Hydraulic Sinus Condensing Technique

For a good discussion on this technique, see J Periodontol. 2005 Mar;76(3):482-91. * Chen L, * Cha J: An 8-year retrospective study: 1,100 patients receiving 1,557 implants using the minimally invasive hydraulic sinus condensing technique. The Conclusion: "Our experience suggests that hydraulic sinus condensing is a predictable and minimally invasive alternative for prosthetic rehabilitation of maxillary anterior and posterior regions in the presence of anatomical restrictions to implant placement."

In what situations is this technique advised? This is a technique that is put forth by the group in Vegas, Chen and Cha. What situations is it advised? Obviously any time there is a low sinus. I don't mean to sound flip, but it is another technique, just like a those put forth by Sommers, Lazzara, Fugozotto and others. You have to buy a ballon and other stuff, but this technique is a variation on a theme. There is no bone graft that is specific to this procedure. As for a Magic Mix that grows bone in the sinus, most specialists will rely on the literature. There are disciples of every type of graft. People swear by Bio-Oss, TCP, Puros, Autogenous etc. Bottom line is that 100% Bone replacement grafts work the best. I am not sure I would put Emdogain up into the sinus. A friend tried it and 6 months later had to go scoop goop out of the sinus. Good Luck

Dear Dr. A, I am VERY familiar with the work of Drs. Chen and Cha. In general, I use the Piezosurgery device with the implant osteotomy tip to the base of the sinus floor. Then I go with a 3 or 4mm round end diamond tip for the same instrument to dissolve the cortical bone left between the osteotomy and the schneiderian membrane. In that way, there is no chance of perforation and you are using sterile irrigant for the hydraulic portion. Then I pack the graft with my Ace concave (single or double cutting tip) osteotomes. As far as graft material goes, the histologic evidence with BioOss shows only 12% vital bone in sinus grafts at the time implants are placed. Also, there is not histologic evidence of the material resorbing past 6 months in situ. As a graft "cocktail", I mix DFDBA and Calcium Sulfate (a la Sottosanti and Anson and others) with 50% pure phase Beta-TCP. The TCP will fully convert to bone in 6 - 12 months and the DFDBA/CS in about 6 months.

Re. JW's comment, "You have to buy a ballon and other stuff....", no ballon is required using the hydraulic condensing technique. You may be thinking of the technique built upon by Dennis Smiler, et. al., but not "invented" by him.

The resaon why you have not nice bone quality with Bio Oss is your surgical technique. In order to succeed with this material it is very important to manage the best Bio Oss to surrounding bone contact and also the adequate graft stability and this depends on your skill and surgical technique

Considering grafting material used for Sinus Augmentation please go over our article published at the IJOMI showing 9 year retrospective study on 731 sinuses augmented with different grafting materials showing NO clinical difference among them.As regarding histological finding I totally agree with Dr Horowitz-Xenograft materials like ABBM do not remodel and will not have a high count of vital bone therefore I would prefer Allograft or TCP mixed with autogenous scraped bone.

This is an old technique first popularized in 1994 by Summers. This is not new and has various modifications that have been described by Chen and others. Chen has a course in Vegas based upon the Summers technique and calls it the “pneumatic sinus lift.” Google “Summer Sinus Elevation” and check the literature. There are very nice descriptions of the original work in Compendium. Always check the literature if you have questions about a technique. The answers are published in peer reviewed literature. Remember anecedotal responses and weekend courses can be misleading.

At NYU we differnet faculties mostly use PUROSS and BI0-OSS with great success,but Dr. Horowitz uses REGENOFORM with CALCIUM SULPHATE and TCP and have great results too, particularly with ridge augmentation. He is one of the most SOUGHT AFTER faculty, when it comes to GBR. We use summer's technique of osteotomes all the time with great results.If you use care and tactile sense to fracture floor. remaining part is easy.

I agree with the use of regenoform and calcium sulphate. Regenoform is an awesome material for GBR and is slowly replacing block grafting in my practice. I am a little wary of Cerasorb (TCP). We had an incident at our school that caused us to shy away. We did an open sinus lift with cerasorb mixed with blood by company direction (in defense of cerasorb they changed the shape since we used it). It was like placing bee bees in the sinus. The lift couldnt have gone more perfect, we placed the cersorb and covered it with a membrane. At 1 week POT we noticed cerasorb granule working there way out and eventually abscess. We tried to milk it along but eventually went back in and clean it out of the sinus. Most of the particules were fiber encapsulated which if you read past literature on TCP that what it basically does. Not sure I agree with Dr Horowitz that it becomes bone in 6 months. However maybe his cocktail of calcium sulfate and regenoform does the trick. BTW Dr Horowitz spoke at our school a couple a years ago and I was quite impressed.

Perioplasticsurgeon, I've had trouble handling the R-form. It never seems soft enough after the water bath. I've thought about using it in place of block grafts, since it is quite solid. Is it solid enough to use screws or can you keep it in place with a resorbable membrane (which one?) and still get a predictable result? Thanks.

Re: Robert Emery's Comment.. "This is an old technique first popularized in 1994 by Summers. This is not new and has various modifications that have been described by Chen and others. Chen has a course in Vegas based upon the Summers technique and calls it the “pneumatic sinus lift.”" I was just looking on Dr. Chen's website. On his forum he actually addresses this exact notion. He explains several reasons why his technique is different than Summer's technique. One of the ones that I found particularly interesting was that he doesn't fracture the crestal bone, but instead he drills into it in order to reach the sinus. All in all I thought it was a very interesting and informative article. I notice the rules here state that outside links are not permitted, but if you go to Dr. Chen's forum, under all other topics, it is pretty easy to find, and well worth the read for people trying to sort out what is different about all of these methods.

Hello All In the Hydraulic technique of Dr.Chen, how does one know when to stop with the final round bur prior to the sinus floor....since that is the most critical step. Does one keep taking radiographs each mm or so? Thanks for comments.

Check out the HPISE (hydrodynamic piezo internal sinus elevation) technique. Dr. Sohn invented a piezo tip that cuts and allows water to pass through it simultaneously.