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Presented ByDR. Saima GulPostgraduate trainee OMFS

DENTAL IMPLANT SINUS LIFT

Contents :Brief sinus anatomyBrief about implantPatient evaluationPosterior maxilla classificationIndications , contraindications for sinus liftDifferent sinus lift proceduresPost-op instructions Complications

Anatomy of maxillary sinusMaxillary sinus is the largest sinus in the head and neck region.SHAPE-Pyramidal with base towards the lateral wall of nose and apex toward zygomatic process of maxilla.BOUNDRIES -Anterior wall-facial surface of maxillaPosterior wall- infratemporal surface of maxilla. Roof- Floor of orbitFloor Alveolar process of maxilla.Opens into middle meatus

The bony walls are thin, except for the anterior wall and the alveolar ridge in the dentate patient.Is lined with a pseudostratified columnar epithelium Schneiderian MembraneIs approximately 15ml in volume air space although the actual size depends on the amount of resorption that has taken place

Formation begins in the second to third year of life and is nearly complete by 12 years of age

What is an Implant? Dental implant is an artificial titanium fixture which is placed surgically into the jaw bone to substitute for a missing tooth.

Surgical procedure STEP 1: INITIAL SURGERY STEP 2: OSSEOINTEGRATION PERIOD STEP 3: ABUTMENT CONNECTION STEP 4: FINAL PROSTHETIC RESTORATION

Patient evaluationMedical evaluationEvaluation of Implant SiteBone Height, Bone Width and Anatomic considerations

Patient evaluationRadiographic evaluation Periapical radiographsPanoramic radiographOccipitomental view CT scan (axial and coronal view)CBCTMRIUltrasound

Anatomic limitationsBuccal Plate 0.5mmLingual Plate 1.0 mmMaxillary Sinus 1.0 mmNasal Cavity 1.0mmIncisive canal Avoid Inter implant distance 3mmInferior alveolar canal 2.0mmMental nerve 5mm from foramen Adjacent to natural tooth 1.5mm

Etiology of decreased bone height in posterior maxilla The maxillary sinus grows by a bone remodeling process named PNEUMATIZATION as age advances. This physiological process accompanied with increased tooth resorption due to tooth loss leads to decrease in bone height in the posterior maxilla.

Limitations to Implant placement in the MaxillaRidge widthRidge height Bone quality

Misch classification of posterior Maxilla

>12mm10mm5-10mm