JIACD
The Journal of Implant & Advanced Clinical Dentistry
Closed vs. Open Lifts
Wed, 11/19/2008 - 13:52 — implantdoc
What threshold is everyone using for determining open vs. closed sinus lifts? Classic lit of Summers notes 5mm residual bone needed for closed lifts. Is that what you are using? Personally, my patients hated the osteotomes...so that means that I hated the osteotomes. I am using a sinus lift kit from MIS for my closed sinus lifts. No osteotomes. Very fast and easy.
JIACD
© 2008 Journal of Implant and Advanced Clinical Dentistry. Privacy Policy | Terms & Conditions
Closed vs Open sinus lift protocol
In determining whether to do a open vs close sinus lift I look at amount of native bone. If I have 5 mm or more I will do close sinus lift, there are many articles to demonstrate decrease success if you attempt a closed sinus lift with less then 5 mm of bone.
If there is less then 5mm I do an open sinus lift/lateral window with a piezo.
Rotary Osteotomes: Question for Kurtzman
What rotary osteotomes do you prefer? The MIS ones are good as well as BIT.
Closed vs Open Sinus lifts: Question for Kurtzman
Dr. Kurtzman have you used the rotary osteotomes? How well do they work? Any complications with them?
Rotary ostetomes
Sorry for delayed reply. The rotary osteotomes are easier to use then those requiring a mallet plus they are more comfortable for the patient. Only potential complication is heat generation if too much pressure is placed and its run dry. So using a intermitent advance works well.
lateral window lift vs summers approach
The rule of thumb is you can typically get 5mm of height when doing a summers approach, so this will depend on what implant your using and if you need more then 5mm more of height then is present already. Beyond that a lateral window approach is more indicated. With regard to when can you place the implant at the same time as doing the lateral lift? You need to get primary stability of the implant so you need at least 3mm of bone (those less experienced may wish to use 5mm as the minimum) I will usually undersize the osteotomy so that the implant compacts the site as its inserted and thus give better primary stability.
There are rotary osteotomes that do not require tapping and will be more comfortable for the pt. Meissenger is one company that sells these, another is MIS (see page 45 on their online catalog at http://www.activepoint.com/mis2009/book.html)
Close vs Open sinus lifts: Parameter of Care
What I look at in determining an open vs close sinus lift is amount of native bone. If I have 5 mm or more I do a close sinus lift, if it is less then 5mm I do an open sinus lift.
I use summers ostetome but lately I been using acteon's intra-lift piezo kit. It works great and I dont have to bang on the patients skull. The kit is easy to use and I have not perforated the membrane using it.
osteotomes vs piezo for internal sinus lift
The difference is that since the bone quality is typcially poor in the posterior maxilla and using osteotomes be they those that require a mallet or rotary ones they compress the bone laterally to improve the density so you can take a D4 and convert it to a D3 or a D3 to a D2. With the piezo there is no lateral compression just a hole is cut thru the bone.
No osteotomes for me either.
I have given up the osteotomes as well. My patients hated the "tap tap tap" with the mallet. I was sedating all of my osteotome closed sinus patients, but now I use one of the rotary kits for closed lifts. No more tapping. The patients love it. No more need to sedate for closed sinuses.
Close sinus lift Osteotomes
I guess I am old school. I still use the tradition summers osteotomes. My patients dont complain about the tapping. I dont even use sedation for it.
I think it may be in ones technique. I take alot of digital radiographs. I drill as close to the membrane as possible and then start tapping. I find that I dont need that much force in my up facture and therefore less pounding = less patient complaints.
Closed sinus lift osteotomes
The Abrahammi instruments work very well and are atraumatic.
Closed vs Open sinus lifts: Depends on amount of native bone
My threshold for determining whether I do a closed or open sinus lift is the how much native bone I have. My cut off on doing a open vs a closed lift is 5 mm of native bone. If I have 5 mm or more of native bone I will do a closed lift with osteotomes. Anything less I will do an open sinus lift.
5mm will also allow for primary stability of your implant placed during the closed sinus lift.
Open vs closed lift
This depends on several conditions that the patient presents: 1)I like to see at least 4mm. of vertical bone for a Sommers. 2) If I need bone for several teeth I will lift the membrane by a lateral method. 3) I have had zero post op issues with the Sommers, so patients do not like the tapping, but they get over it. 4)With both you are working with a 6 walled defect, so you are going to have success. The graft material used determines the sigma. I use both techniques. Your incision also makes a differencs as well ie. remote, mid crestal