Grafting Procedures And Bone Grafts

Sinus Lifting: Maxillary sinus floor augmentation (also termed sinus lift, sinus graft, sinus augmentation or sinus procedure) is a surgical procedure which aims to increase the amount of bone in the posterior maxilla (upper jaw bone), in the area of the premolar and molar teeth, by lifting the lower Schneiderian membrane (sinus membrane) and placing a bone graft.

a.External sinus lifting (with lateral window) – the most frequently used technique when sinus augmentation is needed in case of large (severe) resorptions.

Sinus lifting technique with lateral window involves:

  • Lateral bone incision and gum removal from bone covering the maxillary sinus;
  • Creating a window inside the bone until sinus membrane is reached (an extremely thin membrane, which “coats” the sinus in its inner part, white color in the drawing);
  • Careful membrane detachment from bone and raising (lift – ing) up to the level where bone augmentation will be performed;
  • Filling the space underneath the lifted sinus membrane with bone augmentation (addition),(mixture of various bone addition materials) up to the desired level;
  • Covering the bone window through which sinus was accessed with special barrier role membranes (prevents gum growing inside the sinus) resorbed on their own after a few months;
  • Covering with gum and suture;
  • After approximately 7-9 months, when necessary bone was formed inside the sinus, the dental implant can be inserted without any issues, sustaining the dental work.

b.Internal sinus lifting (with crestal orifice) – represents the technique of choice when sinus resorption and expansion is small, limited and only a 2-3mm bone height lifting inside the sinus is needed.

Internal sinus lifting technique involves:

  • Middle bone area incision and gum removal from bone underneath the sinus;
  • Creating an orifice inside the bone and drilling until sinus level (being a “blind” technique, this procedure is performed only with dental tomography navigation, which offers extremely accurate measurements; if measurements are performed with errors, the risk of accidental sinus opening and infecting is extremely high);
  • Opening the sinus cavity with special, non-traumatic instruments, without sinus membrane alteration;
  • Sinus membrane detachment and lift up to the desired level – with a special balloon progressively filled with liquid or with other specific instruments;
  • Filling the space underneath the sinus membrane up to the desired level with bone augmentation (addition) material (biomaterial mixture);
  • Covering the orifice through which sinus was accessed with special barrier role membranes (prevents gum growing inside the sinus) resorbed on their own after a few months;
  • Covering with gum and suture;
  • After approximately 7-9 months, when necessary bone was formed inside the sinus, the dental implant can be inserted without any issues, sustaining the dental work.

Sinus lifting procedure can be performed individually or concurrently with dental implant insertion. For the second option, when dental implant is needed to be performed in the same time, it is mandatory, that after insertion, an exceptional mechanical stability to be present (to be immobile in the addition material introduced within sinus). This stability can be achieved with special, modern implants and only if under the sinus a bone “headboard” of 3-4 mm thickness (height) exists. Otherwise, implanting will be postponed for 7-9 months until mature bone is formed within the maxillary sinus.

Block grafts: The block bone graft is another type of graft that we use. The block bone graft is necessary when there are large defects in the jawbone. To perform the block bone graft, we harvest a small block of bone from the back of the jaw or iliac bone. We place the block into the defect, then hold it in place with small titanium screws.

the bone graft dental procedure takes between 45-90 minutes and is performed in clinic or hospital. The initial recovery period lasts about two weeks. Following the bone graft procedure, the waiting time until a solid bone mass is received is between 3-6 months, in most clinical cases.

 

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