Contemporary Aspects of Maxillary Sinus Floor Elevation Technique

Elevacija dna maksilarnog sinusa vrsta je operativnog zahvata kojim se premješta sinusno dno prema kranijalnoj kosti, uz istodobnu augmentaciju koštanog defekta, čime se postiže visina koštanog fundamenta neophodna za ugradnju implantata. Tehnike elevacije možemo podijeliti na klasične, u koje spadaju otvorena i zatvorena tehnika, te moderne tehnike, u koje spadaju elevacija dna maksilarnog sinusa balon-tehnikom i piezokirurgija.. Kod otvorene tehnike maksilarnom sinusu pristupamo s lateralne strane alveolarnog grebena. Ako je rezidualna visina alveolarne kosti manja od 5 mm, implantacija se odgađa za najmanje šest mjeseci. Zatvorena je tehnika minimalno invazivan zahvat sa transkrestalnim pristupom te je indicirana kad je visina alveolarne kosti 8–10 mm. Elevacija dna maksilarnog sinusa balon-tehnikom modifikacija je klasične zatvorene tehnike gdje se sinusna membrana podiže hidrauličkim tlakom upotrebom balona. Instrumenti u piezokirugiji koriste ultrazvučne frekvencije koje omogućuju mikrometrijske rezove, koji su precizni i sigurni jer tretiraju samo mineralizirana tkiva. Kontraindikacije su za sve zahvate imunokompromitirani pacijenti, lošeg općeg stanja. Komplikacije koje se tijekom zahvata mogu dogoditi jesu perforacija sinusne membrane te ozljede krvnih žila i živaca. Od postoperativnih komplikacija najčešće su sinusitis te oroantralna fistula, u slučaju kada nije pravodobno liječena perforirana membrana.Maxillary sinus floor elevation is an operative procedure that is used to move the sinus floor toward the cranial bone while simultaneously augmenting the bone defect with the purpose of creating sufficient height at the bone fundament, which is necessary for the placement of implants. The techniques for sinus elevation can be divided into the classic ones, which include the open and closed technique, and the modern ones, which include Ballon-Lift- Control sinus elevation technique and piezosurgery. When performing the open sinus lift technique, the sinus is approached from lateral side of the alveolar ridge. If the height of the residual alveolar ridge is less than 5 mm, the implantation has to be delayed for at least 6 months. The closed technique is a minimally invasive procedure with a transcrestal approach and it is indicated where the height of the alveolar bone is between 8 and 10 mm. Balloon-Lift-Control technique is a modification of the classic closed technique where the sinus membrane is raised with hydraulic pressure using a balloon. Instruments in piezosurgery use ultrasonic frequencies that allow micrometer cuts, which are precise and safe because they only treat the mineralized tissue. Contraindications for all techniques are immunocompromised patients with a poor general condition. Complications which can happen during the procedure are the sinus membrane perforation and the laceration of blood vessels and nerves. The most common post operation complications include sinusitis and oroantral fistula, which occur if the perforation of sinus membrane is not treated in time