Last years for the purpose of rendering assistance to such patients many techniques have been developed (osteal blocks autografting, raising of nasal cavity bottom wall) referred on conditions for the implants installation improvement. One of the most useful techniques is "sine-lifting".

This technique is not new. The successful installation of implants in the osteal file received at sine-lifting, spent still Linkow in the late 50th and the beginning of 60th years. Further to technique improvement which proceeds and now, have devoted the work Tatum and Boyne in 70th years.

There are 2 kinds of "sine-lifting" operation: opened and closed. Closed "sine-lifting" is carried out, when an osteal tissue in a projection of sine supramaxillary not less than 10 mm. If this distance less than 10 mm opened "sine-lifting" is made.

As in cases with other innovations in stomatology and implantology, the failures which have arisen in the first years of procedure use, have led to development and improvement of surgical techniques and materials. Knowledge and the experience, received at carrying out of manipulations then, allows surgeons-stomatologists to carry out today "sine-lifting" as much as possible effectively. The understanding of indications and ability to carry out manipulation helps the surgeon-stomatologist to give to the patient adequate treatment. The technique "sine-lifting" allows a considerable quantity of patients to appreciate advantages of use dental implants.

Substantiation.

The atrophy of lateral departments of the top jaw frames appreciable problems. In general, the top jaw spongiform bone having the big spaces, strongly differs from a bone in other parts of a body. Moreover, loss of teeth leads to sinuses pneumatization and deterioration of the already small volume of an osteal tissue. In combination to insufficient height it leads to expressed depression of the implants installation success on the top jaw, on that can positively affect only "sine-lifting".

"Sinus lift" is a way to improve the results of dental implants with a strong atrophy of the lateral parts of the upper jaw. By means of osteal file augmentation in the field of a sine, "sine-lifting" allows the surgeon-stomatologist to use longer impants that is preferable in jaw lateral departments for creation purpose of conditions to adequate resistance to occlusal load. "Sine-lifting" is shown, when the insufficient height of alveolar process interferes with the implant installation more than 10 mm long. When the alveolar width less than 4 mm are shown augmentation techniques performance of crest width or lamellar implants use.

Preoperative preparation.

Before carrying out of "sine-lifting" the surgeon should be convinced in healthy condition of patient's genyantrums. Presence of surgical interventions in the anamnesis in the sine field can limit possibilities of the clinician at carrying out of operation and even be a contraindication to it. By means of roentgenography and clinical research methods it is necessary to appreciate sinus architecture about revealing of anatomic restrictions which can interfere with intervention performance (for example, plural septums make "sine-lifting" impossible).

Presence big mucocelies (a mucous cyst in the field of sine supramaxillaries) or other pathological formations in the prospective operation field or in implants installation site also can be contraindication to carrying out of "sine-lifting" operation. It is necessary to pay attention to whether is the patient is smoker as it can worsen a procedure outcome. Because presence of secret stasis probability in a sinus and bacteriemic contamination appointment, antibacterial therapy is recommended before the "sine-lifting" operation. Preparations of cephalosporins group can be choice antibiotics, depending on a state of patient's health and an allergy to medical products.

Last researches show, that amoxicillin is the most preferable agent of prophylaxis infectious complications after "sine-lifting" operation has been finished. Preoperative appointment of steroids allows to lower edema and inflammation, and also is capable to improve healing. Well application of such preparations as Afrin - a nasal spray, Dimetapp or Sudafed influences on patient's condition in the postoperative period.

"Sine-lifting" begins with creating the cut from distal hillock from an oral cavity (little bit palate concerning crest edge) to canine area, exposing lateralis sinus wall, exfoliates mucoperiosteal flap. The cortical layer cutting is carried out by means of a round bur accompanied by a plentiful irrigation.

It is necessary to spend manipulation, which defining success of "sine-lifting" operation, extremely cautiously in order to avoid schneider membrane perforation (a mucous sinus). Small perforation points of bone on the top border cuts and then, by special curette usage, the aperture on "doors" type is framed, opening inside (picture № 2) are made.

The breakout procedure, one of the cores in "sine-lifting" operation, is carried out exclusively accurately with a simultaneous spalling of a mucous osteotomy on perimetre with the curette help.

At this moment of "sine-lifting" operation it is expedient to ask patient to deeply breathe by nose that will help to be convinced of absence of perforation mucous. In the presence of mucous movements during the nasal breath, testifying to its integrity, in the prepared space places an osteal material which stamp medially in front, and behind. Material place densely enough not to leave cavities.

Depending on a thickness of alveolar process, implants can be installed simultaneously with "sine-lifting" performance or through a certain time interval after site healing. Indications for the implants installation simultaneously with augmentation concern:

At the implants installation simultaneously with "sine-lifting" it is necessary to lift mucous before manufacturing hole for implant. It will allow to frame easy access for carrying out of drilling without danger of mucous perforation. After that in space an osteal material is placing. It is necessary for carrying out procedure with care and to be convinced, that the material completely surrounds implants.

Having installed implants it is possible to finish space filling with an osteal material (drawings 4-6). On surgeon preference, it is possible to cover hole for implant with a flap or use a membrane.

It is possible to open and gradually load implants, which were installed simultaneously with "sine-lifting" in 6-9 months after operation. The gradual load allows bone to get stronger and gives the chance to stomatologist to appreciate an implant reaction before manufacturing a constant orthopedic design.

When implants don't install simultaneously with "sine-lifting", it is preferable to spend their installation in 4 months after operation. By this moment the most part of material will not be organized yet and remains soft. It makes the implant installation after "sine-lifting" operation concerning easy and noninvasive, and also allows bone to be generated round an implant.

The most frequent complication arising during "sine-lifting" operation is rupture of a mucous sinus. Ruptures and mucous perforation, occurs approximately in 30 % of subantral augmentation cases.

There are many techniques and materials can be used for closing of the perforation caused by "sine-lifting" operation.

Sealing or patching up are one of most often applied ways. According to the author, patching up is more preferable than a sealing as it is technically less difficult. To the materials used for perforations closing, caused by "sine-lifting" operation, concern: autogenic bone; Gelfilm® (resorbable cellulose); Collatape® (at insignificant perforations); cool-dehumidified demineralised laminated bone.

The big septums parting a sinus of the top jaw, can frame complexities during carrying out of "sine-lifting" operation. At revealing of such septums, frame separate access from each of the septum parties in order to avoid its damage and mucous sinus punching.

Complications in the postoperative period.

At accurate and careful "sine-lifting" performance the risk of complications occurrence at patients is minimum. However, at carrying out the report disturbance of a surgical intervention ("sine-lifting") in the wound field such complications as a becoming infected, oroantral fistula formation, implants mobility, bleeding, sinusitis, morbidity and passage disturbance of a liquid from a sinus are possible.

It is necessary to spend treatment of the infectious complications caused by "sine-lifting" operation enough aggressively, to prevent a burrowing and loss of the material used for replanting. At the first symptoms occurrence of the infectious process caused by "sine-lifting" operation, it is necessary to adjust a drainage of the pathological centre at a distance from an osteotomy, and also to spend cultural researches and tests for sensitivity definition of bacteria to antibiotics. By means of well-timed appointment of adequate antibacterial therapy it is possible to prevent a burrowing and material loss.

At development of infectious process and fistula's formation it can be demanded sanation carrying out of the pathological centre and its irrigation. After suppression of infectious process it is necessary to spend fistulous closing course, in the subsequent it is possible to repeat "sine-lifting" procedure.

At sinusitis occurrence, prescribing antibacterials and resolvents.

Osteoplastic materials.

See Bio-Oss®

The conclusion.

Sine-lifting procedure is used more than 30 years. Failures in the way beginning have led to perfection both the technique, and materials. By working out of the report and occurrence of the most effective materials efficiency and safety of "sine-lifting" technique has considerably raised. The surgeon having in the arsenal skills and materials for carrying out described above intervention, dilates a circle of patients with the expressed lateral departments' atrophy of the top jaw which can appreciate ventplants advantages.