COPYRIGHT © 2000 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY . NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITH- OUT WRITTEN PERMISSION FROM THE PUBLISHER. T he surgical lift of the maxillary sinus floor is cur- rently an accepted technique in implant surgery in the rehabilitation of the posterior area of the eden- tulous maxilla. It is a relatively simple and pre- dictable surgical technique. In 1977, Tatum 1 reported penetration of the maxillary sinus with a modified Caldwell-Luc technique (unfinished fenes- tration osteotomy in the maxilla’s external face) to raise the sinus membrane, creating an empty hole in the floor of the antral cavity. After it was refilled with different grafting materials, the anchorage area for placing implants in areas with poor osseous crest height was increased. 2–5 Those who use this procedure know that one of its most common complications is perforation of the Schneiderian membrane when separating it or when making the osseous window for reaching the sinus with the round diamond drill during the rotating ostectomy stage. 2,3,5,6 To reduce this complication, the creation of a vestibular ostectomy by using an odontologic ultrasonic generator is proposed. Ultrasound has been used widely in various fields of medicine, for example, in the treatment of some musculoskeletal disorders, for selective tissue resec- tion in neurosurgery and hepatic surgery, and in the controlled fragmentation of renal calculus. 7–9 In odontology, its applications have increased to include the radicular scrape, instrumentation and filling of the radicular duct, decementation and cementation of prosthodontic restorations, finishing of margins in prosthetic cuttings, and preparation of the retrograde cavity in apicectomies. Described herein is a new application of ultrasonic generators in odontology and their use in the surgical technique for lateral approach of the maxillary sinus. Based on particular features and clinical experience, it is suggested that the sinusal fenestration ostectomy made by ultrasound technique has advantages over the conventional technique using a rotating drill. Materials and Methods The fenestration ostectomy for sinusal approach is performed using the active tip of a conventional peri- odontal ultrasonic generator augmented with an independent irrigation system with sterile saline solu- tion. The convenience of an ultrasonic ostectomy can be realized through an analysis of the physical and mechanical phenomenon generated by the ultra- sounds at the active tip of the device. 7,8,10–13 Ultrasonic Vibration at the Active Tip. Micro- movements of 20 to 200 μm and a frequency of more than 20,000 Hz (20,000 micromovements per sec- ond) are present at the device tip. In this way, the ostectomy line is made by microfracturing and dis- persing the osseous table in a progressive, precise, The International Journal of Oral & Maxillofacial Implants 697 **Professor, Department of Oral Surgery, University of Valencia, Valencia, Spain. **Guest Professor, Department of Oral Surgery, University of Valencia, Valencia, Spain. Reprint requests: Dr Eduardo Anitua, San Antonio, 15–5°, 01005 Vitoria, Spain. E-mail: eduardoanitua@jet.es Ultrasonic Ostectomy for the Surgical Approach of the M axillary Sinus: A Technical N ote Fernando Torrella, MD, DDS*/Julio Pitarch, MD, DDS*/Guillermo Cabanes, MD, DDS*/ Eduardo Anitua, MD, DDS** Because of its physical and mechanical properties, the odontologic applications of ultrasound are increasing. A new application of odontologic ultrasonic generators involves the lateral approach of the maxillary sinus in sinus augmentation. The procedure may provide important advantages over conventional ostectomy using diamond drills, as it reduces the risk of perforating the Schneiderian membrane, improves vision and hygiene of the operating area, and provides a more conservative and controlled osseous incision. (INT J ORAL MAXILLOFAC IMPLANTS 1998;13:697–700) Key words: implant, osseous graft, sinus ostectomy, ultrasound