TRANSCRIPT:

Let's go ahead and take a look at an indirect sinus lift case. I'm here with Ivan. We're going to walk through this together. He may ask some questions, and we'll review each question with you guys as well. So, we have a patient in our office with an edentulous space in the posterior maxilla. Assuming there's a tooth on either side, and this is the edentulous space we're working with. We'll refer to it as a second premolar edentulous space and a molar edentulous space. The goal is to provide the patient with two implants to restore the dentition in that area.

We've reviewed the CT scan and observed close to six millimeters of bone height from the alveolar crest to the sinus floor. Our objective is to place at least an eight-millimeter implant to support the posterior dentition in that area. With the available bone height, we can predictably achieve two to three millimeters of bone growth with an indirect sinus lift. This will allow us to build the six-millimeter bone height to about nine millimeters, supporting our implant placement.

So, we've decided to proceed with an indirect sinus lift rather than a direct sinus lift. In this case, I'll mark two sites with a tissue punch to access the bony alveolar crest. Regarding using a tissue punch for an indirect sinus lift, it's a recommendation because, in most cases, an implant is placed simultaneously. I prefer placing a healing abutment on the implant and avoiding an uncovery, assuming torque and other factors are satisfactory.

Moving on, I'll mark the molar site with a tissue punch. After that, I'll measure the depth of the gingival tissue with a periaprobe. This measurement is essential because, based on our CT scan, we know the distance from the alveolar crest to the sinus floor is six millimeters. During the upcoming sequence with osteotomes and drills, we aim to reach a depth approximately one millimeter shy of the sinus floor. Considering the thickness of the tissue (around three millimeters), we add that to the desired five-millimeter depth, resulting in a target depth of eight millimeters from the gingival crest.

Lesson Summary

Let's go ahead and take a look at an indirect sinus lift case. We have a patient with an edentulous space in the posterior maxilla. Our goal is to provide the patient with two implants to restore the dentition in that area. We've reviewed the CT scan and observed close to six millimeters of bone height from the alveolar crest to the sinus floor. To support our implant placement, we can predictably achieve two to three millimeters of bone growth with an indirect sinus lift, building the six-millimeter bone height to about nine millimeters.

We've decided to proceed with an indirect sinus lift rather than a direct sinus lift. To access the bony alveolar crest, we'll mark two sites with a tissue punch. Using a tissue punch is recommended for an indirect sinus lift, as in most cases, an implant is placed simultaneously. This allows us to place a healing abutment on the implant and avoid an uncovery, assuming torque and other factors are satisfactory.

After marking the sites with a tissue punch, we'll measure the depth of the gingival tissue with a periaprobe. This measurement is important because, based on the CT scan, we know the distance from the alveolar crest to the sinus floor is six millimeters. During the upcoming sequence with osteotomes and drills, we aim to reach a depth approximately one millimeter shy of the sinus floor. Accounting for the thickness of the tissue (around three millimeters), we add that to the desired five-millimeter depth, resulting in a target depth of eight millimeters from the gingival crest.