Complications with transcrestal sinus floor elevation: etiology, prevention, and treatment

The combination of postextraction ridge resorption [1] and pneumatization of the maxillary sinus [2, 3] often limits the bone available for implant placement in the posterior maxilla. Fortunately, the lateral and transcrestal approaches to sinus floor elevation (SFE) and augmentation can reproduce adequate subantral bone volumes for implant-supported rehabilitation in this region. The lateral window osteotomy (LWO) is the most frequently invoked method, providing ready access to the sinus, significant elevation of the floor, and creation of sufficient bone volume to provide long-term support for implants in the posterior maxilla [4–11]. However, this technique can be quite aggressive and often patients would prefer an option that stresses a less invasive (LI) approach. The LI transcrestal approach for SFE was first suggested by Tatum [12] and later developed as an osteotome technique by Summers [13, 14]. Summers’ boneadded osteotome sinus floor elevation (BAOSFE) procedure uses tapered concave-tipped osteotomes to reposition existing crestal bone under the sinus along with graft materials, elevating the sinus floor and increasing osseous support for the simultaneously placed implant [14] (Figs. 20.1 and 20.2). BAOSFE was recommended for patients with at least 5.0–6.0 mm of residual subantral bone height (RSBH). A number of case series reports [15–21] attest to the success of this procedure, furthering its popularity amongst clinicians. It was originally suggested that grafting material be used in combination with osteotome-mediated sinus floor elevation (OMSFE) to facilitate the postulated