Indirect sinus lift: Opinions?

I use the Hi-Ossen Kit all the time, but I place a graft, and I don't try to elevate more than about 3-4mm. I would have placed a shorter implant with a graft or would have done a full sinus lift. If you do get bone around the portion of the implant in the sinus, it will likely be very thin and not aid in stabilizing the implant. It may work, but I'd be more conservative in the future with crestal lifts.

The placement looks very nice. The only suggestion I have is to not go so long and use an implant of larger diameter, perhaps 5mm to 6mm depending on the ridge width. You didn't give that information, so the ridge width may have driven your choice for a smaller diameter implant. No matter, the case will go well except for an open gingival embrasure on the mesial.

Hi. For more than 3 mm i would place a bone graft. Stretching the membrane by 6 mm is too much for me. I would have placed an 8 mm implant here. I am just an old school if u may say. What was your primary stability like? How did u test for perforation? Generally i wait 3-4 months before the second stage.

I would have done a direct sinus approach through the lateral wall with bone graft for this case for greatest predictability. Looks like you countersunk slightly which may have reduced the bone column holding your implant. The pan suggests there was more bone height toward the bicuspid which you may have taken advantage of with slight mesial movement and a bit of tipping. You could have confirmed this with a CBCT. I do not work in sinus areas without CBCT's. Please let us know how it turns out?

An indirect lift is only called for if you need 3mm or less of a lift. If more is needed, you should have gone green stick lift...not indirect. You possibly could have gone indirect if you had gone shorter

Hi Your placement is fine but, as aforementioned, no graft and fixture too long, there’s no real need for longer as wide and short is we’ll document to have similar results. Your main concern now should be the pt’s exessive tooth ware. They are possibly a bruxist or have a destructive occlusion. It’s unlikely to get any significant bone formation inside the sinus cavity and your fixture is integrated in only 3-4 mm of bone. Excessive occlusal forces can cause crestal bone loss, leading to even further loss of support and subsequent loosening of the fixture. If you, or better said the patient, is unlucky, this fixture can even end up inside the sinus cavity. In future , my humble opinion is to graft no matter what fixture size you use. I use cas kit also and always graft with it, never had a problem. Kind Regards ST

I agree that the implant size should have been shorter. A 4.5 by 7 mm implant would work fine and bicortical stabilization would make this a slam dunk. It id difficult to determine much about the implant's position from the PA provided. A properly angled vertical bite wing would best.

Research has shown that one gets bone growth upon lifting of the membrane without any graft material. Should bone growth occur to the level of the displaced membrane, then longer is better. The question that remains to be answered is how does a single implant displace the membrane. Since there is only one point of contact one can assume that the space under the membrane after being lifted by the implant is bell-shaped. That leads us to a conclusion that the new bone will duplicate the architecture of the space at best. Therefore the implant may have substantial bone encasement at the lower area and less at the apex of the implant. If the implant was shorter than the membrane displacement would be lesser and less new bone would form. We have to be aware that we practice based on evidence, not imagination.

Hi in this case I see only 2d RX. When I must work in the sinus area I think I need a 3d cbct. I need to verify the situation of the maxillary sinus and the cleaning of the sinus ostium, which are fundamental evaluations for any procedure involving the maxillary sinus. Working without cbct is like navigating in the fog. I can not comment on what I do not see

Hi, I think this will work totally fine. This case, with no membrane perforation, in essence you are "tenting" the sinus membrane up, creating a void which (in my experience) always fills in with bone nicely. In this case, I would not have personally placed a graft, as in my hands (given that there is no membrane perf), bone will fill in nicely. Take a PA in 3-4 months time, and you will see bone infill where you have "tented" the sinus membrane up.

I fully realize that this forum is mainly about dental implantology...however, viewing the panorex that you supplied, there are so many other dental issues that should have been attended to before the implant placement..... the suggestions above are worth considering before proceeding with your next crestal sinus procedure........ this forum is here for all of us to learn

Getting back to your Summer's Technique Sinus lift, It looks very well done. Years ago Ziv Mazor published a paper doing this type of procedure, but placed a PRF plug into the osteotomy as a cushion before screwing in the implant to protect the Schneiderian membrane...with no bone particulate, just as you have. I think you did an excellent job, with no membrane being torn, osteoblasts will fill the space and start to produce bone.