A simplified approach to the minimally invasive antral membrane elevation technique utilizing a viscoelastic medium for hydraulic sinus floor elevation

PURPOSE

Maxillary sinus augmentation surgery is frequently employed to provide adequate vertical bony dimensions in posterior maxillary sites. When significant gain in bone height is sought for, an invasive lateral-window approach is routinely used to achieve sinus floor elevation. The minimally invasive antral membrane elevation technique was initially conceived as a surgical improvisation that has been shown to lead to up to, or exceeding, 10 mm of bone height, while enhancing the safety profile of the transalveolar sinus augmentation technique. This approach is based on the use of hydraulic pressure that is applied to the schneiderian membrane via a saline-inflatable balloon. Even though this technique has been shown to be a safe and efficacious treatment modality, the need for specialized equipment, training, and corresponding costs may hinder its widespread application. The purpose of this clinical paper is to introduce a simplified approach to the minimally invasive antral membrane elevation technique.

METHODS

The simplified minimally invasive antral membrane elevation technique is based on the application of hydraulic pressure by a viscous bone graft that acts as an incompressible fluid. The specific clinical steps of this technique will be demonstrated to illustrate how grafting of the maxillary sinus is achieved simultaneously with the atraumatic elevation of the schneiderian membrane, thus resulting in even less operative time.

CONCLUSIONS

This simplified technique may make the minimally invasive antral membrane elevation technique more accessible to implant surgeons as it eliminates the need for purchase of specialized equipment and aids in further decrease of intra-operative time accomplished with the original technique.

A clinical and radiographic case series of implants placed with the simplified minimally invasive antral membrane elevation technique in the posterior maxilla

The aim of the present case series was to evaluate a simplified minimally invasive transalveolar sinus elevation technique utilizing calcium phosphosilicate (CPS) putty for hydraulic sinus membrane elevation. The simplified minimally invasive antral membrane elevation technique is based on the application of hydraulic pressure via a viscous bone graft that acts as an incompressible fluid. In this retrospective study, 21 patients (mean age: 48.5 ± 12 years) consecutively treated with the simplified minimally invasive transalveolar sinus elevation technique were evaluated. 28 tapered implants were placed in posterior maxillary sites with less than 6 mm of residual bone height as determined radiographically on cone beam volumetric tomographs. No sinus membrane perforations were noted and none of the patients complained of symptoms of sinusitis post-operatively (0%). The mean gain in bone height post-operatively was 10.31 ± 2.46 mm (p < 0.001). All implants successfully integrated (100% success rate) and were loaded with cement-retained prostheses. The proposed technique is a simple, efficacious, minimally invasive approach for sinus elevation that can be recommended for sites with at least 3 mm of residual height.