Sinus lift, innovative crestal approach: atraumatic technique with multiblande cutters

OBJECTIVESThe placement of implants in the posterior maxilla is very often challenge for the oral surgeon relation to pneumatization of the maxillary sinus and the contextual crestal bone resorption following tooth extraction. In recent years, many crestal approach techniques have been introduced using a variety of burs and instruments. A problem as-sociated with such techniques the lack of visibility during opening of the maxillary sinus floor and manipulation of the Schnei-derian membrane. This case, selected from a series of clinical cases, illustrates a new surgical procedure, minimally invasive with the achievement of the elevation of the maxillary sinus mucosa by transcrestal route, insertion of biomaterial and simultaneous implant positioning, when the bone thickness below the sinus is limited to =5 mm.MATERIALS AND METHODSThe case deals with the implant-prosthetic rehabilitation of young male patient with edentulism of 1.6 and 2.6 and the presence in both sites of approximately 5 mm of residual crestal bone below the maxillary sinus. For the elevation of the maxillary sinus mucosa, a new atraumatic transcrestal surgical technique "Rialto protocol" was used. The characteristic of this new surgical protocol is to gradually and atrau-matically elevate the maxillary si-nus mucosa through the use of multi-blade burs of various diam-eters, depending on the pro-grammed implant, present in the kit and mini dissectors to sepa-rate and raise the sinus mucosa. The multi-blade drills have been designed with the intention of preserving the integrity of the si-nus membrane; moreover, the correlated drill stops allow their penetration without the feared risk of damaging the maxillary si-nus mucosa. In both sites the sur-gical procedure was the same with the only variant that in area 1.6 no biomaterial was used as a filler but only bone, obtained during the preparation of the surgical socket by the function of the multi-blade drill, together with the collagen and the blood clot. Two titanium implants with a diameter of 4 mm and a length of 10 mm were inserted at the same time as the surgical procedure.RESULTSThe intra-and post-operative course went without any complications. Excellent primary stability was obtained in both sites, which allowed us to immediately insert the healing abutments. The patient was monitored weekly for the first month and monthly during recovery. Six months after the intervention, the case was fi-nalized with screw-down crowns in non-precious alloy and ceram-ic relating to 1.6 and 2.6. In both surgical sites, bone regeneration of about 4 mm was obtained in-side the maxillary sinus.CONCLUSIONSThe described technique is a valid alternative to the use of Summer's osteotomes and the surgical hammer to obtain the maxillary sinus elevation via the crestal route. The technique has as its objective the reduction of the most common intra-and post-operative complications and the discomfort of the patient during the surgical procedure, moreover, the reduction of heal-ing times since the regeneration and osseointegration processes take place simultaneously. The approach related to the use of the Rialto protocol was found to be a simple and predictable technique with low patient morbidity.CLINICAL SIGNIFICANCEThe technique described is used for the rehabilitation of the edentulous posterior jaw with a thick-ness of the bone crest below the maxillary sinus mucosa =5 mm.