Sinus Grafting in the Presence of Pathology · PDF fileInability to repair perforations...

84
1 Michael A. Pikos, DDS December 12, 2013 Advanced Bone Grafting Techniques for Clinical Success Sinus Grafting in the Presence of Pathology June 2012

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

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

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

12122013

53

wwwhandsoncoursecom

Ziv Mazor

Thank You

Ziv Mazor DMD drmazornetvisionnetil