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

studies have been carried out which revealed that the rate of perforation using the osteotome technique was 3.8%, and the subsistence rate of the implants was reportedly 92.8%. [12] Thus, the risk of perforation or formation of an excessive bony cavity at the implant placement area led to the jeopardy of the implant stability in the preliminary stage along with numerous hitches post-operatively. The crestal approach, however, offers many advantages over the lateral approach. It is less aggressive and a relatively simpler procedure, facilitating early wound healing than the lateral approach. As it is a “blind” procedure, it is heavily dependent on the skills of the clinician and might cause Schneiderian membrane rupture while malleating. [11- 14] Additionally, this procedure leads to complications such as pain in the head and light-headedness after the procedure. [1, 2, 15, 16] Sequentially, two new devices were developed for both the lateral (LAS kit) and crestal (CAS kit) approach sinus lift and gained immense success over time. According to our knowledge, literature has never discussed both of these techniques together and therefore, we attempted to club our cases, experiences, and literature together to achieve the same. 'Dome' and 'Core' drills, metallic stoppers, and a bone separator tool are included in the lateral approach sinus kit (LAS Kit) (Osstem Implant Co., Busan, Korea). The Dome drill is a one-of-a-kind osseous drill that removes the maxillary sinus's lateral wall while collecting autogenous bone to be put into the sinus (Figure 9). Macro- and micro-cutting blades cut the lateral wall cleanly without rupturing the sinus membrane. These Dome drills are of 5.0- and 7.0-mm diameters and are used with an operating handpiece at 1,200 to 1,500 RPM along with ample irrigation. The metal stoppers (0.5, 1.0, 1.5, 2.0, 2.5, and 3.0 mm), to control the penetration depth, are used sequentially for the safe elevation of the sinus membrane while having restricted penetration depth. The Dome drill can be used to expand the osseous window generated by the side wall drill if required. The flat tip of the drill is planned for innocuous advancement of the sinus membrane. Osseous cutting is done with the side of the spinning drill at 1,500 RPM, in presence of copious irrigation, to increase the size of the window. It can be used with metal drill stoppers to avoid inadvertent penetration into the sinus membrane. The Core drill, like the Dome drill, is available in 5.0- and 7.0-mm diameters. Its center does not cut with bone removal, leaving a bone core over the sinus. This bony lid can be lifted and employed as the new 'roof' of the sinus, with osseous augmentation put beneath it, while the sinus membrane remains attached. Metal drill stoppers allow for regulated depth preparation in a sequential manner. If removal of the osseous core created by the Core drill is desired, the bone separator tool is used to separate it using the practitioner's preferred technique. When less bone height is present, a lateral window approach was preferred to increase crestal bone height and volume for successful implant placement. [8] The lateral sinus augmentation approach can be challenging as rupturing of the sinus membrane often necessitates abandoning the procedure and re- entering at a later date after the completion of the healing. The older techniques involved the use of diamonds or carbides in a high speed handpiece or the use of Piezosurgical units. However, these approaches had the potential for membrane damage (burs at a high speed) or were very slow (Piezo). The LAS kit, from Osstem, employs particularly designed drills that curtail the membrane damage, thereby, refining the safety of the technique. The advantages of LAS-KIT include its convenience, potential to eliminate the number of steps involved in the surgery, highly versatile drill design - allowing it to be used on sinus floors that are flat, inclined, or over a septum, reduction in overall chair time, complications, and patient discomfort, and the adaptable LAS-drills, which can acclimatize with quite a few diverse bone solidities. The CAS kit includes two types of drills, one of which is the twist drill. It can be coupled with a stopper for the initial drilling. Stoppers ranging in length from 2.0 mm to 12.0 mm are included. (Figure 10). The maximum depth of the twist drill is 2.0 mm from the sinus floor with a speed of 1,000 to 1,500 rpm. The CAS drill is the other sort of special drill. Because the CAS drill tip is conical, the bone is drilled with a conical hole. The dentist can safely raise the sinus membrane using the CAS drill. Furthermore, because the CAS drill rounds the lateral side, it may be utilized safely on numerous types of maxillary sinuses. The CAS drill also can gather autogenous bone, and its optimum speed range is 400– 800 RPM. The depth gauge may be used to examine membrane elevation and quantify residual bone height. It's also necessary to attach it to a stopper. A 1.0-mL syringe filled with saline solution is fitted to the hydraulic lifter. The bone carrier, condenser, and spreader are employed for jawbone transplantation. The bone carrier is available in 3.5 mm and 3.9 mm sizes. It's made up of little pieces of bone. The condenser is used to plug the osteotomy with the xenograft, while the bone spreader is used to spread the bone graft material laterally to achieve desired sinus raise, at a low speed of 30 rpm. The CAS kit was originally designed to uplift the maxillary sinus sheath safely using the hydraulic pressure. However, only 75 % of dentists have reported the routine use of the hydraulic lifter for the elevation. [7] Kolhatkar et al. [12] and Teutsch et al. [17] testified 97% success rate for the crestal approach. It is in our opinion that the expected advancement can be safely achieved through the crestal approach with a reduced bone 37 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