Sinus Grafting in the Presence of Pathology · PDF fileInability to repair perforations...
Transcript of Sinus Grafting in the Presence of Pathology · PDF fileInability to repair perforations...
1
Michael A Pikos DDS
December 12 2013
Advanced Bone Grafting Techniques for Clinical Success
Sinus Grafting in the
Presence of Pathology
June 2012
2
Adjunct Assistant Professor
Department of Oral amp Maxillofacial Surgery
bullThe Ohio State University
College of Dentistry
bullNova Southeastern University College of Dental Medicine
Courtesy Clinical Associate Professor
Departments of Periodontology and Prosthodontics
bullUniversity of Florida College of Dentistry
Course Attendees
(1990 ndash Present)
bull gt 2700
bull All 50 States
bull 32 Countries
3
Thickened Sinus Membrane
What would you do
Polyps
What would you do
Mucous Retention Cyst
What would you do
4
Thickened Sinus
Membrane
Polyps Mucous Retention
Cyst
ldquoImage modalities use sensors to record
various aspects of human anatomy but
the quality of information from different
sources varies The gold standard
against which all imaging modalities can
be compared is ldquoanatomic truthrdquo as it
exists in vivordquo
ndash Hatcher D 2005 Carestream
9300
Pikos Institute Protocol
Sequential CT Diagnosis For
Sinus Graft Implant Reconstruction
bull Define recipient site parameters
ndash Assess horizontal and vertical dimensions
5
bull Define recipient site parameters
ndash Assess horizontal and vertical dimensions
ndash Verify OMC patency
Pikos Institute Protocol
Sequential CT Diagnosis For
Sinus Graft Implant Reconstruction
bull Define recipient site parameters
ndash Assess horizontal and vertical dimensions
ndash Verify OMC patency
ndash Identify septa
Pikos Institute Protocol
Sequential CT Diagnosis For
Sinus Graft Implant Reconstruction
bull Define recipient site parameters
ndash Assess horizontal and vertical dimensions
ndash Verify OMC patency
ndash Identify septa
ndash Rule out pathology
Pikos Institute Protocol
Sequential CT Diagnosis For
Sinus Graft Implant Reconstruction
6
Benefits of Interactive CT Diagnosis For
Sinus Graft Implant Reconstruction
bull Direct assessment of defect in three
dimensions before surgery
bull Quantitative and qualitative evaluation
of mandibular donor sites
bull Increase situational awareness
bull Increase predictability
bull Decrease surgical risk and complications
Materials and Methods
bull 45 patients with sinus lift evaluated for sinus pathology
12-60 months after bone grafting amp Stage I
bull Questionnaire conventional radiographic examination and
nasal endoscopy
Results
bull Post-op maxillary sinusitis in 25 patients with predisposition for
sinusitis-but none of the remaining 40 patients
bull Occurrence of perforation was not related to the development of post-
op sinusitis in patients with healthy sinuses
Timmenga NM Raghoebar GM Boering G Van Weissenbruch R
Maxillary sinus function after sinus lifts for the insertion of dental implants
J Oral Maxillofac Surg 199755936-939
Conclusion
bull Post-op chronic sinusitis appears to be limited to patients
with a predisposition for this condition
Pikos Sinus Graft Experience (1989-2010)
bull Highly predictable and successful
bull 21 yr + ( gt98 implant success)
bull gt 1000 grafts
bull gt 2400 implants
bull Infection rate = 6 bull 3 failed grafts
bull Morbidity minimal
bull Cost effective
7
Thickened Sinus Membrane
8
Pikos MA
Maxillary sinus membrane repair report of a
technique for large perforations
Implant Dentistry 19998(1)29-34
Single Stage
Sinus Graft
9
Fibrin Clot
(PRGF)
A procedure for tissue
regeneration based on the
utilization of an autologous
preparation rich in Growth
Factors
What is Plasma Rich in Growth Factors Anitua E
The Use of plasma-rich growth
factors (PRGF) in oral surgery
Pract Proced Aesthet Dent 2001 Aug13(6)487-93
Anitua E et al
Autologous platelets as a source of proteins for healing and tissue regeneration Thromb Haemost
2004 Jan91(1)4-15
10
11
7 mo
12
Polyps
13
Fibrin Clot
(PRGF)
4 mo
14
Fibrotic
Polypoid Tissue
15
9 mo
Bhattacharyya N
Do maxillary sinus
retention cysts reflect
obstructive sinus
phenomena
Arch Otolaryngol Head
Neck Surg
20001261369-1371
Objective To determine the relation of maxillary sinus
retention cyst (RCs) to osteomeatal complex (OMC) obstruction and anatomic variation of the paranasal
sinuses
Methods 410 CT scans reviewed during one year
academic period
Results incidence of RCs was 124 (51 cases)
Conclusion Maxillary sinus RCs do not reflect persistent obstructive pathology of the OMC and are not associated
with potentially obstructive anatomic sinus variations
Jensen OT Shulman LB Block MS Iacono VJ
Report of the Sinus Consensus Conference of 1996 Int J Oral Maxillofac Implants
1998 13 (suppl) 11-12
Results of failure analysis demonstrated that of 164 failures analyzed 79 (48)
could be attributed to perioperative complications 38 (48) of which were associated with sinus membrane perforations
16
Mucous Retention Cyst
Pikos MA
Case Report Sinus grafting in the presence of a large mucous
retention cyst
Journal of Clinical amp Practical Oral
Implantology
2010 Vol 1
Issue 2 5-14
17
18
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus
Membrane
Repair Update on Technique
for Large
and Complete Perforations
Implant Dent
2008 Mar17(1)24-31
19
7 mo
82 Vital Bone
20
3 mo
21
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
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7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
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8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
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10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
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22
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23
To Graft Or Not To Graft
12122013
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25
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26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
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36
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37
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38
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39
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40
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45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
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50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
2
Adjunct Assistant Professor
Department of Oral amp Maxillofacial Surgery
bullThe Ohio State University
College of Dentistry
bullNova Southeastern University College of Dental Medicine
Courtesy Clinical Associate Professor
Departments of Periodontology and Prosthodontics
bullUniversity of Florida College of Dentistry
Course Attendees
(1990 ndash Present)
bull gt 2700
bull All 50 States
bull 32 Countries
3
Thickened Sinus Membrane
What would you do
Polyps
What would you do
Mucous Retention Cyst
What would you do
4
Thickened Sinus
Membrane
Polyps Mucous Retention
Cyst
ldquoImage modalities use sensors to record
various aspects of human anatomy but
the quality of information from different
sources varies The gold standard
against which all imaging modalities can
be compared is ldquoanatomic truthrdquo as it
exists in vivordquo
ndash Hatcher D 2005 Carestream
9300
Pikos Institute Protocol
Sequential CT Diagnosis For
Sinus Graft Implant Reconstruction
bull Define recipient site parameters
ndash Assess horizontal and vertical dimensions
5
bull Define recipient site parameters
ndash Assess horizontal and vertical dimensions
ndash Verify OMC patency
Pikos Institute Protocol
Sequential CT Diagnosis For
Sinus Graft Implant Reconstruction
bull Define recipient site parameters
ndash Assess horizontal and vertical dimensions
ndash Verify OMC patency
ndash Identify septa
Pikos Institute Protocol
Sequential CT Diagnosis For
Sinus Graft Implant Reconstruction
bull Define recipient site parameters
ndash Assess horizontal and vertical dimensions
ndash Verify OMC patency
ndash Identify septa
ndash Rule out pathology
Pikos Institute Protocol
Sequential CT Diagnosis For
Sinus Graft Implant Reconstruction
6
Benefits of Interactive CT Diagnosis For
Sinus Graft Implant Reconstruction
bull Direct assessment of defect in three
dimensions before surgery
bull Quantitative and qualitative evaluation
of mandibular donor sites
bull Increase situational awareness
bull Increase predictability
bull Decrease surgical risk and complications
Materials and Methods
bull 45 patients with sinus lift evaluated for sinus pathology
12-60 months after bone grafting amp Stage I
bull Questionnaire conventional radiographic examination and
nasal endoscopy
Results
bull Post-op maxillary sinusitis in 25 patients with predisposition for
sinusitis-but none of the remaining 40 patients
bull Occurrence of perforation was not related to the development of post-
op sinusitis in patients with healthy sinuses
Timmenga NM Raghoebar GM Boering G Van Weissenbruch R
Maxillary sinus function after sinus lifts for the insertion of dental implants
J Oral Maxillofac Surg 199755936-939
Conclusion
bull Post-op chronic sinusitis appears to be limited to patients
with a predisposition for this condition
Pikos Sinus Graft Experience (1989-2010)
bull Highly predictable and successful
bull 21 yr + ( gt98 implant success)
bull gt 1000 grafts
bull gt 2400 implants
bull Infection rate = 6 bull 3 failed grafts
bull Morbidity minimal
bull Cost effective
7
Thickened Sinus Membrane
8
Pikos MA
Maxillary sinus membrane repair report of a
technique for large perforations
Implant Dentistry 19998(1)29-34
Single Stage
Sinus Graft
9
Fibrin Clot
(PRGF)
A procedure for tissue
regeneration based on the
utilization of an autologous
preparation rich in Growth
Factors
What is Plasma Rich in Growth Factors Anitua E
The Use of plasma-rich growth
factors (PRGF) in oral surgery
Pract Proced Aesthet Dent 2001 Aug13(6)487-93
Anitua E et al
Autologous platelets as a source of proteins for healing and tissue regeneration Thromb Haemost
2004 Jan91(1)4-15
10
11
7 mo
12
Polyps
13
Fibrin Clot
(PRGF)
4 mo
14
Fibrotic
Polypoid Tissue
15
9 mo
Bhattacharyya N
Do maxillary sinus
retention cysts reflect
obstructive sinus
phenomena
Arch Otolaryngol Head
Neck Surg
20001261369-1371
Objective To determine the relation of maxillary sinus
retention cyst (RCs) to osteomeatal complex (OMC) obstruction and anatomic variation of the paranasal
sinuses
Methods 410 CT scans reviewed during one year
academic period
Results incidence of RCs was 124 (51 cases)
Conclusion Maxillary sinus RCs do not reflect persistent obstructive pathology of the OMC and are not associated
with potentially obstructive anatomic sinus variations
Jensen OT Shulman LB Block MS Iacono VJ
Report of the Sinus Consensus Conference of 1996 Int J Oral Maxillofac Implants
1998 13 (suppl) 11-12
Results of failure analysis demonstrated that of 164 failures analyzed 79 (48)
could be attributed to perioperative complications 38 (48) of which were associated with sinus membrane perforations
16
Mucous Retention Cyst
Pikos MA
Case Report Sinus grafting in the presence of a large mucous
retention cyst
Journal of Clinical amp Practical Oral
Implantology
2010 Vol 1
Issue 2 5-14
17
18
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus
Membrane
Repair Update on Technique
for Large
and Complete Perforations
Implant Dent
2008 Mar17(1)24-31
19
7 mo
82 Vital Bone
20
3 mo
21
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
3
Thickened Sinus Membrane
What would you do
Polyps
What would you do
Mucous Retention Cyst
What would you do
4
Thickened Sinus
Membrane
Polyps Mucous Retention
Cyst
ldquoImage modalities use sensors to record
various aspects of human anatomy but
the quality of information from different
sources varies The gold standard
against which all imaging modalities can
be compared is ldquoanatomic truthrdquo as it
exists in vivordquo
ndash Hatcher D 2005 Carestream
9300
Pikos Institute Protocol
Sequential CT Diagnosis For
Sinus Graft Implant Reconstruction
bull Define recipient site parameters
ndash Assess horizontal and vertical dimensions
5
bull Define recipient site parameters
ndash Assess horizontal and vertical dimensions
ndash Verify OMC patency
Pikos Institute Protocol
Sequential CT Diagnosis For
Sinus Graft Implant Reconstruction
bull Define recipient site parameters
ndash Assess horizontal and vertical dimensions
ndash Verify OMC patency
ndash Identify septa
Pikos Institute Protocol
Sequential CT Diagnosis For
Sinus Graft Implant Reconstruction
bull Define recipient site parameters
ndash Assess horizontal and vertical dimensions
ndash Verify OMC patency
ndash Identify septa
ndash Rule out pathology
Pikos Institute Protocol
Sequential CT Diagnosis For
Sinus Graft Implant Reconstruction
6
Benefits of Interactive CT Diagnosis For
Sinus Graft Implant Reconstruction
bull Direct assessment of defect in three
dimensions before surgery
bull Quantitative and qualitative evaluation
of mandibular donor sites
bull Increase situational awareness
bull Increase predictability
bull Decrease surgical risk and complications
Materials and Methods
bull 45 patients with sinus lift evaluated for sinus pathology
12-60 months after bone grafting amp Stage I
bull Questionnaire conventional radiographic examination and
nasal endoscopy
Results
bull Post-op maxillary sinusitis in 25 patients with predisposition for
sinusitis-but none of the remaining 40 patients
bull Occurrence of perforation was not related to the development of post-
op sinusitis in patients with healthy sinuses
Timmenga NM Raghoebar GM Boering G Van Weissenbruch R
Maxillary sinus function after sinus lifts for the insertion of dental implants
J Oral Maxillofac Surg 199755936-939
Conclusion
bull Post-op chronic sinusitis appears to be limited to patients
with a predisposition for this condition
Pikos Sinus Graft Experience (1989-2010)
bull Highly predictable and successful
bull 21 yr + ( gt98 implant success)
bull gt 1000 grafts
bull gt 2400 implants
bull Infection rate = 6 bull 3 failed grafts
bull Morbidity minimal
bull Cost effective
7
Thickened Sinus Membrane
8
Pikos MA
Maxillary sinus membrane repair report of a
technique for large perforations
Implant Dentistry 19998(1)29-34
Single Stage
Sinus Graft
9
Fibrin Clot
(PRGF)
A procedure for tissue
regeneration based on the
utilization of an autologous
preparation rich in Growth
Factors
What is Plasma Rich in Growth Factors Anitua E
The Use of plasma-rich growth
factors (PRGF) in oral surgery
Pract Proced Aesthet Dent 2001 Aug13(6)487-93
Anitua E et al
Autologous platelets as a source of proteins for healing and tissue regeneration Thromb Haemost
2004 Jan91(1)4-15
10
11
7 mo
12
Polyps
13
Fibrin Clot
(PRGF)
4 mo
14
Fibrotic
Polypoid Tissue
15
9 mo
Bhattacharyya N
Do maxillary sinus
retention cysts reflect
obstructive sinus
phenomena
Arch Otolaryngol Head
Neck Surg
20001261369-1371
Objective To determine the relation of maxillary sinus
retention cyst (RCs) to osteomeatal complex (OMC) obstruction and anatomic variation of the paranasal
sinuses
Methods 410 CT scans reviewed during one year
academic period
Results incidence of RCs was 124 (51 cases)
Conclusion Maxillary sinus RCs do not reflect persistent obstructive pathology of the OMC and are not associated
with potentially obstructive anatomic sinus variations
Jensen OT Shulman LB Block MS Iacono VJ
Report of the Sinus Consensus Conference of 1996 Int J Oral Maxillofac Implants
1998 13 (suppl) 11-12
Results of failure analysis demonstrated that of 164 failures analyzed 79 (48)
could be attributed to perioperative complications 38 (48) of which were associated with sinus membrane perforations
16
Mucous Retention Cyst
Pikos MA
Case Report Sinus grafting in the presence of a large mucous
retention cyst
Journal of Clinical amp Practical Oral
Implantology
2010 Vol 1
Issue 2 5-14
17
18
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus
Membrane
Repair Update on Technique
for Large
and Complete Perforations
Implant Dent
2008 Mar17(1)24-31
19
7 mo
82 Vital Bone
20
3 mo
21
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
4
Thickened Sinus
Membrane
Polyps Mucous Retention
Cyst
ldquoImage modalities use sensors to record
various aspects of human anatomy but
the quality of information from different
sources varies The gold standard
against which all imaging modalities can
be compared is ldquoanatomic truthrdquo as it
exists in vivordquo
ndash Hatcher D 2005 Carestream
9300
Pikos Institute Protocol
Sequential CT Diagnosis For
Sinus Graft Implant Reconstruction
bull Define recipient site parameters
ndash Assess horizontal and vertical dimensions
5
bull Define recipient site parameters
ndash Assess horizontal and vertical dimensions
ndash Verify OMC patency
Pikos Institute Protocol
Sequential CT Diagnosis For
Sinus Graft Implant Reconstruction
bull Define recipient site parameters
ndash Assess horizontal and vertical dimensions
ndash Verify OMC patency
ndash Identify septa
Pikos Institute Protocol
Sequential CT Diagnosis For
Sinus Graft Implant Reconstruction
bull Define recipient site parameters
ndash Assess horizontal and vertical dimensions
ndash Verify OMC patency
ndash Identify septa
ndash Rule out pathology
Pikos Institute Protocol
Sequential CT Diagnosis For
Sinus Graft Implant Reconstruction
6
Benefits of Interactive CT Diagnosis For
Sinus Graft Implant Reconstruction
bull Direct assessment of defect in three
dimensions before surgery
bull Quantitative and qualitative evaluation
of mandibular donor sites
bull Increase situational awareness
bull Increase predictability
bull Decrease surgical risk and complications
Materials and Methods
bull 45 patients with sinus lift evaluated for sinus pathology
12-60 months after bone grafting amp Stage I
bull Questionnaire conventional radiographic examination and
nasal endoscopy
Results
bull Post-op maxillary sinusitis in 25 patients with predisposition for
sinusitis-but none of the remaining 40 patients
bull Occurrence of perforation was not related to the development of post-
op sinusitis in patients with healthy sinuses
Timmenga NM Raghoebar GM Boering G Van Weissenbruch R
Maxillary sinus function after sinus lifts for the insertion of dental implants
J Oral Maxillofac Surg 199755936-939
Conclusion
bull Post-op chronic sinusitis appears to be limited to patients
with a predisposition for this condition
Pikos Sinus Graft Experience (1989-2010)
bull Highly predictable and successful
bull 21 yr + ( gt98 implant success)
bull gt 1000 grafts
bull gt 2400 implants
bull Infection rate = 6 bull 3 failed grafts
bull Morbidity minimal
bull Cost effective
7
Thickened Sinus Membrane
8
Pikos MA
Maxillary sinus membrane repair report of a
technique for large perforations
Implant Dentistry 19998(1)29-34
Single Stage
Sinus Graft
9
Fibrin Clot
(PRGF)
A procedure for tissue
regeneration based on the
utilization of an autologous
preparation rich in Growth
Factors
What is Plasma Rich in Growth Factors Anitua E
The Use of plasma-rich growth
factors (PRGF) in oral surgery
Pract Proced Aesthet Dent 2001 Aug13(6)487-93
Anitua E et al
Autologous platelets as a source of proteins for healing and tissue regeneration Thromb Haemost
2004 Jan91(1)4-15
10
11
7 mo
12
Polyps
13
Fibrin Clot
(PRGF)
4 mo
14
Fibrotic
Polypoid Tissue
15
9 mo
Bhattacharyya N
Do maxillary sinus
retention cysts reflect
obstructive sinus
phenomena
Arch Otolaryngol Head
Neck Surg
20001261369-1371
Objective To determine the relation of maxillary sinus
retention cyst (RCs) to osteomeatal complex (OMC) obstruction and anatomic variation of the paranasal
sinuses
Methods 410 CT scans reviewed during one year
academic period
Results incidence of RCs was 124 (51 cases)
Conclusion Maxillary sinus RCs do not reflect persistent obstructive pathology of the OMC and are not associated
with potentially obstructive anatomic sinus variations
Jensen OT Shulman LB Block MS Iacono VJ
Report of the Sinus Consensus Conference of 1996 Int J Oral Maxillofac Implants
1998 13 (suppl) 11-12
Results of failure analysis demonstrated that of 164 failures analyzed 79 (48)
could be attributed to perioperative complications 38 (48) of which were associated with sinus membrane perforations
16
Mucous Retention Cyst
Pikos MA
Case Report Sinus grafting in the presence of a large mucous
retention cyst
Journal of Clinical amp Practical Oral
Implantology
2010 Vol 1
Issue 2 5-14
17
18
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus
Membrane
Repair Update on Technique
for Large
and Complete Perforations
Implant Dent
2008 Mar17(1)24-31
19
7 mo
82 Vital Bone
20
3 mo
21
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
5
bull Define recipient site parameters
ndash Assess horizontal and vertical dimensions
ndash Verify OMC patency
Pikos Institute Protocol
Sequential CT Diagnosis For
Sinus Graft Implant Reconstruction
bull Define recipient site parameters
ndash Assess horizontal and vertical dimensions
ndash Verify OMC patency
ndash Identify septa
Pikos Institute Protocol
Sequential CT Diagnosis For
Sinus Graft Implant Reconstruction
bull Define recipient site parameters
ndash Assess horizontal and vertical dimensions
ndash Verify OMC patency
ndash Identify septa
ndash Rule out pathology
Pikos Institute Protocol
Sequential CT Diagnosis For
Sinus Graft Implant Reconstruction
6
Benefits of Interactive CT Diagnosis For
Sinus Graft Implant Reconstruction
bull Direct assessment of defect in three
dimensions before surgery
bull Quantitative and qualitative evaluation
of mandibular donor sites
bull Increase situational awareness
bull Increase predictability
bull Decrease surgical risk and complications
Materials and Methods
bull 45 patients with sinus lift evaluated for sinus pathology
12-60 months after bone grafting amp Stage I
bull Questionnaire conventional radiographic examination and
nasal endoscopy
Results
bull Post-op maxillary sinusitis in 25 patients with predisposition for
sinusitis-but none of the remaining 40 patients
bull Occurrence of perforation was not related to the development of post-
op sinusitis in patients with healthy sinuses
Timmenga NM Raghoebar GM Boering G Van Weissenbruch R
Maxillary sinus function after sinus lifts for the insertion of dental implants
J Oral Maxillofac Surg 199755936-939
Conclusion
bull Post-op chronic sinusitis appears to be limited to patients
with a predisposition for this condition
Pikos Sinus Graft Experience (1989-2010)
bull Highly predictable and successful
bull 21 yr + ( gt98 implant success)
bull gt 1000 grafts
bull gt 2400 implants
bull Infection rate = 6 bull 3 failed grafts
bull Morbidity minimal
bull Cost effective
7
Thickened Sinus Membrane
8
Pikos MA
Maxillary sinus membrane repair report of a
technique for large perforations
Implant Dentistry 19998(1)29-34
Single Stage
Sinus Graft
9
Fibrin Clot
(PRGF)
A procedure for tissue
regeneration based on the
utilization of an autologous
preparation rich in Growth
Factors
What is Plasma Rich in Growth Factors Anitua E
The Use of plasma-rich growth
factors (PRGF) in oral surgery
Pract Proced Aesthet Dent 2001 Aug13(6)487-93
Anitua E et al
Autologous platelets as a source of proteins for healing and tissue regeneration Thromb Haemost
2004 Jan91(1)4-15
10
11
7 mo
12
Polyps
13
Fibrin Clot
(PRGF)
4 mo
14
Fibrotic
Polypoid Tissue
15
9 mo
Bhattacharyya N
Do maxillary sinus
retention cysts reflect
obstructive sinus
phenomena
Arch Otolaryngol Head
Neck Surg
20001261369-1371
Objective To determine the relation of maxillary sinus
retention cyst (RCs) to osteomeatal complex (OMC) obstruction and anatomic variation of the paranasal
sinuses
Methods 410 CT scans reviewed during one year
academic period
Results incidence of RCs was 124 (51 cases)
Conclusion Maxillary sinus RCs do not reflect persistent obstructive pathology of the OMC and are not associated
with potentially obstructive anatomic sinus variations
Jensen OT Shulman LB Block MS Iacono VJ
Report of the Sinus Consensus Conference of 1996 Int J Oral Maxillofac Implants
1998 13 (suppl) 11-12
Results of failure analysis demonstrated that of 164 failures analyzed 79 (48)
could be attributed to perioperative complications 38 (48) of which were associated with sinus membrane perforations
16
Mucous Retention Cyst
Pikos MA
Case Report Sinus grafting in the presence of a large mucous
retention cyst
Journal of Clinical amp Practical Oral
Implantology
2010 Vol 1
Issue 2 5-14
17
18
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus
Membrane
Repair Update on Technique
for Large
and Complete Perforations
Implant Dent
2008 Mar17(1)24-31
19
7 mo
82 Vital Bone
20
3 mo
21
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
6
Benefits of Interactive CT Diagnosis For
Sinus Graft Implant Reconstruction
bull Direct assessment of defect in three
dimensions before surgery
bull Quantitative and qualitative evaluation
of mandibular donor sites
bull Increase situational awareness
bull Increase predictability
bull Decrease surgical risk and complications
Materials and Methods
bull 45 patients with sinus lift evaluated for sinus pathology
12-60 months after bone grafting amp Stage I
bull Questionnaire conventional radiographic examination and
nasal endoscopy
Results
bull Post-op maxillary sinusitis in 25 patients with predisposition for
sinusitis-but none of the remaining 40 patients
bull Occurrence of perforation was not related to the development of post-
op sinusitis in patients with healthy sinuses
Timmenga NM Raghoebar GM Boering G Van Weissenbruch R
Maxillary sinus function after sinus lifts for the insertion of dental implants
J Oral Maxillofac Surg 199755936-939
Conclusion
bull Post-op chronic sinusitis appears to be limited to patients
with a predisposition for this condition
Pikos Sinus Graft Experience (1989-2010)
bull Highly predictable and successful
bull 21 yr + ( gt98 implant success)
bull gt 1000 grafts
bull gt 2400 implants
bull Infection rate = 6 bull 3 failed grafts
bull Morbidity minimal
bull Cost effective
7
Thickened Sinus Membrane
8
Pikos MA
Maxillary sinus membrane repair report of a
technique for large perforations
Implant Dentistry 19998(1)29-34
Single Stage
Sinus Graft
9
Fibrin Clot
(PRGF)
A procedure for tissue
regeneration based on the
utilization of an autologous
preparation rich in Growth
Factors
What is Plasma Rich in Growth Factors Anitua E
The Use of plasma-rich growth
factors (PRGF) in oral surgery
Pract Proced Aesthet Dent 2001 Aug13(6)487-93
Anitua E et al
Autologous platelets as a source of proteins for healing and tissue regeneration Thromb Haemost
2004 Jan91(1)4-15
10
11
7 mo
12
Polyps
13
Fibrin Clot
(PRGF)
4 mo
14
Fibrotic
Polypoid Tissue
15
9 mo
Bhattacharyya N
Do maxillary sinus
retention cysts reflect
obstructive sinus
phenomena
Arch Otolaryngol Head
Neck Surg
20001261369-1371
Objective To determine the relation of maxillary sinus
retention cyst (RCs) to osteomeatal complex (OMC) obstruction and anatomic variation of the paranasal
sinuses
Methods 410 CT scans reviewed during one year
academic period
Results incidence of RCs was 124 (51 cases)
Conclusion Maxillary sinus RCs do not reflect persistent obstructive pathology of the OMC and are not associated
with potentially obstructive anatomic sinus variations
Jensen OT Shulman LB Block MS Iacono VJ
Report of the Sinus Consensus Conference of 1996 Int J Oral Maxillofac Implants
1998 13 (suppl) 11-12
Results of failure analysis demonstrated that of 164 failures analyzed 79 (48)
could be attributed to perioperative complications 38 (48) of which were associated with sinus membrane perforations
16
Mucous Retention Cyst
Pikos MA
Case Report Sinus grafting in the presence of a large mucous
retention cyst
Journal of Clinical amp Practical Oral
Implantology
2010 Vol 1
Issue 2 5-14
17
18
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus
Membrane
Repair Update on Technique
for Large
and Complete Perforations
Implant Dent
2008 Mar17(1)24-31
19
7 mo
82 Vital Bone
20
3 mo
21
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
7
Thickened Sinus Membrane
8
Pikos MA
Maxillary sinus membrane repair report of a
technique for large perforations
Implant Dentistry 19998(1)29-34
Single Stage
Sinus Graft
9
Fibrin Clot
(PRGF)
A procedure for tissue
regeneration based on the
utilization of an autologous
preparation rich in Growth
Factors
What is Plasma Rich in Growth Factors Anitua E
The Use of plasma-rich growth
factors (PRGF) in oral surgery
Pract Proced Aesthet Dent 2001 Aug13(6)487-93
Anitua E et al
Autologous platelets as a source of proteins for healing and tissue regeneration Thromb Haemost
2004 Jan91(1)4-15
10
11
7 mo
12
Polyps
13
Fibrin Clot
(PRGF)
4 mo
14
Fibrotic
Polypoid Tissue
15
9 mo
Bhattacharyya N
Do maxillary sinus
retention cysts reflect
obstructive sinus
phenomena
Arch Otolaryngol Head
Neck Surg
20001261369-1371
Objective To determine the relation of maxillary sinus
retention cyst (RCs) to osteomeatal complex (OMC) obstruction and anatomic variation of the paranasal
sinuses
Methods 410 CT scans reviewed during one year
academic period
Results incidence of RCs was 124 (51 cases)
Conclusion Maxillary sinus RCs do not reflect persistent obstructive pathology of the OMC and are not associated
with potentially obstructive anatomic sinus variations
Jensen OT Shulman LB Block MS Iacono VJ
Report of the Sinus Consensus Conference of 1996 Int J Oral Maxillofac Implants
1998 13 (suppl) 11-12
Results of failure analysis demonstrated that of 164 failures analyzed 79 (48)
could be attributed to perioperative complications 38 (48) of which were associated with sinus membrane perforations
16
Mucous Retention Cyst
Pikos MA
Case Report Sinus grafting in the presence of a large mucous
retention cyst
Journal of Clinical amp Practical Oral
Implantology
2010 Vol 1
Issue 2 5-14
17
18
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus
Membrane
Repair Update on Technique
for Large
and Complete Perforations
Implant Dent
2008 Mar17(1)24-31
19
7 mo
82 Vital Bone
20
3 mo
21
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
8
Pikos MA
Maxillary sinus membrane repair report of a
technique for large perforations
Implant Dentistry 19998(1)29-34
Single Stage
Sinus Graft
9
Fibrin Clot
(PRGF)
A procedure for tissue
regeneration based on the
utilization of an autologous
preparation rich in Growth
Factors
What is Plasma Rich in Growth Factors Anitua E
The Use of plasma-rich growth
factors (PRGF) in oral surgery
Pract Proced Aesthet Dent 2001 Aug13(6)487-93
Anitua E et al
Autologous platelets as a source of proteins for healing and tissue regeneration Thromb Haemost
2004 Jan91(1)4-15
10
11
7 mo
12
Polyps
13
Fibrin Clot
(PRGF)
4 mo
14
Fibrotic
Polypoid Tissue
15
9 mo
Bhattacharyya N
Do maxillary sinus
retention cysts reflect
obstructive sinus
phenomena
Arch Otolaryngol Head
Neck Surg
20001261369-1371
Objective To determine the relation of maxillary sinus
retention cyst (RCs) to osteomeatal complex (OMC) obstruction and anatomic variation of the paranasal
sinuses
Methods 410 CT scans reviewed during one year
academic period
Results incidence of RCs was 124 (51 cases)
Conclusion Maxillary sinus RCs do not reflect persistent obstructive pathology of the OMC and are not associated
with potentially obstructive anatomic sinus variations
Jensen OT Shulman LB Block MS Iacono VJ
Report of the Sinus Consensus Conference of 1996 Int J Oral Maxillofac Implants
1998 13 (suppl) 11-12
Results of failure analysis demonstrated that of 164 failures analyzed 79 (48)
could be attributed to perioperative complications 38 (48) of which were associated with sinus membrane perforations
16
Mucous Retention Cyst
Pikos MA
Case Report Sinus grafting in the presence of a large mucous
retention cyst
Journal of Clinical amp Practical Oral
Implantology
2010 Vol 1
Issue 2 5-14
17
18
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus
Membrane
Repair Update on Technique
for Large
and Complete Perforations
Implant Dent
2008 Mar17(1)24-31
19
7 mo
82 Vital Bone
20
3 mo
21
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
9
Fibrin Clot
(PRGF)
A procedure for tissue
regeneration based on the
utilization of an autologous
preparation rich in Growth
Factors
What is Plasma Rich in Growth Factors Anitua E
The Use of plasma-rich growth
factors (PRGF) in oral surgery
Pract Proced Aesthet Dent 2001 Aug13(6)487-93
Anitua E et al
Autologous platelets as a source of proteins for healing and tissue regeneration Thromb Haemost
2004 Jan91(1)4-15
10
11
7 mo
12
Polyps
13
Fibrin Clot
(PRGF)
4 mo
14
Fibrotic
Polypoid Tissue
15
9 mo
Bhattacharyya N
Do maxillary sinus
retention cysts reflect
obstructive sinus
phenomena
Arch Otolaryngol Head
Neck Surg
20001261369-1371
Objective To determine the relation of maxillary sinus
retention cyst (RCs) to osteomeatal complex (OMC) obstruction and anatomic variation of the paranasal
sinuses
Methods 410 CT scans reviewed during one year
academic period
Results incidence of RCs was 124 (51 cases)
Conclusion Maxillary sinus RCs do not reflect persistent obstructive pathology of the OMC and are not associated
with potentially obstructive anatomic sinus variations
Jensen OT Shulman LB Block MS Iacono VJ
Report of the Sinus Consensus Conference of 1996 Int J Oral Maxillofac Implants
1998 13 (suppl) 11-12
Results of failure analysis demonstrated that of 164 failures analyzed 79 (48)
could be attributed to perioperative complications 38 (48) of which were associated with sinus membrane perforations
16
Mucous Retention Cyst
Pikos MA
Case Report Sinus grafting in the presence of a large mucous
retention cyst
Journal of Clinical amp Practical Oral
Implantology
2010 Vol 1
Issue 2 5-14
17
18
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus
Membrane
Repair Update on Technique
for Large
and Complete Perforations
Implant Dent
2008 Mar17(1)24-31
19
7 mo
82 Vital Bone
20
3 mo
21
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
10
11
7 mo
12
Polyps
13
Fibrin Clot
(PRGF)
4 mo
14
Fibrotic
Polypoid Tissue
15
9 mo
Bhattacharyya N
Do maxillary sinus
retention cysts reflect
obstructive sinus
phenomena
Arch Otolaryngol Head
Neck Surg
20001261369-1371
Objective To determine the relation of maxillary sinus
retention cyst (RCs) to osteomeatal complex (OMC) obstruction and anatomic variation of the paranasal
sinuses
Methods 410 CT scans reviewed during one year
academic period
Results incidence of RCs was 124 (51 cases)
Conclusion Maxillary sinus RCs do not reflect persistent obstructive pathology of the OMC and are not associated
with potentially obstructive anatomic sinus variations
Jensen OT Shulman LB Block MS Iacono VJ
Report of the Sinus Consensus Conference of 1996 Int J Oral Maxillofac Implants
1998 13 (suppl) 11-12
Results of failure analysis demonstrated that of 164 failures analyzed 79 (48)
could be attributed to perioperative complications 38 (48) of which were associated with sinus membrane perforations
16
Mucous Retention Cyst
Pikos MA
Case Report Sinus grafting in the presence of a large mucous
retention cyst
Journal of Clinical amp Practical Oral
Implantology
2010 Vol 1
Issue 2 5-14
17
18
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus
Membrane
Repair Update on Technique
for Large
and Complete Perforations
Implant Dent
2008 Mar17(1)24-31
19
7 mo
82 Vital Bone
20
3 mo
21
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
11
7 mo
12
Polyps
13
Fibrin Clot
(PRGF)
4 mo
14
Fibrotic
Polypoid Tissue
15
9 mo
Bhattacharyya N
Do maxillary sinus
retention cysts reflect
obstructive sinus
phenomena
Arch Otolaryngol Head
Neck Surg
20001261369-1371
Objective To determine the relation of maxillary sinus
retention cyst (RCs) to osteomeatal complex (OMC) obstruction and anatomic variation of the paranasal
sinuses
Methods 410 CT scans reviewed during one year
academic period
Results incidence of RCs was 124 (51 cases)
Conclusion Maxillary sinus RCs do not reflect persistent obstructive pathology of the OMC and are not associated
with potentially obstructive anatomic sinus variations
Jensen OT Shulman LB Block MS Iacono VJ
Report of the Sinus Consensus Conference of 1996 Int J Oral Maxillofac Implants
1998 13 (suppl) 11-12
Results of failure analysis demonstrated that of 164 failures analyzed 79 (48)
could be attributed to perioperative complications 38 (48) of which were associated with sinus membrane perforations
16
Mucous Retention Cyst
Pikos MA
Case Report Sinus grafting in the presence of a large mucous
retention cyst
Journal of Clinical amp Practical Oral
Implantology
2010 Vol 1
Issue 2 5-14
17
18
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus
Membrane
Repair Update on Technique
for Large
and Complete Perforations
Implant Dent
2008 Mar17(1)24-31
19
7 mo
82 Vital Bone
20
3 mo
21
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12
Polyps
13
Fibrin Clot
(PRGF)
4 mo
14
Fibrotic
Polypoid Tissue
15
9 mo
Bhattacharyya N
Do maxillary sinus
retention cysts reflect
obstructive sinus
phenomena
Arch Otolaryngol Head
Neck Surg
20001261369-1371
Objective To determine the relation of maxillary sinus
retention cyst (RCs) to osteomeatal complex (OMC) obstruction and anatomic variation of the paranasal
sinuses
Methods 410 CT scans reviewed during one year
academic period
Results incidence of RCs was 124 (51 cases)
Conclusion Maxillary sinus RCs do not reflect persistent obstructive pathology of the OMC and are not associated
with potentially obstructive anatomic sinus variations
Jensen OT Shulman LB Block MS Iacono VJ
Report of the Sinus Consensus Conference of 1996 Int J Oral Maxillofac Implants
1998 13 (suppl) 11-12
Results of failure analysis demonstrated that of 164 failures analyzed 79 (48)
could be attributed to perioperative complications 38 (48) of which were associated with sinus membrane perforations
16
Mucous Retention Cyst
Pikos MA
Case Report Sinus grafting in the presence of a large mucous
retention cyst
Journal of Clinical amp Practical Oral
Implantology
2010 Vol 1
Issue 2 5-14
17
18
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus
Membrane
Repair Update on Technique
for Large
and Complete Perforations
Implant Dent
2008 Mar17(1)24-31
19
7 mo
82 Vital Bone
20
3 mo
21
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
13
Fibrin Clot
(PRGF)
4 mo
14
Fibrotic
Polypoid Tissue
15
9 mo
Bhattacharyya N
Do maxillary sinus
retention cysts reflect
obstructive sinus
phenomena
Arch Otolaryngol Head
Neck Surg
20001261369-1371
Objective To determine the relation of maxillary sinus
retention cyst (RCs) to osteomeatal complex (OMC) obstruction and anatomic variation of the paranasal
sinuses
Methods 410 CT scans reviewed during one year
academic period
Results incidence of RCs was 124 (51 cases)
Conclusion Maxillary sinus RCs do not reflect persistent obstructive pathology of the OMC and are not associated
with potentially obstructive anatomic sinus variations
Jensen OT Shulman LB Block MS Iacono VJ
Report of the Sinus Consensus Conference of 1996 Int J Oral Maxillofac Implants
1998 13 (suppl) 11-12
Results of failure analysis demonstrated that of 164 failures analyzed 79 (48)
could be attributed to perioperative complications 38 (48) of which were associated with sinus membrane perforations
16
Mucous Retention Cyst
Pikos MA
Case Report Sinus grafting in the presence of a large mucous
retention cyst
Journal of Clinical amp Practical Oral
Implantology
2010 Vol 1
Issue 2 5-14
17
18
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus
Membrane
Repair Update on Technique
for Large
and Complete Perforations
Implant Dent
2008 Mar17(1)24-31
19
7 mo
82 Vital Bone
20
3 mo
21
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
14
Fibrotic
Polypoid Tissue
15
9 mo
Bhattacharyya N
Do maxillary sinus
retention cysts reflect
obstructive sinus
phenomena
Arch Otolaryngol Head
Neck Surg
20001261369-1371
Objective To determine the relation of maxillary sinus
retention cyst (RCs) to osteomeatal complex (OMC) obstruction and anatomic variation of the paranasal
sinuses
Methods 410 CT scans reviewed during one year
academic period
Results incidence of RCs was 124 (51 cases)
Conclusion Maxillary sinus RCs do not reflect persistent obstructive pathology of the OMC and are not associated
with potentially obstructive anatomic sinus variations
Jensen OT Shulman LB Block MS Iacono VJ
Report of the Sinus Consensus Conference of 1996 Int J Oral Maxillofac Implants
1998 13 (suppl) 11-12
Results of failure analysis demonstrated that of 164 failures analyzed 79 (48)
could be attributed to perioperative complications 38 (48) of which were associated with sinus membrane perforations
16
Mucous Retention Cyst
Pikos MA
Case Report Sinus grafting in the presence of a large mucous
retention cyst
Journal of Clinical amp Practical Oral
Implantology
2010 Vol 1
Issue 2 5-14
17
18
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus
Membrane
Repair Update on Technique
for Large
and Complete Perforations
Implant Dent
2008 Mar17(1)24-31
19
7 mo
82 Vital Bone
20
3 mo
21
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
15
9 mo
Bhattacharyya N
Do maxillary sinus
retention cysts reflect
obstructive sinus
phenomena
Arch Otolaryngol Head
Neck Surg
20001261369-1371
Objective To determine the relation of maxillary sinus
retention cyst (RCs) to osteomeatal complex (OMC) obstruction and anatomic variation of the paranasal
sinuses
Methods 410 CT scans reviewed during one year
academic period
Results incidence of RCs was 124 (51 cases)
Conclusion Maxillary sinus RCs do not reflect persistent obstructive pathology of the OMC and are not associated
with potentially obstructive anatomic sinus variations
Jensen OT Shulman LB Block MS Iacono VJ
Report of the Sinus Consensus Conference of 1996 Int J Oral Maxillofac Implants
1998 13 (suppl) 11-12
Results of failure analysis demonstrated that of 164 failures analyzed 79 (48)
could be attributed to perioperative complications 38 (48) of which were associated with sinus membrane perforations
16
Mucous Retention Cyst
Pikos MA
Case Report Sinus grafting in the presence of a large mucous
retention cyst
Journal of Clinical amp Practical Oral
Implantology
2010 Vol 1
Issue 2 5-14
17
18
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus
Membrane
Repair Update on Technique
for Large
and Complete Perforations
Implant Dent
2008 Mar17(1)24-31
19
7 mo
82 Vital Bone
20
3 mo
21
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
16
Mucous Retention Cyst
Pikos MA
Case Report Sinus grafting in the presence of a large mucous
retention cyst
Journal of Clinical amp Practical Oral
Implantology
2010 Vol 1
Issue 2 5-14
17
18
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus
Membrane
Repair Update on Technique
for Large
and Complete Perforations
Implant Dent
2008 Mar17(1)24-31
19
7 mo
82 Vital Bone
20
3 mo
21
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
17
18
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus
Membrane
Repair Update on Technique
for Large
and Complete Perforations
Implant Dent
2008 Mar17(1)24-31
19
7 mo
82 Vital Bone
20
3 mo
21
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
18
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus
Membrane
Repair Update on Technique
for Large
and Complete Perforations
Implant Dent
2008 Mar17(1)24-31
19
7 mo
82 Vital Bone
20
3 mo
21
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
19
7 mo
82 Vital Bone
20
3 mo
21
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
20
3 mo
21
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
21
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
22
Pikos MA
Maxillary sinus
membrane repair
report of a technique for
large perforations
Implant Dentistry
19998(1)29-34
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
23
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique for Large and Complete Perforations Implant Dent 2008 Mar17(1)24-31
10 yr
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
24
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
25
4
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
26
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
27
ldquoTreatment of the offending etiology (polyps)
must eradicate the pathologic condition prior to
sinus graft augmentationrdquo Chiapasco M et al
Contraindications for Sinus Graft Procedures
In Jensen O ed The Sinus Bone Graft Second Edition 2006 (87-101) Hanover Park IL Quintessence Publishing Co Inc
ldquoWhatever method is chosen if the rent is
too large the sinus graft procedure should
be ABORTED until the membrane has had
the opportunity to be re-epithelializedrdquo
Malevez C
Sinus Reactions to Invasive Surgery In Jensen O ed The Sinus Bone Graft Second Edition 2006 (115-125)
Hanover Park IL Quintessence Publishing Co Inc
Pikos MA
Maxillary Sinus Membrane Repair Update on Technique
for Large and Complete
Perforations
Implant Dent
2008 Mar17(1)24-31
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
28
10 mo
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
29
4 yr
12 13 14
4 yr
Thickened Membrane ndash Membrane elevation vs pathology
removal depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
30
Polyps - Membrane elevation vs pathology removal
depends on size and proximity to ostium
bull 8mm or less elevate membrane and graft
bull gt8mm ndash remove pathology and simultaneous graft
Conclusions What to do
Mucous Retention Cysts ndash Membrane elevation vs
pathology removal depends on size and proximity
to ostium
bull Recommend removal and simultaneous graft
Conclusions What to do
ldquoIn general pathology removal with
simultaneous grafting is recommendedrdquo
Dr Michael A Pikos 1996
Sinus Grafting in the Presence of Pathology Summary
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
31
Thank you
Dr Michael A Pikos Pikos Institute
Palm Harbor FL 34684
wwwPikosInstitutecom
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
1
State of the Art with Sinus
Augmentation ndash Current
Approaches
Ziv Mazor DMD
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
2
State of The Art 2013
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
3
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
4
Goals
bullCreate bone in the posterior maxilla
bullAchieve osseointegration in that bone
bullMaintain occlusal function under load
And all with high predictability
Two Approaches
Crestal Approach Lateral Window Technique
Maxillary sinus floor elevation using
the (transalveolar) osteotome
technique with or without grafting
material Part I Implant survival and
patients perception U Braumlgger C Rast BE Pjetursson K Schmidlin
Lang NPM Zwahlen
Clin Oral Implants Res 2009 Jul20(7)667-76
252 Implants in 181 patients
5 year follow up
974 survival rate with bone height above 5mm
476 survival of short implants-6mm in length
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
5
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
6
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
7
Nkenke et all Int J Oral
Maxillofac Implants 2002 Jul-
Aug17(4)557-66
Limitations of
Closed Approach
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
8
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
9
Sinus Membrane Tears
Reiser GM et al IJOMI (2001)
Pommer B et al COIR (2009)
Fugazzotto P J Perio (2005)
Reasons for Sinus Membrane
Tears
Inserting the osteotome beyond the sinus
border
Sinus anatomy - eg proximity to septae or
collateral wall of nose
Adaptive capacity to the Schneiderian
membrane
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
10
Membrane Tear
Repair this tear
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
11
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Benign Paroxysmal Positional
Vertigo (BPPV)
Saker M Ogle O JOMS (2005)
DiGirolamo M et al Eur Arch Oto
(2005)
Peacuterez-Garrigures H et al Act
Oto Esp (2001)
Kim MS Lee JK Chang BS Um HS
Benign paroxysmal positional vertigo as a
complication of sinus floor elevation
J Periodontal Implant Sci 2010
Apr40(2)86-9
Vernamonte S Mauro V Vernamonte S
Messina AM
An unusual complication of osteotome sinus
floor elevation
benign paroxysmal positional vertigo
Int J Oral Maxillofac Surg 2010 Aug 27
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
12
Closed Approach limitations amp
Complications
5-7mm of residual bone height
Sloped sinus floor
Presence of septa
Inability to repair perforations
Inadequate ridge width
Benign paroxysmal positional vertigo
(BPPV)
and experience Patientrsquos trauma
Poor Patient Experience
Diserens V et al IJPRD (2006)
Pjetursson BE et al COIR (2009)
Oroantral communication as an
osteotome
sinus elevation complication
Anzalone JV Vastardis S
J Oral Implantol 201036(3)231-7
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
13
Minimal amount of 4-5 mm of
crestal bone height is a
prerequisite for simultaneous
implant placement during sinus
lift procedure
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
14
Sinus floor augmentation with
simultaneous implant placement in
the severely atrophic maxilla
Peleg M Mazor Z Chaushu G Garg Ak
55 implants20 sinuses grafted in 20
patients1-stage procedurehellipresidual bone
height 1-2mm
J Periodontol 1998691397-1403
Sinus Floor Augmentation with Simultaneous Implant Placement in the Severely Atrophic Maxilla
bull1-2 mm Residual Alveolar Bone Height
bull55 Implants Placed
bull264 Month Follow-up after loading (15-29 month range)
bullNo Failures
Michael Peleg Ziv Mazor Gavriel Chaushu Arun K Garg J Perio 1998691397-1403
Augmentation of the Maxillary
Sinus and Simultaneous Implant
Placement in Patients with 3-
5mm of Residual Alveolar Bone
Height
Peleg MMazor ZGarg A
JOMI 1999vol 144549-556
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
15
Augmentation Grafting of the Maxillary Sinus and Simultaneous Implant Placement in Patients with 3
to 5 mm of Residual Alveolar Bone Height
bull3-5 mm Residual Alveolar Bone Height
bull160 Implants in 63 Sinuses
bull31 Month Follow-up after loading (23-48 month range)
bullNo Failures
Michael Peleg Ziv Mazor Arun K Garg IJOMI 199914549-556
Int J Oral Maxillofac Implants
2006 Jan-Feb21(1)94-102
Predictability of simultaneous implant placement in the
severely atrophic posterior maxilla A 9-year longitudinal
experience study of 2132 implants placed into 731 human
sinus grafts
Peleg M Garg AK Mazor Z
In Summary
Between 1994-2003
731 Total of sinuses grafted
2132 of implants inserted
44 of implants lost
97 9 of implants successfully
integrated
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
16
Adequate Width of Ridge
Width of Ridge is More Critical
Than Height of Ridge for
Simultaneous Sinus Graft and
Implant Placement
What type of implant should
we use
in vitro experiments and human clinical
trials have demonstrated that implants with
roughened surfaces achieved greater
bone-to-implant apposition and interfacial
strength than implants with conventional
machined surfaces
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
17
Mini
Micro
Nano
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
18
Ericsson I Hohansson CB Bystedt H Norton MR A histomorphometric evaluation
of bone-to-implant contact on machined-prepared and roughened titanium dental
implants A pilot study in the dog Clin Oral Impl Res 19945202-206
Buser D Schenk RK Fiorellini JP Fox CH Stich H Influence of surface
characteristics on bone integration of titanium implants A histomorphometric study
in miniature pigs J Biomed Mat Res 199125889-902
Trisi P Rao W Rebaudi A A histometric comparison of smooth and rough titanium
implants in human low-density jawbone Int J Oral Maxillofac Implants 199914689-
698
Buser D Nydegger T Oxland T Cochran DL Schenk RK Hirt HP Snetivy-Lutz D
Nolte P Interface shear strength of titanium implants with a sandblasted and acid-
etched surface A biomechanical study in the maxilla of miniature pigs J Biomed
Mater Res 19994575-83
Piatelli A Manzon L Scarano A Paolantonio M Piatelli M Histological and
histomorphometric analysis of the bone response to machined and sandblasted
titanium implants An experimental study in rabbits Int J Oral Maxillofac Implants
199813805-810
Orsini G Assenza B Scarano A Piattelli M Piattelli A Surface analysis of
machined versus sandblasted and acid-etched titanium implants Int J Oral
Maxillofac Implants 200015779-784
Sinus Lift ndashBony Window Osteotomy
With Traditional Instruments
10-35 of membrane tears
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
19
Schnaiderian Membrane Perforation Rate during Sinus Elevation Using
Piezosurgeryreg Clinical Results of 100 Consecutive Cases
Wallace SS Mazor Z Froum SJ
Cho S-C Tarnow D
Int J Periodontics Restorative Dent 2007 27413ndash419
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
20
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
21
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
22
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
23
To Graft Or Not To Graft
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
24
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
25
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
26
33 Bone 100 Vital
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
27
Sinus floor Augmentation With
Simultaneous Implant Placement
Using Choukrounrsquos PRF (Platelet-
Rich Fibrin) as sole grafting
material a radiological and
histological study at 6 months
Ziv Mazor DMD Robert A Horowitz DDS Marco
Del Corso DDS Hari S Prasad BS
MDT Michael D Rohrer DDS MSD and David M
Dohan Ehrenfest DDS MS PhD
Of Periodontology 2009 Vol 80(12) 2056-64 Journal
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
28
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
29
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
30
Intraoperative
Complications associated
with the lateral window
approach
bullBleeding
bullMembrane Perforation
bullSepta
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
31
Postoperative
Complications
Hematoma
Edema
Pain and Discomfort
Infection
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
32
How Can We
Minimize The
complications
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
33
Is There Another
Alternative To Lateral
Window Sinus
Augmentation
Minimally Invasive
Antral Membrane Balloon
Elevation
MIAMBE
First Cases Done With Angioplasty Device
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
34
The balloon is inflated with contrast fluid and
emerges from the metal sleeve under the Antral
membrane
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
35
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
36
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
37
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
38
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
39
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
40
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
41
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
42
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
43
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
44
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
45
Minimally invasive antral
membrane balloon elevation
report of 36 procedures
Kaluski E Eliav E Kfir V Kfir E
J Periodontol 2007 Oct78(10)2032-5
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
46
Kfir E Goldstein M Yerushalmi I
Rafaelov R Mazor Z Kfir V Kaluski E
Membrane AntralMinimally Invasive
Results of a -Balloon Elevation
Multicenter Registry
Clin Implant Dent Relat Res 2009 Aug 3
MINIMALLY INVASIVE ANTRAL
MEMBRANE
BALLOON ELEVATION IN THE
PRESENCE OF
ANTRAL SEPTA A REPORT
OF 26 PROCEDURES
Efraim Kfir DMD Moshe Goldstein DMD
Ronen Rafaelov DMD Israel Yerushalmi DMD
Vered Kfir DMD
Ziv Mazor DMD Edo Kaluski MD
Journal of Oral Implantology 2009 Vol
35(5)257-262
antralMinimally invasive
membrane balloon elevation for
tooth implant placement-single
Kfir E Kfir V Kaluski E Mazor
Z Goldstein M
Quintessence Int 2011
Sep42(8)645-50
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
47
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
48
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
49
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
50
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
51
2 year post op
Flapless approach to maxillary sinus
augmentation
using minimally invasive antral
membrane balloon elevation
Ziv Mazor Efraim Kfir
Adi Lorean Eitan Mijiritsky Robert A Horowitz
Implant Dent 2011 Dec20(6)434-8
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil
12122013
52
Advantages of Using The
MIAMBE Technique
Minimal post operative complications- No
painedema or hematoma
Reduced chair time
Less graft material needed
Overcoming anatomical obstacles ndashsepta
Reduced sinus perforation rate
Short learning curve
12122013
53
wwwhandsoncoursecom
Ziv Mazor
Thank You
Ziv Mazor DMD drmazornetvisionnetil