Dr. V, a prosthodontist asks:
I have a patient for whom I have treatment planned implants in his maxillary posterior. The problem is a pneumaticized maxillary sinus leaving only about 5-6mm of bone between the alveolar crest and floor of the sinus. What I would like to do is to avoid surgery of the maxillary sinus. Endodopore [Innova] has a 4.8x5mm implant with a highly porous surface that I supposed to encourage bony in-growth and osseointegration. I would like to find out from experienced users about using this implant for this purpose. Have any of you used the Endopore implant for this kind of situation to avoid maxillary sinus surgery?
Can Certain Dental Implants Help Me Avoid Maxillary Sinus Surgery?
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Sure you can use a ultra short 5mm implant for this case… infact that was the purpose they were made for !!
Personally i use Bicon short implants, and i dont find any difference in success of short vs long implants.
If you have enough width of bone – Bicon works well and their Integrated Abutment Crowns are proabably the most user friendly and fail safe restorative system out there.
Concider using the STR from Pacific Implant.
I agree with a couple of the posters…go with Bicon!!!
Go to their web site and they have videos you can watch; also you might even want to do an “internal sinus lift” using their technique if need be.
Bill I.
I used the full line of Endopore implants (external & internal attachment/ 5.0, 4.1, 3.5mm in various lengths) for eight years. I discontinued using that system five years ago for several reasons:1) The beaded surface is a plaque magnet which must be removed with diamond burs if exposure occurs(difficult, unpredictable process/no guarantees).
2) I and other implantologists have experienced late term implant failure (delamination of sintered titanium beads from the implant body)4-5 years after successful function. 3) Sybron purchased Innova Corp. with the resulting customer service degradation.
I would not hesitate at all to use the ” Summers” or bump technique and place a 10mm inplant. This only works if you have at least 5mm of bone which seems to be the case. I’ve done this very successfully without periotomes and using a much gentler process to lift the membrane using the expanders from Meisinger .( Salvin sells them. By expanding and condensing at the same time , you are also transforming a probable type IV bone to a type II . I’ve done this with and without using graft material. Bone will form in both cases in the sinus space within 6 months. Good luck.
Eric
Endopore implants are my choice for this kind of situations and have been for the last 9 years with great success, a 5×5 is a great choice to replace a mollar. Have a 98% rate at 9 years, using 4.1×7 and 5×5, but this implant requires a very strict surgical protocol and demands the correct undisturbed healing time. If you are a good and strict prosthodontist you shouldnt have problems.
I added the Endopore as a niche implant approximately 15 months ago. The long term published data is impressive 96% success with long term multi-center studies. I have used mostly the 4.1 x 7mm implants. Deporter one of the originators uses these almost exclusively. The majority I have placed in the posterior maxillary ridge area for folks utilizing the internal sinus lifts. The protocol must be religious followed, and deviation will lead to failure. I have had one failure of twenty placement so far. There is a learning curve and they are less forgiving than screw shaped implants.
I have used BCS (Bicortical Screw) and BOI (Basal Osseo-Integration) implants manufactured by Dr.Ihde Dental to avoid sinus lifts. The BCS implants can be used as “Tubero-Pterygoid Screws” – they go engage the maxillary tuberosity & /or the pterygoid bone which gives excellent support. Two BCS implants – one ahead of the sinus and one behind the sinus region, in the tuberosity area will certainly help solve problem in such cases.
The BOI implants can be placed trans-antrally and give excellent results.
The use of short implants can be an excellent option for reconstructive techniques. I have experienced a success rate exceeding 98.5% with Nobel Biocare Shorty Speedy implants, both in mandible and maxilla. It is crucial to choose an implant system that has reliability. Success!
The other option is to drill straight through, place an 8 mm implant, and not worry about it. 5-6 mm (assuming types 1-3 bone) is more than enough to anchor an implant.
The sinus lining will reform over the implant, and eventually bone will creep up the sides of the portion that remains in the sinus, and all will be well.
I’ve done it this way for 14 years, and have not had a single infection. The only contraindication is a patient with active sinus infection.
I totally disagree with my other colleagues using short implants avoiding sinus augmentation.In my clinical experience i’ve encountered numerous cases where short implant failed especially in the posterior molar areas.There is a recent article published in 2009 showing the efficacy of closed elevation with 97% success if long implants were used while 65% with implants 6mm in length…
Why not do a lift?If you do not want to get into lateral window technique go for the minimally invasive crestal balloon elevation.
Well spoken!
Ziv…I agree as well…well said. A direct sinus lift is a predictable and highly successful method to gain bone in the posterior maxilla. Why compensate and compromise with placing a short implant, which can provide many more problems both short and long term. Remove the compensation and compromise by re-building what is ideal, and then place implants that are the ideal height (12-13mm in height) based on the research.
The question is…would you want such short implants in your own mouth, or would you want an implant that is 4×13 or 5×13???
If patient has a good bone density and sufficient bone width, short implants work for me. Otherwise, bonegraft is a must.
Dr. T
personally i use summers technique always even with a 2mm of bone, naturally i place in that case implants after 4-5 mounths.
If Summer’s technique used, why wait 5 months, may not be able to gain primary stability during insertion and then have to wait additional 5 months! If you didn’t tear sinus membrane during lift try to stabilise tapered implant neck in a cortical bone with some 25-30 Ncm. In that case you even don’t need a grafting material, since coagulum around the implant and lifted bone “cork” would form a new bone. Without two stage surgery you will be able to load the implant after 3-6 months depending on the hight of the residual bone
…for this modified technique with trephan burs and 4 mm concave osteotome I use Nobel Biocare Tapered Groovy 5.0/8 mm implant. The primary stability is achieved by underpreparation of the residual bone because of conical implant design and microthreads in the neck portion. Good luck!
Are the short implants made for dentists who are SCARED of the sinus lift procedures? I suppose yes is the answer. would appreciate the comments by the Big guys.
Would you like to use 8mm implant with a summers technique or lateral window approach to your mother? And re-operate after 9 months? And open again for gingival healing?
Its not that everyone is SCARED of sinus lift, BUT whether you require it or not….
Obviously for a patient with residual bone of less than 3mm, i would prefer a summers lift OR even less bone – a lateral lift, If you have 5-6mm of bone why not place a short implant….
And yes i would be comfortable doing the said procedure in my parents mouth or for that matter get it done on myself either if required.
I have cases with more than four year follow up, if interested mail me, i’ll share them with you.
A big issue is width of ridge as well , seen many shorts failing due to lack of width and exposed threads or fins in Bicon cases.
Lateral window safer and predicable and when using Dask even more so as well as fast and PAIN free , all our patients are of pain medication by the following day.
This is a no-brainer unfortunately and yes good for mother as you will see her again where failure is worse. whilst you do not need long implants the shortest we use is 10 mm , 15 years down the line possibly the best option.
Dask makes lateral windows a 5 minute procedure completely safely.
Thank you Dr. Narang for your comments.
what is the success rate for short implants? The four year follow up is for the sinus lift procedure or of the short implants? My apprehension is to use the short implants!
when there are possibilities to do a sinus lift ( I am in favor of sinus lift), why not do a sinus lift, grow some bone, increase the height of available bone and put a longer implant.
I believe one should not use short implants to avoid sinus lift. Correct me if i am wrong please.
In my hands Bicon short implants do very well, infact i dont find any difference in Bicon short / Bicon long implants.
Agreed if possible – do a lift BUT i think – if possible you avoid it also.
What would you do in lower jaw ? i dont think many people are comfortable doing lateralistion of the nerve, atleast i’m not…. there you have only one choice – Short Implants !!
Yes short implant may be one of the choices in mandibular division C-h type bone.
I still would prefer to go ahead with bone augmentation procedures and use a longer implant. As the literature says, several studies have shown a lower success rates as the implant height decreases.
…short implants is not the only choice we have.bone augmentation procedures can be carried out but requires greater skills.
The endopore implants work, the summers technique works, the lateral window works, although more time is required. The important details are in the clinicians expertise and the patient’s understanding of the risks.
I have placed the Endopore implants using the osteotome condensing tecnique, as well as the typical screw-type implants in posterior maxillary areas where 5-6mm of bone is present. Of great importance is the initial stability of these implants. By using the osteotomes to condense the bone, and keeping the osteotomy narrower than the suggested size, you can improve the stability. This is in my view one of the important determinants to implant success.
Anybody using Rescue implants?
Dr. Pace
I have been using the Rescue implant for past 4 years and it has been working great for me.
I posted my #14 rescue 6 by 10 case recently.
A direct sinus lift is a predictable and highly successful method to gain bone in the posterior maxilla. Why compensate and compromise with placing a short implant, which can provide many more problems both short and long term
At the Academy of Osseointegration meeting in San Diego, 2009, a Bicon presentation demonstrated that strtss on crown/implant systems occurs in the fiorst 6-8 mm of bone. Of course all presented photo-documentation showed success. That is not the issue. Short implants that are not placed sub-crestally risk the loss of the crestal bone (Bicon is placed sub-crestal with a mini bone graft over the top at time of placement). If a 5 mm implant loses 1 mm of bone, that implant has lost 20% of its support. At some point crown/implant ratios exceed 1:1 and architectural failure is a distinct probability. Just because in someones limited experience they have not seen this, it does not justify the risky engineering design.
dear Dr.
it is about 22 years that a special type of long fixtures(more than 45mm in lengh)are available in market which i,ve used some of them in past 20 years and all are porking properly now,these typ of fixtures pass thriugh sinus cavity and in fixed in suborbital zonr of zygoma,recently i,ve seen 2 defferent typs of thiese fixtures made by a company called dentoflex,in brazil,sugest to have a look in their documents and even if you like i can attach some of my records and X rays from my paitents,with a detailed instruction concerning how to use them.ragards