Crestal Sinus Lifting Using Densah Burs Versus Lateral Window Technique at Residual Alveolar Ridge Height 3-5 mm With Simultaneous Implant Placement

* Crestal flap was made. * 2 mm densah bur was used first as a pilot drill in clockwise direction and stopped 1 mm before sinus floor. Implant surgical motor setting was changed to reverse. * The next wider densah bur (3.00 mm) was used and advanced into the previous created osteotomy. When feeling the haptic feedback of the bur reaching the dense sinus floor, pressure was modulated with a pumping motion to advance past the sinus floor in 1 mm increments, up to 3 mm. * The sequential wider densah burs were used in densifing mode with copious irrigation with pumping motion to achieve additional width with maximum membrane lift of 3 mm to reach final desired width for implant placement. * The osteotomy was filled with a well hydrated, xenograft. The last densah bur was used in densifing mode with low speed 150-200 rpm with no irrigation. * The implant was placed into the osteotomy.

* Trapezoidal flap was made and full thickness mucoperiosteal flap was raised to visualize the lateral side of the maxilla. (Fig. 23) * Complete osteotomy of lateral window was made to gain access to the Schneiderian membrane using piezosurgery unit to minimize the probability of membrane perforation with round tip (SL3). * Sinus membrane elevators were used carefully to free up sinus membrane in all directions (mesially, distally and medially). * The membrane at the inferior aspect of the osteotomy was dissected from the floor of the maxillary sinus and elevated upward to create a space in the floor of the sinus for the bone graft material. * Drilling of the implant was done using surgical implant kit while using periosteal elevators to protect schniderian membrane. * Bone graft was packed under the membrane in all directions with the help of pluggers till reach the medial wall of the maxillary sinus. * Implant was placed and the lateral osteotomy was covered with collagen membrane