Objectives: To reduce morbidity of lateral window sinus grafting using a minimally invasive (flapless) surgical technique with piezoelectric osteotomy and hydraulic pressure from the same instrument. The grafting material was Bio-Oss collagen, a well-documented material for regenerating bone in the maxillary sinus. Methods: Five patients in the private clinic of the author were randomly selected for the study, and cone-beam CTs (CBCTs) were taken. Patients with at least 3mm of bone from the crestal ridge to the floor of the sinus and a width of more than 6mm were recruited. In order to prevent resorption of the crestal bone, a flapless approach was used, with tissue punches. Preparation of the osteotomy and fracture of the floor of the sinus was performed using the Intra Lift Kitä/®. Hydraulic pressure was applied using the same instrument to lift the Schneiderian membrane. The integrity of the membrane was confirmed by the Valsalva test. Bio-Ossä/® collagen block was soaked in saline and cut in to pieces, then each piece was introduced into the osteotomy using tweezers and TKW5TM/®, beneath the elevated membrane. The diameter of all implants was 4.5mm. The osteotomy was undersized by about 1mm to ensure that all implants had good primary stability. They were covered with healing abutments on the day of surgery and IOPA were taken. After a 6-month‘ healing period, implants were progressively loaded with composite crown before final fabrication of the definitive crowns. Further CBCTs were taken after 6 months to confirm bone growth in the sinus. Results: Membrane perforation was observed in one patient in whom the implant was placed in the upper second molar region due to inadvertent slippage of TKW4TM/®. However no complications were reported. Newly formed bone along the implant was recorded in all cases, and average bone height gain was about 5mm. Conclusions: Although there was a perforation of the sinus membrane in one case, no complications occurred and there was bone gain and osseointegration of the implants. Given the small sample size of five cases, it seems that the minimally invasive approach using xenograft Bio-OssTM/® collagen as the sole grafting material, results in an average bone gain of 5mm and osseointegration of implants.

Gliederung - Schnittführung - Lappenbildung - Transplantatfixation - Nahtverschluss Inhalt: Deckung multipler Rezessionen mittels einer modifizierten Tunnelierungstechnik, die charakterisiert ist durch ein minimalinvasives, atraumatisches Vorgehen ohne die Durchführung vertikaler Inzisionen.

Fallbeschreibung: Indikation für eine mikrochirurgische Fremdkörperbeseitigung unter Verwendung eines Operationsmikroskopes bei einer Patientin, der nach einer endodontischen Vorbehandlung des Zahnes 46, ein frakturiertes Wurzelkanalinstrument entfernt werden muss. Der Fremdkörper reicht über den Apex hinaus bis in den Canalis mandibularis. Gliederung: - Zugang und Schnittführung: Vestibulär gestielter Mukoperiostlappen als Zahnfleischrandschnitt unter Erhaltung der Papille - Abtragen des Knochens von vestibulär in der Regio 46 mit mikrochirurgischem Instrumentarium - Freilegen des Gefäßnervenbündels - Entfernung des Fremdkörpers - Readaptation des Mukoperiostlappens - Wundverschluss mit atraumatischem Nahtmaterial