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Accuracy of implant osteotomy depth and membrane perforation analysis of an in vitro of crestal sinus lift procedure, comparing dynamic navigation system and static guides.


Hung-Chi Liao, DDS – Resident, Loma Linda University School of Dentistry


Purpose of the Study: Crestal sinus lift approach is widely used in implant dentistry when inadequate bone is presented while no lateral approach is needed. However, crestal sinus lift is a blind procedure, in order to drill closer to the sinus floor without perforating the sinus floor, multiple times of periapical x rays are required to confirm it. Therefore, the purpose of this study was to use dynamic navigation system in crestal sinus lift bypass taking periapical x rays and compared with usage of static surgical guide and periapical x ray.

Methods: 10 identical maxillary custom made drillable models with bilaterial sinus cavities and artificial membranes were fabricated. Only #3 and # 14 are edentulous sites, the distance from the crest ridge of #3 and #14 to the sinus floor is 6 mm. The characteristic of artificial membrane closely resembles real human being sinus membrane. 20 4.3 mm x 10 mm Nobel Replace Conical Connection dummy implants (Nobel Biocare®, Yorba Linda, CA, USA) were used in the study. Presurgical CBCT scans were taken on all the models with fiducial markers for static guided and dynamic navigation planning. 5 operators with various implant clinical experience were randomly assigned to place implant in one side by using static surgical guide and confirmed with periapical x rays during the procedure while the other side’s implant was placed using dynamic navigation system by the same operator. Each operator was required to place 4 implants in 2 models. Once the final drill closed to 1 mm from the sinus floor, osteotome instruments and mallet were used to lift the sinus floor up to 4 mm. In conventional procedure side, implant was delivered by hand wrench while in dynamic navigation side, implant was delivered by looking the dynamic navigation system screen. Postsurgical CBCT scans were taken for these 10 models after the implant delivery. Accuracy analysis was performed by using a mathematical algorithm to measure the deviations between planned and delivered implants. Perforation of membrane was evaluated visually.

Results: TBD

Conclusion: TBD

Articles: 1. 2. 3.

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