Maxillary Sinus Lifts: Hydraulic Intracrestal Approach

Last Updated: Apr 13, 2015

This post is a continuation of the first post in the series Maxillary Sinus Lift techniques: Maxillary sinus lift surgical techniques: Hammerless intra-crestal approach

In 1994 Dr. Summers introduced the first intracrestal sinus lift as alternative to lateral window when 6-8mm of residual bone was found. Other techniques have followed: motorized, balloon, hammerless and a few more. Different implant companies have created crestal kits with different designs of safe-sinus drills and other gadgets to assist elevating the membrane.

Dr. Mongalo™s criteria for sinus lift techniques:
A) 1-3mm of residual bone: lateral window with bone augmentation. Implants placed 4-6 months later.

B) 4-7mm of bone height: intracrestal lift with simultaneous implant placement.

C) 8-11mm: implosion of the floor of the sinus without grafting and simultaneous implant placement.

Clinical Case
52 year old healthy Hispanic male desires to replace his ill-fitting RPD with a couple of fixed PFM bridges. Patient is missing the cuspids and premolars bilaterally, three out of six sites selected for implant placement have 5-7mm of residual bone height. Measure the lowest point from the alveolar crest to the floor of the sinus, subtract 1mm and drill the entire sequence, pilot to final, using safe-drills with pre-measured stoppers. Increase height of stoppers until the floor is pushed and the membrane is exposed. Add bone and condense several times until the dome shape is seen on the x-ray. Six taper implants were placed and allowed to integrate for 6 months. Care must be taken not to abuse this technique, the clinician must perform every step using gentle touch as to avoid membrane perforations.

![]DSC_0047](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2015/04/DSC_0047-e1428956937742.jpg)

![]DSC_0069](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2015/04/DSC_0069-e1428956947174.jpg)

![]DSC_0098](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2015/04/DSC_0098-e1428956956926.jpg)

![]DSC_0114](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2015/04/DSC_0114-e1428956966283.jpg)

![]DSC_0111](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2015/04/DSC_0111-e1428956976220.jpg)

Please share your comments and Thank you for reading,
Chairman and Clinical Director of Live Implant Training
Virgil Mongalo D.M.D.
www.liveimplants.com

3 Comments on Maxillary Sinus Lifts: Hydraulic Intracrestal Approach

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Eric Klein

04/14/2015

Looks good so far. What material are you using for the bone graft and how much do you put into the osteotomy without causing too much pressure and risking tearing the membrane when you place the implant? Thanks.

CRS

04/15/2015

What concerns me more is the width I would have grafted there also for a better long term result especially since ther are those large flaps already raised. Would like to see the opposing occlusion to see if the placements should be more buccal. I would have also cleaned off all the dried blood prior to taking a photo. However I do agree with the criteria for the technique. I like to replace what was lost, the buccal bone since the RPD has a buccal flange which did this. If this case were restored with an implant retained RPD then the thin buccal bone is okay, restoring with fixed crowns then pink porcelain may be needed. Since I don't know the restorative, my comments need to be taken with that in mind I just like a few mm of buccal plate around my implants, this could also be grafted in the palatal. I've seen cases like this resorb and have perio issues down the road. Very nice technique don't get me wrong however.

greg steiner

04/20/2015

The term hydraulic indicates that a fluid is used to lift the membrane. Isn't the granular graft material lifting the membrane mechanically? Greg Steiner Steiner Biotechnology

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