A review of the literature shows a recommended thickness of 5 to 6 mm for the bone wall separating the maxillary sinus and oral cavity as the virtually exclusive indication for the performance of a pericrestal sinus lift. The criterion for success is the implant survival rate supported by radiologic follow-up. The currently recommended surgical techniques include elevation of a portion of the maxillary sinus floor together with the surrounding mucosa using either an osteotome or balloon. There are no studies on the adequate anatomic bone situations or on parameters potentially affecting the success of the procedure or on the mechanical characteristics of the mucosa to be elevated. Virtually any material suitable for application via the pericrestal access is recommended without assessing whether the material will allow for even filling of the elevated secondary defect. Unresolved questions have prevented more extensive use of the pericrestal sinus lift. In contrast to conventional sinus elevation from the buccal aspect, its advantages are obvious, including the minimally invasive nature of the procedure, the preserved integrity of the local bony environment, and the increased osseous regenerative capacity. Techniques, studies, and considerations for optimal use of the pericrestal sinus lift procedure will be presented, including site and timing of the procedure, consideration of the anatomic environment, and adjustment of the surgical approaches with due consideration of the findings obtained. Moreover, the mechanical requirements and application for augmentation materials will be analyzed, and modifications of commonly used materials will be presented. Overall, new approaches for a simplified but reliable use of pericrestal sinus elevation will be provided.
Georg Watzek, MD, DDS, PhD, is head of the Dental School at the University of Vienna. He is president of the Austrian Society of Oral Surgery and Implantology and a former president of the European Association for Osseointegration. Dr Watzek is the author of more than 200 publications, including 7 textbooks. His most recent book, Implants in Qualitatively Compromised Bone, was published earlier this year by Quintessence.