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lateral approach – step-by-step

Prior to carrying out the augmentation procedure, it is necessary to interview and examine the patient in compliance with the principles of medical art. Additional tests should include CBCT scanning or calibrated pantomographic scans. If there are any symptoms of chronic pathological changes to the nose or sinuses, a laryngological consultation should be ordered.

Tools for the maxillary sinus floor lateral augmentation are constructed on the same principle of fixing stoppers on standard round burs made from tungsten carbide. A drill with a diameter of 5 mm with standard handle length makes a perfect tool for cutting the bone and allows an easy access to the lateral wall of the sinus.

The depth of tissue penetration is restricted to 2.8 mm (adaptor A5/2.8) and 4 mm (adaptor A5/4). Adaptors are fitted with integrated stoppers.

IMPORTANT!

The handpiece should be placed perpendicular or at a small angle to the lateral wall of the maxillary sinus and only moderate pressure should be applied.

Having completed a round bone window, it is possible to extend it in the mesial-distal direction by applying subtle horizontal movements of the handpiece.

The recommended working parameters of the drilling system include approx. 1,500 rpm and intensive external cooling.

Stopper A5/2.8 should be used for both a standard and thin bone of the sinus’ lateral wall (livid tint).

IMPORTANT!

Drilling in the lateral wall of the maxillary sinus must always begin with adaptor A5/2.8.

If there is no contact with the mucous membrane, adaptor A5/4 should be used.

In the case of a very thick lateral wall, it is necessary to use a round bur without a stopper or a bone scraper to remove the bone around the incomplete bone window and then apply a bur with an appropriate stopper.

Having reached the mucous membrane, it is necessary to separate it from the edges of the bone window and bone surface by using appropriate sinus curettes.

When performing larger augmentations and in the case of the presence of bony septa in the maxillary sinus (Underwood’s septa), it is recommended that two or more openings are made, which can be connected by removing the bone bridge with e.g. Luer forceps.

This method can also be used to enlarge a single bone window and adjust its shape to the clinical needs.

Prior to filling the space with the biomaterial, it is recommended that fibrinous membranes or a flat collagen sponge is placed on the sinus’ mucous membrane. The procedure is ended according to the surgeon’s preferences by covering the bone window with the periosteum, the fibrinous membrane, or a collagen membrane and suturing the edges of the wound without applying any pressure. Simultaneous placement of implants is possible, if satisfactory original stability has been obtained.

Detailed description of the entire procedure is also available in a PDF file.