HERZBERGER LANDSTRASSE 25A
37085 GOETTINGEN (GERMANY)
By applying endoscopy and 3D navigation, a new technique for minimal-invasive sinus lifting was created, which completely passes on the formation of flaps. The augmentation and implantation is carried out under maximum protection of hard and soft tissue. This technique was presented for the first time by Prof. Dr. Dr. Wilfried Engelke on the international foundation congress of the Global Oral Implant Academy (GOIA) in Bremen in May 2004. 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 (fig. 1/fig. 2), whose high success rate has already been documented for more than five years, was improved by the use of a new 3D operation template (fig. 3) 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.
The following work steps during the implantation are carried out under endoscopic control and under endoscopic assistance.
Bonemapping – Endoscopic documentation of the mounting bone
During the endoscopic investigation of the bony implant cavity, the endoscope is inserted into the bore hole and the whole course of the bore is examined (fig. 4: Endoscopy of a bone cavity). The results are documented by video. In addition to the physiological bone structure, the spongiosa (fig. 6) and the compacta (fig. 7), degenerative alterations (fig. 8) or osseous dysplasias are also evident. Possible fenestrations and penetrations in the adjoining structures are shown. Moreover, contaminating of the bone with metal splinters is discovered.
The subantroscopic latero-basal sinus floor augmentation: SALSA technique
Schematics of the method
The access is carried out through a dental trepanation of the bony wall of the maxillary sinus with a diameter of about 5 mm, directly anterobasal of the crista zygomaticoalveolaris. Starting from the bony trepanation, the mucosa of the maxillary sinus is detached in the area of the recessus alveolaris.
By expanding the tunnel up to the back wall of the maxillary sinus, the subantral area is created under cranial shifting of the mucosa of the maxillary sinus. This gets thoroughly examined regarding its dimension and regarding the condition of the detached mucosa of the maxillary sinus.
During the step-by-step augmentation, the distal part of the subantral area is augmented first and is controlled endoscopically. After inserting the distal implant, the position of augmentation and implant is checked again.
The middle part gets augmentated last, and the third implant in this area is inserted near the place of trepanation.
The combination of the presented endoscopic techniques with the computer-supported 3D navigation nowadays renders it possible to carry out a sinus lifting without flap formation under simultaneous implantation.
For the patient, this new method involves smaller wound areas, less danger of bleeding and therefore less swelling and pain. For the surgeon, this new technique brings along a longer period of adjustment to the endoscopic techniques. Eventually, however, this leads to a significantly higher quality of operation.
