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implants - international magazine of oral implantology

user report _ augmentation I Today, it is common knowledge that the long- term success of dental implants depends on the degree of osseointegration. This, in turn, is depend- ent on the primary stability, on the one hand, which isdeterminedbythedensityofcorticalboneandthe bone quality, and on the secondary stability, on the other hand. The latter results from the progressive deposition of bone along the implant surface. Although an implant that is inserted into bone with reduced height and width and that extends from one end into the sinus cavity shows a good primary stability with a sufficient solid cortex, its anchor remainslimited.Thus,osseointegrationoftheentire implant surface, which is critical to the long-term success, cannot be achieved. If a progressive loss of crestal bone takes place over time, the implant sta- bility is further affected. Therefore, in the posterolateral maxillary it is oftennecessarytoperformasinusflooraugmenta- tion if there is poor bone quality and insufficient alveolarprocessheight.Asinusflooraugmentation and significant pneumatisation of the maxillary sinus are indicated in order to be able to use suffi- ciently long implants to guarantee the anchor in a region of high functional load. In 1980, Boyne and James wrote the first pub- lication on the treatment of patients with end- osseous implants in combination with sinus floor elevation. Access to the maxillary sinus was by meansoftheintra-oralantrostomyandtheprepa- ration of a “bone window”. This was then carefully advanced into the cavity and drawed. Therefore, a partial detachment of the Schneiderian mem- brane from the sinus floor was needed. Subse- quently, a bone graft was placed under the mem- brane and the opening was obturated again. Gen- erally, the bone from the patients themselves was used as the graft. In a second step, several months afterthesinusfloorelevation,bladeimplantswere successfullyimplanted.Theprostheticreconstruc- tionsexistedinfixedorremovabledentures,which were placed in the edentulous sections of the pos- terior maxilla. Soon thereafter, Tatum etal. worked on this sur- gical technique intensively, seeking to improve the resultsbymeansofmodifiedprocedures.TatumSun took on a key role in the development of the proce- dure for sinus floor elevation using an autogenous bonegraftfromtheiliaccrestforthepreparationof the implant insertion (Tatum 1977, 1986). Progress in the field of biomaterials and refined techniques and protocols for the rehabilitation of tooth loss by osseointegrated implants have increased the success rate and the predictability of implant treat- ment. _Xenogeneic grafts Tosparepatientsanadditionalremovalofautol- ogous bone in other areas of the spine or of the iliac crest, bone substitute materials (xenogeneic grafts) are used increasingly today. Xenogeneic grafts are now mostly deproteinized (inorganic) bovine bone specimens. These grafts are used either alone or are mixed and used as part of a mixed transplant with Fig. 4_Extraction of the patient’s own (autologous) bone chips by Safescraper. Fig. 5_Careful dissection of the Schneiderian membrane by the use of a diamond bur. Fig. 6_Illustration of the intact Schneiderian membrane in region #16. Fig. 7_Carefully solution of the Schneiderian membrane from lateral to caudal. Fig. 8_Lifting and moving of the Schneiderian membrane. Fig. 9_Preparation of the implant cavity after pilot hole with bone- condensing instruments. I 37implants2_2011 Fig. 7 Fig. 8 Fig. 9 Fig. 4 Fig. 5 Fig. 6