Just had a case yesterday referred to me by a GP. Read Tofflers response it is worthwhile.

Years back, I too was looking for a better way to treat those internal lift cases without having to bang on skulls. I found a company called iit (Innovative Implant Solutions) iitweb.com. Using their sinus lift kit, you no longer need the mallot and osteotomes...unless you want to do the osteotomy with hand instruments from the start. As the web site shows, it works by combining a non-cutting screw within a cutting screw. Very ingenious. Once you pop through the bone, you simply use the special elevators to lift the schneiderian membrane off the floor and place your bone. Implant placement to follow. The technique and system works so well that the University of Washington School of Dentistry has been using it in their Oral Surgery department.

Now we just use the mallot to break the ice in the back of the fridge. Hope this helps.

Dr. Toffler that was a perfect response, I copied and pasted that in word as a reference.

In my experience vertigo is rare but does happen and you need to be prepared for it. I have had this happen to 3 patients in my career.

It is scary to a patient so know how to handle it

Guy

In reviewing the reports on BPPV (Peñarrocha et al. 2001; Flannagan 2004; Peñarrocha-Diago et al. 2008), it appears that this malady was induced after using osteotomes to aid in alveolar expansion.
I have found that ridge expansion or widening of the osteotomy with osteotomes generates significantly more percussive force than osteotome-mediated sinus floor infracture or apical graft displacement. It is for this reason that I presently use drills to widen and undersize the osteotomy and solely use osteotomes to facilitate localized sinus floor elvation (SFE).
Increased Risk
If the patient is positioned with the neck in hyperextention during osteotome-mediated site preparation, the risk of BPPV is higher. Also, during malleting place a towel on the patient's forehead providing slight pressure to stabilize the head.The risk is also higher in the elderly patient.

TREATMENT
Treatment of BPPV consists of maneuvers to restore the calcic carbonate crystals from the anomalous location in the semicircular canal to their correct position in the utricle (Peñarrocha-Diago et al. 2008).Medications such as antihistamines, anticholinergic, and sedative–hypnotics may be used for brief periods and are best administered to patients with prominent symptoms (Flannagan 2004). Acute severe vertigo could be lessened with 2.5 to 5.0mg diazepam intravenously, and associated nausea and vomiting relieved with an antiemetic delivered intramuscularly or by rectal suppository (25mg prochlorperazine intramuscularly or 25mg rectally every 6 hours).
INCIDENCE
Di Girolamo et al. (2005) reported an incidence of OMSFE-related BPPV of less than 3% (4 in 146 patients). Peñarrocha-Diago et al. (2008) reported a 1.25% postoperative incidence of BPPV in 320 patients that underwent alveolar expansion with osteotomes prior to placing implants in the atrophic maxilla. They also reported that the incidence of this complication may have been higher as there could be cases where the vertigo did not appear for days or weeks after the surgical trauma and were therefore not associated with the implant placement procedure.

How can you prevent this?

This can be avoided with proper head position and minimize the banging with the osteotome. If you have to bang to hard redrill the site and get closer to the sinus floor.

I been burned by this before. Treatment is symptomatic but you should refer to an ENT to rule out any serious issue.

Opinions

I would refer you to this article below. If you email the author Dennis will provide you with a copy of the article.

Implant Dent. 2004 Jun;13(2):129-32. LinksLabyrinthine concussion and positional vertigo after osteotome site preparation.
Flanagan D.
dffdds@mindspring.com

An incident of positional vertigo associated with osteotome technique for installation of multiple maxillary dental implants is reported. The symptoms resolved after 2 weeks with restricted physical activity and prohibition of lifting. There is a discussion of labyrinthine concussion and treatments. Suggestions for prevention are to use small sizes of osteotomes first and then progress to larger sizes and to avoid neck extension head position during osteotome use.