The unique characteristics of Sinus Graft have enabled the development of new surgical procedures. In adults, the size of the maxillary sinus often needs to be reduced to permit tooth replacement with dental implants. However, the cost, morbidity, and surgical complexity associated with maxillary bone augmentation has limited the use of this procedure. The Steiner Sinus Lift addresses each of these issues with the intention of making maxillary bone augmentation in the floor of the sinus a simple, non-traumatic procedure within the skill level of all dental practitioners.
The Steiner Sinus Lift
When the alveolar ridge that separates gingiva from the sinus is 2.5 mm in thickness or greater, this area of the maxilla will contain trabecular bone in the remaining alveolar ridge. The bone lining the sinus wall will contain an osteoid-like layer. The osteoid-like layer of bone is firm, but flexible and lucent (Figure 1). This layer appears to have minimal mineralization, which accounts for its flexible nature. Histologically, this layer of bone is indistinguishable from cortical bone. When preparing an osteotomy into the maxillary sinus form the lateral wall, hard bone is present until encountering what appears to be a soft tissue separation from this osteoid-like layer. Histology bears out this clinical finding (Figure 1).
O: Osteoid-like layer
CT: Soft connective tissue
B: Mineralized bone
The presence or absence of regenerative cells in the local tissues dictates the tissue engineering principals that need to be considered in order to achieve clinical success. The surgical procedure outlined here is designed for those patients who have approximately 2.5 mm of alveolar ridge remaining or more.
Materials and Method
A series of 30 implants were placed in grafted sinuses via the Steiner Sinus Lift technique, using Sinus Graft as the graft material. The average age of the patient pool was 58 years. The age range of the patient pool was 44-92 years. There was no screening for various disease states or habits. A wide range of diseases were represented in the patient pool. A small percentage of the patients were smokers. No patients were excluded from the study for health reasons. At the end of the study, the average time since placement was 16 months with a time range of 6 to 33 months. The range of pregraft alveolar bone was between 2.5 and 8 mm with an average alveolar bone thickness of 4.6mm.
Sinus manipulation and grafting was performed using 6X magnification on surgical glasses with headlamp illumination (Designs for Vision Inc.) To perform the Steiner Sinus Lift, a crestal incision is made to accommodate implant placement and to expose the buccal alveolar ridge of the maxilla to the lowest point of the maxillary sinus. Periapical radiographs are used to approximate the floor of the sinus.
Figure 2: A #8 round bur is used to prepare the osteotomy
O: Osteoid-like bone lining
M: Sinus membrane
The micropaddle is approximately 1mm in diameter
The sinus has been grafted and pilot holes are started.
Three months after sinus lift and implant placement.
Restorative dentistry courtesy of Dr. Ron Ask, Jackson, CA.
The bridge was sectioned from tooth #2, and after the removal of tooth #4, a significant alveolar defect remained. As a result of the root fracture complete loss of the buccal alveolar bone and partial loss of the lingual alveolar bone occurred leaving only a shell of bone separating the lesion from the maxillary sinus. The osteotomy for the completed sinus lift is filled with Sinus Graft, which is white in color and located to the left of the extraction site (Figure 15). The sinus was lifted with Sinus Graft and the ridge was augmented with Ridge Graft followed by primary flap closure. No membranes were used.
NB: New Bone
OB: Old Bone
Seven months after grafting. Three months after restoration.
The advantages of the Steiner Sinus Lift include:
- Procedure is minimally invasive
- The osteotomy is minimal being 1-3 mm deep and 3 to 4mm wide
- The dark sinus can be easily visualized prior to reaching the membrane
- The membrane is easily visualized assuring detachment without damage
- Directed hydraulic pressure lifts the membrane in the desired direction
- The amount of lift is determined by the volume of graft injected
- Lifting the membrane with hydraulic pressure prevents membrane damage
- The graft material sets hard and supports implants placed in minimal bone
- The graft material bonds to the implant and sinus bone facilitating integration
- The graft material is osteogenic and quickly resorbed
- Minimal instrumentation with closed graft permits a sterile technique
- Implants are placed at the time of sinus grafting
- Implant are restored 3 months after grafting
- Simplicity of the procedure requires less time and expertise
Clinicians interested in the Steiner Sinus Lift are encouraged to contact us at firstname.lastname@example.org. You can also email a periapical radiograph of the surgical site to us for a presurgical consultation prior to performing this surgery.