CASE REPORT Crestal Sinus Elevation for Simultaneous Implant Placement Arun K Garg 1 , Gregori M Kurtzman 2 , Lanka Mahesh 3 A BSTRACT Insufcient crestal height may present in the posterior maxilla that will require osseous grafting to place implants. When sufcient height is present to stabilize the implant at placement, simultaneous sinus augmentation via a crestal approach with implant placement can be performed. The crestal approach when applicable has fewer complications then lateral sinus augmentation procedures and is more comfortable for the patient during the post operative period. This article shall describe the crestal sinus augmentation technique using special reamers that are safe ended to elevate the sinus membrane without potential tearing. Keywords: Crestal sinus augmentation, Sinus grafting, Summers approach. International Journal of Oral Implantology and Clinical Research (2018): 10.5005/jp-journals-10012-1182 I NTRODUCTION The posterior maxilla can be a challenge to implant placement related to the maxillary sinus. The sinus may enlarge (pneumatize) related to patient age, sinus issues, and how long the site has been edentulous or related to periodontal bone loss on the tooth that will or has been extracted. 1 Crestal bone height, hence, may be diminished from the superior direction (enlargement of the sinus) or from the inferior aspect of the ridge (periodontal bone loss). This can complicate implant placement due to insufcient available to house an implant. Short implants have been advocated for these clinical situations but may not be the approach desired or insufcient height may not be present to even place these short implants. Two approaches have been reported in the literature to the increase crestal bone height so that sufcient bone height may allow implant placement. The lateral sinus augmentation was frst reported in 1980 by Boyne related to the pioneering work performed by Tatum. 2 This technique was complex and required surgical skill with utilization being applied to any crestal height remaining from paper thin to varying residual thicknesses. The other technique was frst reported by Summers in 1994 and used a crestal approach to simplify the surgical aspect. This was designed when there was a sufcient height to stabilize the implant at placement, but an additional height was needed to encompass the implant within the bone. 3 The crestal approach requires sufcient bone height to stabilize the implant as the implant is required in this technique to tent up the sinus membrane and allow the graft to mature into host bone to encompass the apical portion of the implant. It has been suggested that a minimum height of 4 mm is required to achieve that goal. 4,5 There is some consensus that a 4-mm increase in height can be achieved with the crestal approach. 6,7 With other authors stating greater height increases are possible to a possible 10 mm gain. 8 When less available initial crestal height presents, a lateral sinus augmentation should be considered a better approach. The crestal approach works well in single sites or two adjacent sites but may not be suitable when more than two adjacent implants are planned and grafting needed at each site. The crestal approach for sinus augmentation has demonstrated a clinical success of over 93% as reported in the literature. 9 Typically, multiple adjacent sites will require graft placement medial to where the implants are being placed and elevation of the sinus membrane medially cannot be performed through the crestal osteotomy. Crestal sinus elevation may be performed in a site that has been edentulous and healed or at the time of extraction when implant stability can be achieved simultaneous with sinus augmentation. The process begins with the evaluation of the radiograph to determine the height of the residual ridge between the crest and the sinus foor. This height is measured with an instrument on the radiographic flm or with software when a digital radiograph has been taken. The resulting height measurement will determine how deep the initial drill will be taken to avoid potentially tearing the sinus membrane and it is recommended by the authors that 2 mm be deducted from the determined height. For example, if the height measures 7 mm, that depth for the pilot drill be set at 5 mm. Traditional osteotomy burs are not suited for sinus elevation procedures as the tip of the drill, although well suited for bone cutting, will tear the sinus membrane when it contacts it. Thus, osteotomy drills are required with safe ends that will bump up the membrane (elevate it) when contact the delicate structure during site preparation. Although safer than traditional drills, these drills should be limited in how high they are taken past the sinus foor to avoid creating tension in the sinus membrane and subsequent tearing with further advancement. Thus, a physical stop on the drill ensures that accidental advancement is not possible due to free-handing drill depth. S INUS C RESTAL A PPROACH K IT The Sinus Crestal Approach kit (ImplantVision, Miami, FL) contains all the tools required for a crestal sinus elevation from site preparation 1 Private Practice, Miami, Florida, USA 2 Private Practice, Silver Spring, Maryland, USA 3 Private Practice, New Delhi, India Corresponding Author: Gregori M Kurtzman, Private Practice, Silver Spring, Maryland, USA, Phone: +13015983500, e-mail: drimplants@ aol.com How to cite this article: Garg AK, Kurtzman GM, et al. Crestal Sinus Elevation for Simultaneous Implant Placement. Int J Oral Implantol Clin Res 2018;9(1–3):49–54. Source of support: Nil Confict of interest: None © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons. org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.