Anklyos Implants: Can I Use them For This Patient that Needs Bilateral Sinus Lifts?

Hi, what is the final prosthesis? Is there enough height below the floor of the nose for some 11mm implants. I looks like you may be able to fit some short fat ones (4-5mm by 8mm) in the premolar regions. Therefore you have alot of prosthodontic choices. To answer your question using a tapered implant like astra tx or nobel replace select with prevent loosing it into the sinus due to there self tapping nature. Regards.

What is final prosthesis? Fixed or fixed removable? May want to consider ct scan to know more of what you are working with in the sinus region.

Bicon has healing temp abutments designed to limit sinus "ingress". The finned design can integrate in a stale clot, not requiring intimate boney contact. The two sinus abutment sizes are readily available, overnite, in the USA and frequently used. Check out their webcast library for sinus lift procedures.

Dear Dr. G. May I recomend a different brand?, There is an Israelly company called Cortex (www.cortex-dental.com) and they have a wonderful implant called Saturn that is designed for this cases exactly.Its a very simple system and extremely funtional, I hope it helped.

Dr G. It better in this case to avoid migration of implants , use two stage surgery. First do sinus lift bone graft after 5 to 6 mon. place ankylosis implants. Good luck to you Dr. Vaziri from Iran

Dear Dr.Berg, I have been following your posts for years now and they have been very knowledgeable and profound so far. It highly surprises me to read something like that from you. There is no clinical research about Cortex implants especially Saturn which their latest addition. Everyone in the implant world I spoke to is actually very sceptical about the massive top thread which seems to be a perfect bacterial trap. I personally think it is irresponsible to recommend something like this to a colleague . Regards

Thank you all for your comments. Please let me add some more information. - I'm still waiting for the CBCT (I don't have one in office). - My first choice is a fixed removable prosthesis, even though I haven't discussed with the patient every option in detail. I know some would anchor it in the premaxillary region, even tilting distal implants, but I feel much more comfortable using 6-8 implants and grafting the both sinuses. - I heard about the Bicom abutments John Manuel DDS writes about. That's why I was thinking about this 6 mm wide cover screw for Ankylos. I know sometimes is better to use a different implant system. That's what I'll probably do, using XiVE. Anyway, I'm still curious if anybody has tried to solve cases like this with Ankylos (with simultaneous sinus lifts). Thanks

Hi Dr.G I would not attempt this without a CBCT. Also, a two stage procedure will allow you to evaluate bone density & maturity prior to implant placement. I did a sinus lift with DFDB and BMP-2 waited six months, then placed my implants. One of the BSB implants was a spinner. This allowed me to replace it with a larger diameter implant, attain excellent stability, and recommend waiting another six months before stage two. This worked nicely on a compliant 55 y.o. male patient.

I have placed Ankylos combined with sinus elevations. Ankylos has strong connection with a great track record. The threads are not as agreesive as Xive though, but it works for me. Depending on the height and quality of the available bone you may want to slightly under prepare with your last osteotomy drill. I do it by just slightly introducing the conical reamer into the osteotomy (NOT FULL LENGHT). Also to prevent the implant from backing out when removing the implant fixture, you may want to hold it steady with the tool provided or a hemostat while you are unscrewing. Best Regards,

I do a vertical lift in on the crest and sinus floor to achieve excellent stability. followed by bio oss mixed with autogenous bone protected by a membrane- osseoguard tacked with pins and a membrane screw on the crest,

Dear Dr.G what is your final prosthetic design. If you are planning a fixed prosthesis ı recommend you to use the anterior and premolar region for implant placement. Six to eight implants with short cantilevers will be succesfull in this case. At the posteior regions do not hesitate to use short implants (8-9 mm) with osteotome sinus floor elevation technique. if you are planning a bilateral sinus floor elevation procedure ı recommend you to use the staged approach. Implant placement should be made after 4 to 5 months of healing. I highly recommend you to use autogenous particulate or block bone grafting. Ankyloss implant system is very succesfull in maintaining crestal bone and it has a high primery stability compared to other systems. but if you look very closely to the implant you will notice that the threads are at the apical region. At the crestal area there are no threads so if your bone volume is limited to 2 or 3 mm the primary stability will be very poor. In this situation the one stage operation will result poor implant insertion torque and implant failure.

Dr G The question here is not the type of implant to be used but two other issues: 1) Acheiving primary implant stability- that can be acheived using tapered implants . 2) Avoiding a full denture. If you can not acheive one of the two go for a two step procedure. Good luck

Without knowing the amount of bone that is available between the crest and the floor of the sinus, it would be difficult for any one to give you any worthy advice. I believe the cbct in this case , is "standard of care". This is one of the more demanding implant cases!! Bv

Dr. Leo, with all due respect, if we are waiting on clinical trials to dictate some of the things we do, our profession would go no where . I have no intention of using the Saturn implant, but the suggestion is not inappropriate . I was the first omfs to use BMP ( according to Medtronics ) several years ago, on a surgeon for a continuity defect and this still considered " off label ". Sometimes our good judgement, acumen and persistence outweighs all genius, FDA approval or clinical trials. Bv

Dr.G. I would not even think about doing one step surgery. Lateral sinus lift,wait 6 months and put the implants then. Why not Ankylos?

Recently we have had good success using Bicon short implants(5,5.7 and 6mm) with a "Fixed on 4" technique...in my practice we try to do internal sinus lifts were possible and the short implants help with this... we place 4 implants..and the patient wears their existing denture...after a healing period of about 3 months ...and implants are uncovered...and impressions taken...a cast framework is made using thin metal and then..bites are registered...the porcelain or IPS e.Max is placed for the teeth...sometimes gingival (pink) material is used to avoid a longer then wanted tooth...this technique has allowed us to give the patient a fixed case and not an o-ring overdenture...which they certainly appreciate...we have run into only minor problems so far and are cementing these with IRM temporary cement for 3-4 months then removing to evaluate the tissues.