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    Piezo Hydrodynamic Internal Sinus Lift A Safe Step in Implant Surgery


    Emad Salloum - DDS, OMS

    Consultant Oral & Maxillofacial Surgeon
    Private Practice, Salloum Dental Clinic, Tartous – Syria | emad@salloumdental.net

     

     

    ABSTRACT
    As more and more Dental implants are now placed in posterior maxilla by general dentist, and as the patients and implantologists demands became more and more towards less invasive, less complicated and easier surgical procedures. The more this demand raised towards innovating new technologies development with new surgical techniques that fulfill those demands.


    Background and Aim: Sinus lifting via crestal approach by Summer’s technique (internal sinus lift) is a common and a non invasive procedure in implantology practice compared to sinus lift via external approach. However, patient discomfort, shocking feeling, positional Vertigo, membrane tearing, difficulty in graft packing, and the unsafe use of hammer and osteotomes are disadvantages and drawbacks of this technique.


    Materials & Methods: Piezo surgery opened a new era in implantology surgery practice as a safe and easy to use technology by means of respecting and protecting the soft tissues. Special modifications and improvement had been made on Dental piezo technology instrumentation with all its advantages to make it applicable on internal sinus lifting surgery.


    74 Seventy four documented sinus lifts cases done utilizing piezo hydrodynamic internal sinus technique via crestal approach in my private practice, using piezo Intralift kit by (Acteon – Sattelec) with 18 months follow up. All cases were grafted using BTCP (RTR – Septodont), 124 implants inserted in grafted sinuses using Xive implants (Dentsply). 61 cases with immediate implantation (96 implants), 13 cases with late implantation (28 implants), none of the cases had immediate loading or immediate temporization.

     


    KEYWORDS
    Piezo, Internal sinus lift.



    INTRODUCTION
    This article is a clinical study of a new innovative technique for a safer internal sinus lift surgery utilizing hydrodynamic piezo technology.

    Hydrodynamic sinus lift principle was first introduced & published by Leon Chen, using the hydraulic pressure of the saline introduced via the
    internal irrigation through the bur, to smoothly & atraumaticaly elevate the sinus membrane - Dr. Leon Chen: Journal of Advanced Periodontics, Volume 76 #3, 2004.

     

     

    Fig.1                                   Fig.2                                 Fig. 3                                 Fig.4

    Fig.5                                  Fig.6                                Fig.7                                  Fig.8

    Schematic drawing of piezo hydrodynamic Intralift technique

     

    PIEZO HYDRODYNAMIC INTRALIFT TECHNIQUE

     

    • Figure 1: Intralift kit
    • Figure 2: Cortical >3mm - Use a 2mm pilot drill of any implant system and drill down to 2mm of sinus floor
    • Figure 3: Pilot drill (TKW1): Ø 1.35mm, 90μm, Mode 1 80ml/min
    • Figure 4: Primary drilling/widening (TKW2): Ø 2.1mm, 90μm, Mode 1 80ml/min
    • Figure 5: Secondary drilling/widening (TKW4): Ø 2.80mm, 90μm, Mode 1 80ml/min
    • Figure 6: Microcavitation effect (TKW5): Internal irrigation, Mode 2-3, >40ml/min, >50ml/min, >60ml/min - Max 5 sec. at each stage
    • Figure 7: Packing of filling material (TKW5): Mode 4, 4ml/min - Max 3 sec.
    • Figure 8: Immediate* or delayed implant: * If only residual bone height is >3mm

     

    CASE REPORT
    A 40 years old male patient. Bilateral Hydrodynamic Intra lift with immediate implantation on the left side, Hydrodynamic Intra lift with delayed implantation on the right side. (Fig 9 - 18)

     

    (Fig. 9) Pre op panorex 2mm residual bone (left), >1mm (right)

     

    (Fig. 10) Piezo diamond tips in sequenced sizes prepares the osteotomy site and safely exposes the sinus floor without membrane injury

     

    (Fig. 11) Collagen plug inserted deep under the membrane through the osteotomy site

     

    (Fig. 12) Trumpet tip with special pumping frequency safely and easily elevates the sinus membrane

     

    (Fig. 13) BTCP graft material inserted through osteotomy sites

     

    (Fig. 14) Hydrodynamic trumpet tip facilitates easy graft material packing

     

    (Fig. 15) Xive implants are immediately inserted

     

    (Fig. 16) Pre op

     

     

    (Fig. 17) Immediate post op

     

    (Fig. 18) Eight months post op

     

     

    RESULTS
    Reviewing the data of 74 (seventy four) sinus lifts cases done utilizing piezo hydrodynamic internal sinus technique via crestal approach in my private practice, with 18 months follow up. Only one membrane perforation was noticed during surgery, 3 failed implants out of 124 placed implants, 7.5mm average (5 to 10mm) of extra bone height gain was achieved, 121 implants were loaded after 6-8 months with cemented crowns, no significant difference in final result between cases with immediate or delayed implantation, all patients were highly satisfied in term of post operative symptoms as well as final result.

     

    CONCLUSIONS
    Piezo Hydrodynamic sinus lift (Intralift) technique via crestal approach is an easy, fast, and reliable technique for internal sinus lift, with highest success rate, especially for non surgeons and in less experienced hands, it is a less invasive, a traumatic procedure that achieves more safety, easy graft packing, extra membrane protection, with less complications, less edema, less post operative pain, and more patient acceptance.


    REFERENCES
    1. Summers RB. A new concept in implant surgery: the osteotom technique - parts 1,2,3.
    2. Misch. Maxillary sinus augmentation for endosteal implants: organized alternative treatment plans. Int J Oral Implantol. 1987;4(2):49-58.
    3. Chen L, Cha J. An 8-year retrospective study: 1,100 patients receiving 1,557 implants using the minimally invasive hydraulic sinus condensing technique. J Periodontol. 2005;76(3):482-91.
    4. Dennis Flangan. Labyrinthine concussion and positional vertigo after osteotome site preparation. Implant Dent.