Comparative evaluation of extent of sinus lift achieved by crestal approach and Osseodensification: A Randomized controlled trial

With the rise of implant dentistry, dental implants have become the favored and reliable method for replacing missing teeth. However, optimal osseointegration after implant placement requires sufficient quality and quantity of live bone surrounding the osteotomy, ideally 2mm or more. Sinus pneumatization poses a challenge to successful endosseous implant placement in the posterior maxilla. Elevating the sinus is often necessary to facilitate implant placement, requiring the operating clinician’s familiarity with sinus anatomy to prevent intraoperative complications. Various techniques for sinus augmentation have been developed and proven to yield successful outcomes. Over half of implants inserted in the posterior maxilla necessitate sinus floor elevation (SFE). This necessity arises from continuous ridge resorption following tooth extraction, coupled with progressive sinus pneumatization and the common occurrence of poor bone quality in the maxilla. Sinus membrane perforation is identified as the primary complication during SFE procedures, with the incidence varying based on the technique employed. Perforations may occur during either the fracturing of the sinus floor or the elevation of the mucosa. Here, we will compare two distinct techniques of indirect sinus lift, known interchangeably as sinus lift, sinus augmentation, sinus floor elevation, or augmentation of an atrophic maxillary sinus. The two techniques of indirect sinus lifting we will compare are

1.) Crestal approach

2.) Osseodensification approach

The crestal approach to the sinus offers a safe and effective method for sinus elevation. This approach utilizes a reamer, known as the CAS drill, to create a conical-shaped osteotomy and fracture the bony floor. The osseodensification (OD) technique involves a specialized set of burs that operate through a non-excavating drilling process. Rotating counterclockwise, these burs induce low plastic deformation of trabecular bone, leading to bone accumulation apically and laterally. This approach has demonstrated high success rates in crestal sinus floor elevation with minimal risk of membrane perforation, utilizing osseodensification (OD) burs, which rotate in the noncutting counterclockwise (CCW) direction