Site development in the posterior maxilla using osteocompression and apical alveolar displacement

Implant placement in the posterior maxilla is often compromised by reduced bone quality and limited bone height beneath the sinus floor. Techniques have been developed using osteotomes to improve localized bone density through osteocompression and provide for additional implant length through apical alveolar displacement. The clinical indications and proposed limitations for these procedures are presented along with the biologic rationale based on relevant literature. The author cites his personal experience with osteotome procedures and presents procedural modifications to aid in simplifying staged sinus elevation. Localized internal sinus elevation may represent a more conservative approach to treat the deficient posterior maxilla, but at present the histologic and clinical comparisons to the traditional lateral sinus elevation are lacking.