INTRODUCTION
 
An inadequate bucco-lingual and apico-occlusal dimension of the crestal bone under the maxillary sinus, is a frequent anatomical restriction for the prosthetic rehabilitation of the posterior region of the upper jaw. The loss of teeth, together with a marginal and cortical resorption, produces a reduction in the alveolar bone height: as a matter of fact, after every extraction, the periosteum of the Schneider's membrane shows an increasing osteoclastic activity and, meantime, there's a resorption of alveolar bone following the loss of marginal bone. As a direct consequence of this process, the distance between the highest point of the ridge and the sinus floor decreases and is not suitable for the insertion of implants.

 
 

Various techniques have been proposed in order to accomplish the necessary bony dimension for the insertion of implants:
1) The Guided Bone Regeneration (GBR) of the crestal bone, that is still quite unpredictable and unsatisfactory, and
2) the elevation of sinus membrane by the lateral approach introduced by Tatum. For many years the surgical technique used for this operation involved a lateral approach , that caused quite a trauma to the patient and required certain technical skills from the surgeon because of its difficulties. In 1994 Summers introduced a new technique with a crestal approach, reducing the problems linked to the surgical procedure. What I' m showing here is a step forward of the crestal approach introduced by Summers, because the exposure of the sinus membrane is gained through the use of atraumatic drills of increasing lengths which highly decrease the risk of accidental laceration of the membrane. Furthermore, the sinus lift together with the insertion of the implants can be performed even in presence of a reduced alveolar bone height. Still, this kind of surgery requires a good experience in implantology.

Dott. Cosci Ferdinando                    
 
 
< Dr. Ferdinando Cosci >
Graduated in Medicine at the University of Florence, since 1979 he has focused his work on implantology and prosthesis upon implants. He attended Prof. R. Meffert and Prof. G. Chiche's departments at the LSU and various Stages and Congresses in the States. He has been lecturer in several International Congresses ( S.Diego, Vancouver, Bangkok, Istambul, Tokyo…) and is currently involved with lectures and courses in Implantology in Italy in many Universities (Chieti, Modena, Pisa), Spain and Japan. He has approximately placed approximately 7000 implants among which 1500 are post-extractive immediate implants performed with a personal technique that has been reported in many international Journals. Since 1994 he has successfully approached the maxillary sinus lifting (about 700 cases performed) with a new surgical approach using peculiar drills that he invented. Author of numerous articles published in Italian, American, and Latin American Journals and "DIPLOMATE" of I.C.O.I.
 

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