A modified graftless sinus lift: case report

Aim AAA (Alveolar Antral Artery) injuries are the most frequent intra-operative lesions occurring during maxillary sinus surgery. The aim of this work is to evaluate the role of preoperative CBCT and the effectiveness of piezosurgery to prevent bleeding. Furthermore, a modified Lundgren technique is presented, that can significantly reduce the risk of bleeding and of damages to maxillary sinus structures. Methods A case of maxillary sinus lift with immediate implants placement is reported. Preoperative CBCT scan allowed to study the course in the anterior-lateral sinus wall of the AAA and the variability of its patency. Antrostomy was  performed with piezosurgery device. Results Through preoperative identification of the course of the artery and trough this modified piezosurgery technique, it was possible to preserve membrane and artery integrity. Schneider membrane therefore was detached from the sinus floor, and contextually three implants were positioned. Conclusions In the preoperative phase, a study with CBCT scan is suggested, in order to identify intraosseous arterial  course, patency variability and the distance from alveolar ridge. Furthermore, it is strongly recommended the use of piezosurgery, to preserve vascular structures and soft tissues. A modified Lundgren technique can be useful to avoid the use of round bur and thus reduce the risk of perforation of the underlying structures.