Correcting maxillary sinus deficiencies

The use of hydraulic force to condense bone particulate into the maxillary sinus is a predictable and less invasive method of site preparation for many, but not all, dental implant candidates. It is our approach in the primary indication for HSC--patients with advanced periodontitis in whom insufficient cortical bone at the alveolar ridge of the posterior maxilla stands as a detriment to effective implantation. A second indication for HSC is for those patients who suffer blood disorders or sensitivity to certain medications, such as vasoconstrictors, and in whom it is crucial to manage bleeding during surgery. In these cases, changes in the armamentarium used for the procedure can effectively accommodate special needs. Indication three refers to the patient in whom robust bone is absent in some localized area of the sinus floor, possibly as a result of a failed implant or poor post-extraction healing. Hydraulic force in this scenario is abandoned altogether in favor of a special split-thickness soft dissection and graft that has shown predictable regenerative effect. Utilizing the techniques presented in this article, real-time chair side relief is a possibility for a much wider variety of patients. All clinical cases presented were followed for 10 years to show the continued success of the Hydraulic Sinus Condensing technique, and multiple follow-ups with the patients were performed. The sinus condensing instruments referenced in this article can be purchased separately from the Dental Implant Institute. The instrument set is specifically designed to aid in performing HSC with the least risk to the patient. Suitable replacement instruments may also be found with other traditional instrument manufacturers, though it may prove difficult to use when compared to the specifically designed Hydraulic Sinus Condensing instruments.