January 2010

The sinus floor elevation technique with Summers’ osteotome is simpler and less invasive than access through the lateral wall of the sinus; however, it is susceptible to a higher level of sinusal membrane rupture. The objective of the present study was to display a modification of the osteotomy technique by connective tissue interposition in order to weaken the impact of sinus cortical fracture, and therefore prevent perforations in the sinusal membrane. A case is reported in which a patient presented with an absent tooth #4 for osseointegrated implant rehabilitation. Maxillary sinus elevation was required to perform the procedure. Initially, the flap was raised and the receptor site was prepared with a sequence of burs, without disrupting cortical bone. In order to weaken the fracture impact with the osteotome, a connective tissue graft was interposed to allow access to the sinus. Clinically, a satisfactory primary locking was obtained with torque greater than 50 Ncm. Through radiographic evaluation, good bone filling was observed immediately after surgery, with maxillary sinus wall elevation without membrane rupture. Two years after the initial procedure, a 5.3 mm increase in bone extension formed in contact with implant distal surface was observed. Thus, the osteotomy technique modification with connective tissue interposition was successful, both clinically and radiographically, showing an image suggesting long-term osseous formation.