Crestal Sinus Lift Protocol II

Overview

Minimum residual bone height 4-5 mm. Minimum alveolar width needed = 5 mm
Use Densah Burs in full step increments. For example: 2.0 mm, 3.0 mm, 4.0 mm, 5.0 mm.
• MEASURE BONE HEIGHT TO SINUS FLOOR
• AVOID USING A PILOT DRILL
• DENSAH BUR (2.0) OD MODE TO SINUS FLOOR
• ENTER WITH DENSAH BUR (3.0) OD MODE UP TO 3 MM PAST THE SINUS FLOOR
• DENSAH BUR (4.0), (5.0) OD MODE UP TO 3 MM PAST THE SINUS FLOOR TO FURTHER EXPAND THE OSTEOTOMY
• USE DENSAH BURS IN FULL STEP INCREMENTS FOR EXAMPLE: 2.0 MM, 3.0 MM, 4.0 MM, 5.0 MM
• USE THE LAST DENSAH BUR IN LOW SPEED TO GENTLY PROPEL WELL HYDRATED ALLOGRAFT

Step 1:

Measure bone height to sinus floor.
Flap the soft tissue using instruments and technique normally used.

Step 2:

Densah Bur (2.0) OD Mode to sinus floor.
Avoid using a pilot drill. Depending upon the implant type and diameter
selected for the site, begin with the narrowest Densah Bur (2.0). Change the
surgical motor to reverse (counterclockwise drill speed
1000 rpm-Densifying Mode with copious irrigation). Begin running the bur into
the osteotomy until reaching the dense sinus floor. Confirm Bur position with a
radiograph.

Step 3:

Enter with Densah Bur (3.0) OD mode up to 3 mm past the sinus floor.
Use the next wider Densah Bur (3.0) and advance it into the previously created
osteotomy with modulating pressure and a pumping motion. When feeling the
haptic feedback of the bur reaching the dense sinus floor, modulate pressure
with a pumping motion to advance past the sinus floor in 1 mm increments, up
to 3 mm. Maximum bur advancement past the sinus floor, at any stage, must
not exceed 3 mm. Bone will be pushed toward the apical end and will begin to
gently lift the membrane and autograft compacted bone up to 3 mm. Confirm
the bur vertical position with a radiograph.

Step 4:

Densah Bur (4.0), (5.0) OD mode up to 3 mm past the sinus floor.
Use the sequential wider Densah Burs in Densifying Mode (Counterclockwise
drill speed 1000 rpm) with copious irrigation with pumping motion to achieve
additional width with maximum membrane lift of 3 mm (in 1 mm increments)
to reach final desired width for implant placement. Densah Burs must not
advance more than 3 mm past the sinus floor at all times regardless of the
Densah3 Bur diameter.

Step 5:

Propel allograft.
After achieving the final planned osteotomy diameter, fill the osteotomy with a
well hydrated, mainly cancellous, allograft. Use the last Densah Bur used in
step 4 in Densifying Mode (Counterclockwise) with low speed 150-200 rpm
with no irrigation to propel the allograft into the sinus. The Densah Bur must
only facilitate the allograft material compaction to further lift the sinus
membrane, and not to advance beyond the sinus floor more than 2-3 mm.
Repeat the graft propelling step to facilitate additional membrane lift as
needed according to implant length.

Step 6:

Place implant.
Place the implant into the osteotomy. If using the surgical motor to tap the
implant into place, the unit may stop when reaching the placement torque
maximum. Finish placing the implant to depth with a torque indicating wrench.