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Loosing teeth mostly involves loss of the bone as well. This does in particular affect the collateral part of the upper jaw, because teeth are lost there at an early stage and the maxillary sinus is only milimetres from the roots of the teeth. The result is that the already weak bone provides a particular bad hold for dental implants. Therefore, a reconstruction of bone (sinus lift) is often required for implantations.
Until now, the jaw mucosa was opened up and detached for a sinus lift; the maxillary sinus septum was opened up in a window-like way (fig. 1: Open windowing of the maxillary sinus during conventional reconstructing) and a bone graft was inserted. Later on, implants were inserted in this complex and exhausting procedure.

Fig. 3

The keyhole technique in dental implantology
During the international establishment congress of the Global Oral Implant Academy (GOIA) in Bremen in May 2004, Prof. Dr. Dr. Wilfried Engelke presented a new process: The “Flapless Sinus Lift” (fig. 2), a minimal-invasive reconstruction of the upper jaw. This technique abstains from the previous large-scale detachment of gingiva in favour of only minimal cuts for the endoscope (fig. 3: Dental endoscope).
An endoscopic keyhole access now replaces the windowing of the bone, i. e. instead of the previous open technique, a closed implantation directly through the gums is carried out now. The endoscopic technique, which high success rate has already been documented for more than five years, was improved by the use of a new 3D operation template (fig. 4: 3D Special template) in such a way that a precise implantation can mostly be carried out at the same time as the bone reconstruction in only one sitting. This shortens the treatment, facilitates the subsequent production of dental prostheses and reduces discomfort following the operation.

Fig. 4

Provided that the conditions for the operation are fulfilled, it will be planned in detail directly before the intervention with the help of the special template.
This saves time as well as additional appointments for treatment. Bone reconstruction can usually be carried out on the day of the first appointment. The duration of the intervention is between 30 and 120 minutes, depending on the degree of bone loss and on the number of dental implants to be inserted.

Advantages: Safety of treatment

• Template-guided implantation with high precision
• 3D computer planning in case of major bone loss
• Endoscopically controlled steps of treatment with video documentation
• Documented safety of treatment of the endoscopic procedure

Advantages: Low invasivity

• Exclusively ambulant treatment with local anaesthetics and sedation
• Little swelling of the wound
• Little discomfort following the intervention
• Maximum maintenance of bone substance
• Optimum pre-conditions for bone regeneration