Hydraulic sinus lift technique : description of a clinical case

approach, for implant purposes, today are widely used in ambulatory clinical practice, for managing bone atrophy of the lateral– posterior sectors of the upper maxillary1–4. Their indication has progressively increased over the years also due to their lower morbidity compared with the techniques with a lateral approach5–7. The fracture or wear of the cortical sinus floor and the later displacement of the sinus membrane constitutes the crucial phases of all the crestal lifting techniques1,8 not supported by direct visual monitoring. Detachment of the Schneiderian membrane can be performed directly with manual instruments9 or indirectly through the graft material, most techniques use the latter1,10–12. The reason is found in the fact that the graft material is usually permeated with blood that, being a liquid, is not compressible. In 1994, Summers10 stated that the pressure, exercised by the compactors on the graft material mixed with the blood, forced the indirect hydraulic detachment of the maxillary sinus mucosa12. Conversely it should be noted that the force transmitted by the compactors on graft material is not easily controlled to the point of sometimes being detrimental to the integrity of the sinus membrane9. Some authors have recently proposed crestal lifting techniques that use hydraulic pressure for the displacement of the sinus membrane with alternative methodologies to those currently in use13,14. The proposed methods provide a preliminary detachment of the Schneiderian membrane through injection of a liquid followed by its spontaneous expulsion or aspiration, to then pass on at the insertion of the graft material in the sub-schneiderian space created this way. These methods, while effective, involve a prolongation of the operating procedure since it is conceptually simpler to use a graft material in a liquid state that when injected hydraulically raises the mucosa and fills the subschneiderian space at once. Furthermore, the method described above used conventional single-use syringes in which it is not possible to finely check on the progression of the piston since this is connected with individual sensitivity. Other authors also have proposed, in the past, direct injection of fluid graft materials in the sub-antral space but always through conventional singleuse syringes activated manually15. In 2010, Andreasi Bassi and Lopez16 proposed a new method that takes advantage of the hydraulic pressure exercised on a graft material of a pasty consistency to detach the antral mucosa and simultaneously fill the sub-antral space created this way. The authors called the technique Hydraulic Sinus Lift (HySiLift)16. The instruments made for this purpose consist of three components: a titanium syringe (Hydromab, FMD, Rome, Italy) ( Figure 1) equipped with a micrometric control piston on which it is possible to assemble single-use plastic syringes of various volumes, possibly equipped with a Luer-lock attachment; a dispenser in threaded surgical steel (ML Injector, FMD, Rome, Italy) available in two forms (conical and cylindrical) and four measurements (two cylindrical of ø 3.2 and 4.0 mm and two conical of ø 2.8–4.0 and 3.5–4.6 mm) and a needle in surgical steel, also equipped Abstract Introduction In this work the authors describe a new method, indicating in the maxillary sinus lifting through a crestal approach, characterised by the hydraulic detachment of the mucosa and simultaneous filling of the subschneiderian space, with a graft material of a pasty consistency. Case report In a 56-year-old non-smoking patient, edentulous in area 1.6 (Figure 2), presented to our observation for the need to reintegrate the missing element, we planned the implant placement and the later completion with an implantsupported metal-ceramic crown. The endoral x-ray exam of the edentulous site showed a reduced thickness of the residual bone which was confirmed by the Denta Scan CT exam (Figure 3.1); it was decided to make, along with the implant positioning, the maxillary sinus floor lifting, through the hydraulic sinus lift technique. Conclusion The hydraulic sinus lift technique allows the hydraulic detachment of the maxillary sinus mucosa and, at the same time, the filling of the subschneiderian space with the graft material.