Sinus floor elevation utilizing the transalveolar approach

Abstract

A transalveolar approach for sinus floor elevation with subsequent placement of dental implants was first suggested by Tatum in 1986. In 1994, Summers described a different transalveolar approach using a set of tapered osteotomes with increasing diameters. The transalveolar approach of sinus floor elevation, also referred to as 'osteotome sinus floor elevation', the 'Summers technique' or the 'Crestal approach', may be considered as being more conservative and less invasive than the conventional lateral window approach. This is reflected by the fact that more than nine out of 10 patients who experienced the surgical procedure would be willing to undergo it again. The main indication for transalveolar sinus floor elevation is reduced residual bone height, which does not allow standard implant placement. Contraindications for transalveolar sinus floor elevation may be intra-oral, local or medical. The surgical approach utilized over the last two decades is the technique described by Summers, with or without minor modifications. The surgical care after implant placement using the osteotome technique is similar to the surgical care after standard implant placement. The patients are usually advised to take antibiotic prophylaxis and to utilize antiseptic rinses. The main complications reported after performing a transalveolar sinus floor elevation were perforation of the Schneiderian membrane in 3.8% of patients and postoperative infections in 0.8% of patients. Other complications reported were postoperative hemorrhage, nasal bleeding, blocked nose, hematomas and benign paroxysmal positional vertigo. Whether it is necessary to use grafting material to maintain space for new bone formation after elevating the sinus membrane utilizing the osteotome technique is still controversial. Positive outcomes have been reported with and without using grafting material. A prospective study, evaluating both approaches, concluded that significantly more bone gain was seen when grafting material was used (4.1 mm mean bone gain compared with 1.7 mm when no grafting material was utilized). In a systematic review, including 19 studies reporting on 4388 implants inserted using the transalveolar sinus floor elevation technique, the 3-year implant survival rate was 92.8% (95% confidence interval: 87.4-96.0%). Furthermore, a subject-based analysis of the same material revealed an annual failure rate of 3.7%. Hence, one in 10 subjects experienced implant loss over 3 years. Several of the included studies demonstrated that transalveolar sinus floor elevation was most predictable when the residual alveolar bone height was 5 mm and the sinus floor anatomy was relatively flat. AbstractA trans-alveolar approach for sinus floor elevation with subsequent placement of dental implants was first suggested by Tatum in 1986. Later on, Summers (1994) described a different transalveolar approach using set of tapered osteotomes with increasing diameters. The trans-alveolar approach, also referred to as "Osteotome Sinus Floor Elevation (OSFE)",...

Immediate implant placement combined with maxillary sinus floor elevation utilizing the transalveolar approach and nonsubmerged healing for failing teeth in the maxillary molar area: A randomized controlled trial clinical study with one‐year follow‐up

“…Maxillary sinus floor elevation using the transalveolar approach cannot be conducted under direct vision, and postoperative complications are often discussed by scholars. Maxillary sinus perforation is the most common complication of maxillary sinus floor elevation using the transalveolar approach . Endoscopic findings showed that the maxillary sinus mucosa could be elevated by 5‐mm without perforation .…”

Regenerative potential of leucocyte‐ and platelet‐rich fibrin. Part B: sinus floor elevation, alveolar ridge preservation and implant therapy. A systematic review

“…Similar bone gain around both implant surfaces was reported (4.0 ± 1.6 mm and 4.4 ± 1.7 mm respectively) after 1‐year follow‐up. The main challenge in SFE procedures is to avoid the perforation of the Schneiderian membrane (Pjetursson & Lang 2014). It has been reported that L‐PRF can be used to cover the perforation since it has a good intrinsic adherence to the Schneiderian membrane.…”

Volumetric changes of grafted volumes and the Schneiderian membrane after transcrestal and lateral sinus floor elevation procedures: A clinical, pilot study

“…The drawbacks of this technique are the limited intra‐operative complication management and the, although rare, complication of benign paroxysmal positional vertigo (BPPV). It includes the displacement of otoliths by vibratory forces transmitted by osteotomes and mallet along with the hyperextension of the head during the operation, causing them to float around in the endolymph (Akcay, Ulu, Kelebek, & Aladag, ; Giannini et al., ; Pjetursson & Lang, ). Unexpectedly, the data of this study shows that this technique causes the most post‐operative pain during the first two post‐operative days.…”

“…In literature, tSFE procedures are predominantly used when the RBH is >5 mm, as a lesser remaining bone height may not allow a primary implant stability (Pjetursson & Lang, ). However, recently tSFE have been successfully used in patients with less RBH (Nedir et al., ; Si et al., ) and extreme cases (Nedir et al., ).…”