Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1118_Библиотеки_им_академика_М_И_Перельмана

The crestal approach was refined later by Robert Summers, the change/transition which can be attributed to the so-called mini­mal invasive sinus lift surgery [32]. Summers actually described another crestal approach designated the osteotome sinus floor eleva- tion (OSFE) using tapered osteotomes with increasing diameters, each with concave tip (Fig. 10.6) in attempt to gain vertical bone height by retaining and relocating all the exist­ing bone. Thus, when the osteotome is pushed toward the sinus floor, bone shavings from the lateral walls of the osteotomy are collected in its concave part before being pushed upward into the subantral plane elevating the sinus floor and membrane with minimal risk. Using this approach, Summers reported a 96% suc­cess rate at 18 months after loading 143 press­fit submerged implants in type IV bone [33]. Advantages of this approach are well reported in the literature, citing reduced morbidity and postoperative discomfort as well as shortened surgical time [34–36]. Our opinion is that the minimal drilling for osteotomy preparation may be required before introducing the osteotome in some cases (such as in type III bone quality). Summers further modified the OSFE technique by adding bone graft into the osteotomy prior to sinus elevation [36]. This was referred to as the bone-added osteotome sinus floor elevation (BAOSFE) technique. Autogenous, allogenic, and/or xenogenic bone grafts were added to increase the volume below the elevated sinus membrane. Using the BAOSFE technique, con­sistent sinus membrane elevation of 4–5 mm was described by Summers. Other reports have demonstrated a wide variation in the amount of sinus elevation that could be predictably achieved [37–39].