Global Journal of Medical Research, J: Dentistry and Otolaryngology, Volume 23 Issue 1

Case report 1 A female aged 29 presented with the complaint of missing teeth in her upper right back tooth region for 3-4 years and desired the replacement of the same. Her CBCT revealed an enlargement of the maxillary sinus with a bone height of 2.55 mm at the desired site (Figure 1). Therefore, a sinus lift procedure using the lateral approach was indicated before implant placement and we accomplished it with the help of the LAS kit. After the surgical preparation mentioned above, a one-stage implant placement technique was carried out. The flap was extended up to the inferior border of the zygoma, to allow the visibility of the lateral wall of the maxillary sinus. The lateral window was created using the dome drill of 5.0 mm diameter with a stopper system (0.5mm increments) for effective depth control. When the maximum desired depth was achieved with the 0.5 mm drill stopper, it was changed to a 1.0 mm stopper, and drilling was proceeded chronologically while scrutinizing for any perforation. The drilling of the osseous wall continued with increasing depths and stoppers till full penetration of the lateral wall was achieved and the bony window was removed in-toto (Figure 2). Sinus curettes were then used to gently lift the sinus membrane by moving it between the membrane and bony wall anteriorly, posteriorly, and medially. Once the membrane was free of all the attachments, we encountered the movement of the membrane that was concomitant with the breathing. The osteotomy was then prepared into the ridge and an implant of the desired length was placed and the cover screw was tightened (Figure 3). After that, the apical portion of the implant was packed with a xenograft (Cerabone, Biotiss, Germany). The bony window, that was cut out, was placed back in the position and was covered with a PRFmembrane. Primary closure of the soft tissue was obtained. The flap was repositioned with a non-absorbable braided suture, first with horizontal mattress sutures, and, then with interrupted sutures to seal the crest (Figure 4). Postoperative instructions were provided to the patient (Table 1). The patient was recalled after 10 days and then 3 months later. The soft tissue confirmed no inflammation and satisfactory wound healing. The radiographic analysis verified the densification of the xenograft and the osseointegration of the implant (Figure 5). Case report 2 A 44-year male patient desired the replacement of a grossly decayed tooth in his upper right back teeth region. The CBCT revealed a reduced bone height of 8 mm (Figure 6). Minimal atraumatic extraction of the maxillary right first molarroot piece was performed before proceeding with the implant surgery. Then, the osteotomy was started with a 2.0 mm diameter twist drill from the CAS kit. It was used along with the stopper. It was then followed by the drills with increasing diameter upto 1 mm short of the sinus floor with a drilling speed of 800 rpm. Then, the 3.6 mm bur was used for the extension of the osteotomy, perforating the sinus floor. The integrity of the membrane was analyzed with the depth gauze while slightly lifting the membrane. Then, the hydraulic hoist was implanted and steadied into the drilled hole and the saline solution was injected. 3 mm sinus floor elevation is expected by using 0.30 mL solution . [7]It was then drowned out and injected again until the anticipated advancement was achieved. The xenograft was condensed with the help of the carrier and condenser. It was then followed by implant placement using the self-tapping method and the cover screw was placed (Figure 7), followed by adequate soft tissue closure. The patient was instructed with proper oral hygiene instructions and was recalled after 10 days for suture removal. A healing abutment was used to replace the cover screw after four months. And by the end of the 4 th month, the final prosthesis was delivered (Figure 8). The patient is being followed up for 1 and a half years now and has shown satisfactory results. III. D iscussion Successful implant surgery is attained only if the implants are placed in a sufficient and decent quality of bone for its proper osseointegration. Because of low bone quantity and quality, as well as its closeness to the sinus floor, the maxillary arch has traditionally been one of the most challenging places to properly insert dental implants. Thus, Sinus lift surgery, also known as sinus augmentation, helps to correct these problems by elevating the sinus floor, forming space for an appropriate bone graft material to help in the formation of new bone for successful treatment. Several approaches are being used to reach this goal. When there is less than 5 mm bone height available, the lateral window sinus lift procedure is recommended. [8] The Schneiderian membrane may be seen directly through the lateral window. [8] Nevertheless, it is more intrusive, results in postoperative pain, and difficulties, and has a higher infection risk. [9, 10] This procedure might cause rupture of the sinus sheath, further allowing microbial adulteration into the sinus. In another scenario, when the remaining maxillary bone height is greater than 5 millimetres, a transalveolar sinus elevation technique is frequently needed. [8] Since Summers [6] proposed the osteotome technique in 1994, it has been applied widely with the advantage of being an effortless procedure, with a briefer therapeutic period than the conventional lateral hole-in-the-wall technique. However, if it is performed improperly, it might cause compression necrosis or breakage of the cortical wall. [8-11] Various 36 Year Global Journal of Medical Research Volume XXIII Issue I Version I ( D ) 2023 J © 2023 Global Journals Lateral Approach Sinus (LAS) and Crestal Approach Sinus (CAS): The Unravelled Paraphernalia for Maxillary Sinus Membrane Advancement