Placing implants Below the Maxillary Sinus – Challenges and solutions.

Alveolar ridge resorption has long been considered an unavoidable consequence of tooth extraction and can be a significant problem in implant and restorative dentistry.

A striking feature is the chronic progressive catabolic remodeling of the residual alveolar process that results in atrophy described as reduction of residual ridges. Through the years, multiple procedures and augmentation materials have emerged to augment deficient bony ridges. The augmentation of bony defects is done either in conjunction with the implant placement (simultaneous approach), or during a surgical intervention prior to implant placement (staged approach). The staged approach is primarily the treatment of choice in situations with large bone defects, where the primary stability of the implants in the prosthetically desired position is questionable. Bone augmentation procedures used in implant dentistry include, graft reconstruction, GBR, maxillary sinus floor elevation, and alveolar distraction osteogenesis. Sinus pneumatization is another factor that contributes to the problem in the maxillary posterior region. However, reconstruction using an inlay graft in the sinus have been thought to resolve the problem in some indications. Some cases of course required an intervention inside the sinus as well as onlay augmentation to the resorbed ridges. For decades, autogenous bone has been considered as the gold standard; however it has the disadvantages of donor site morbidity. An understanding of the biological processes of augmentation and graft replacement, the three processes: osteogenesis, osteoinduction, and osteoconduction, has questioned this thought with a notion to substitute autogenous bone with a combination of a non-autogenous scaffold and autologous Concentrated Growth Factors CGF, with some recent thoughts suggest the use of CGF alone without the addition of any mineral scaffold. The purpose of this presentation is to deliberate the various materials and modalities available for rehabilitation of atrophic posterior maxilla to restore with implant- supported prostheses, taking into account the amount of atrophy, the morbidity rate, any aesthetical concerns and prosthetic and functional compromise. Learning objectives:
  • Attendees will acquire the understanding of the challenges in placing implants in the posterior maxillary region
  • Attendees will acquire the knowledge of expansion pattern of the maxillary sinus
  • Attendees will acquire the knowledge of the expansion pattern of the maxillary sinus
  • Attendees will acquire the knowledge of the challenges a surgeon face when placing implants below the maxillary sinus
  • Attendees will acquire the knowledge of the role of Concentrated Growth Factors in tissue regeneration in the maxillary sinus.