Geistlich - Indication sheets S3 - Sinus floor augmentation

Sinus floor augmentation 4.4 Septa References Pascal Valentini: « When a septum is detected by the radiograph and the insertion of the bony lid is impossible, two separate lateral windows have to be established, one mesial and the other distal to the septum. The bony lid has to be removed completely and the sinus membrane is detached with caution.» In the case of a septum, two separate lateral windows have been prepared. 31182.2/0604/e Indication sheet S3 1 2 3 4 5 Del Fabbro M., Testori T., Francetti L., Weinstein R.; Int J Periodontics Restorative Dent, 24:565-577;2004 Wallace S., Froum S.; Ann Periodontol, 8:328-343;2003 Valentini P., Abensur D.; Int J Oral Maxillofac Implants, 18:556-560;2003 Hallmann M., Sennerby L., Lundgren S.; Int J Oral Maxillofac Implants, 17, pp: 635-643, 2002 Valentini P., Abensur D., Wenz B., Peetz M., Schenk R.; Int J Periodontics Restorative Dent 2000;20 Application of Bio-Oss® from both windows. Clinical procedure by Dr Pascal Valentini University of Corsica, France 4.5 Avoiding perforations of the sinus membrane Pascal Valentini: “1. At the beginning of the osteotomy, in the case of a thin bony wall, I recommend blunt diamond burs or, even better, ultrasonic instruments. 2. Initially, when the first 2 mm of the bony lid is detached, it is advantageous to use a disc-shaped ultrasonic end piece. 3. The presence of septa or osseous irregularities (e.g. extraction sites, tooth roots that extend into the antrum) increase the risk of perforations of the sinus membrane. Scar tissue is strongly adherent. Therefore, I use an ultrasonic end piece in order to release the bone without damaging the sinus membrane.” > Sinus floor augmentation with lateral access, simultaneous and staged > Avoiding autogenous bone grafts > Dealing with septa and perforations of the sinus membrane 4.6 What to do when perforations of the sinus membrane occur? Pascal Valentini: “The sinus membrane should be carefully detached from the bone wall at a reasonable distance from the perforation, thus loosening tension from the membrane and reducing the size of the perforation. According to my experience a dry Bio-Gide® should be subsequently placed over the perforation. Only after the Bio-Gide® is positioned a flat instrument can be used to moisten Bio-Gide®.” 1. Decision criteria according to Pascal Valentini Augmentation technique depending on residual bone height x x Addition of autogenous bone x x Membrane application x x Implant loading Bio-Gide® in situ, covering a perforation of the Schneiderian membrane. 5 x 1 Standard implantation without augmentation > 8 mm residual bone height Osteotome technique: not applied One-stage procedure > 2 – 3 mm bone height Two-stage procedure < 2 – 3 mm bone height Yes No Over the lateral window In case of perforations of the sinus membrane to cover the tears 2 months after implantation for two-stage procedure 4 months after augmentation and implantation 6 months after augmentation and implantation for one-stage procedure © Geistlich Pharma AG Division Biomaterials CH - 6110 Wolhusen, Switzerland Tel. ++ 41- 41 - 49 25 -630 Fax ++ 41- 41 - 49 25 -639 www.geistlich.com 6

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