Читать книгу Practical Procedures in Implant Dentistry - Группа авторов - Страница 66

A frequently encountered challenge when treating the edentulous posterior maxilla with dental implants is insufficient bone volume in an area with poor bone quality [20]. The bone volume of the residual alveolar ridge available for implant placement in this region may be limited by the presence of the maxillary sinus with or without pneumatisation, the loss of alveolar bone height following tooth loss, or a combination of both [21]. Bone volume may be increased via augmentation procedures of the maxillary sinus utilising a variety of surgical techniques and grafting materials in a predictable fashion [22–24].

Current evidence suggests that both lateral sinus floor elevation (SFE) and crestal SFE techniques are both predictably successful and safe, resulting in good long‐term implant survival rates [25, 26]. Examples of lateral sinus floor elevation are depicted in Figure 7.4. The clinician may utilise parameters including residual bone height, residual bone width, length of edentulous span, and residual bone quality to help guide the selection of a lateral versus crestal SFE, as well as determining whether a simultaneous or delayed implant placement is indicated. Future research on the long‐term viability of short implants (4–6 mm) may show a decrease in the need for SFE altogether [27].

Figure 7.4 Implant placement following maxillary sinus augmentation in a staged approach. Sinus floor elevation (SFE) via a lateral window approach was performed on both the right and left posterior edentulous segments, as the bone quality and residual bone height as shown in the panoramic radiograph (a) were not favourable for a simultaneous implant placement in conjunction with the grafting procedure. Following sinus graft consolidation over a period of six months, implants were placed in the posterior segments uneventfully as shown in the panoramic radiograph (b).