepared osteotomy. The material gently lifts membrane due to its consistency. Thereafter, implant is placed. MITSA technique is minimally invasive as this technique uses osteotome only once so is less traumatic to the patient.
Minimally invasive transcrestal-guided sinus lift technique was given by Pozzi and Moy.[35] This is a new procedure with computer-guided planning and a guided surgical approach to elevate the maxillary sinus. The use of computer-aided design/computer-aided manufacturing generated surgical template in combination with expander-condensing osteotomes, make this surgical technique minimally invasive.
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