Sinus augmentation by crestal approach with the Sinus Physiolift device

_Since its introduction, sinus floor augmentation has generated great interest in the international scientific community and been subject to many changes in procedure. The first documented maxillary sinus augmentations using bone grafts date back to the work of Philip J. Boyne in the 1960s.1 An access osteotomy to elevate the sinus membrane can be performed by a vestibular or a crestal approach. The main advantage of the crestal approach is that it is less invasive than the vestibular one, which, while it gives the surgeon a view of the site, creates patient discomfort. A minimally invasive crestal surgical approach was proposed by Tatum in 19862 and subsequently refined by Summers in 1994.3,4 The approach theoretically described by Summers can be successful if the residual bone height is at least 5.6 mm. Depending on whether the bone material resulting from the osteotomy or other graft materials are used, we get the OSFE technique (osteotome sinus floor elevation) or the BAOSFE technique (boneadded osteotome sinus floor elevation). If the ridge is lower than 5.6 mm and cannot offer primary stability, an implant placement procedure is required that takes longer than the sinus lift procedure.5 In the delayed approach, an osteotomy to the sinus floor is performed using a 5-mm trephine drill. Following that, the bone cylinder obtained by the trephine drill is pushed forward using a No. 5 osteotome with a concave tip. As a result, the Schneiderian membrane is lifted by the cylinder. Under no circumstances must the osteotome penetrate the sinus. As early as 1985, Muller et al. suggested avoiding such instruments if the force required was greater than 20 MPa, so as not to cause tissue damage from excessive compression.6 In 2001, Fugazzotto developed a modification of this method for situations where a molar extraction was performed that included the interradicular septum and at least 50 percent of the postextractive alveoli in the cylinder to be elevated.7 The crestal bone defect is then filled with bone substitute in the stages before healing. The delayed approach forces the patient to undergo at least two surgical procedures. The insertion of the implant, by contrast, may be performed concurrently with a crestal sinus lift if primary stability can be guaranteed. Summers described this technique in 1995. Using an appropriate range of osteotomes (whose tip must never enter the sinus), he managed to lift the membrane by pushing the collected bone towards the apex to allow enough room for the fixture. A modification of the Summers method is to use osteotomes of ascending length with crestal stops. They are alternatively concave and convex as their size increases (Malchiodi 2003). This approach ensures a Sinus augmentation by crestal approach with the Sinus Physiolift device