Minimally Invasive Antral Membrane Balloon Elevation Followed by Maxillary Bone Augmentation and Implant Fixation
The posterior maxillary segment frequently suffers from insufficient bone mass to support dental implants. Current bone augmentation methods, including the lateral maxillary approach (ie, hinge osteotomy) and sinus elevation by osteotome, have many shortcomings. The objective of our study was to assess the safety and efficacy of minimally invasive antral membrane balloon elevation (MIAMBE) followed by bone augmentation and implant fixation (executed during the same procedure). Alveolar crest exposure and implant osteotomy were followed by sequential balloon inflations yielding >10 mm MIAMBE. A mix of autologous fibrin and bone particles with bone speckles was injected beneath the antral membrane. Implants were fixated into the osteotomies, and primary closure was performed during the same sitting. A total of 24 patients were enrolled. Successful conclusion of this procedure was accomplished in 91.6% of the initial 12 patients and 100% in the second dozen cases without significant complications. Patient discomfort was minimal. Long-term follow up revealed satisfactory bone formation, resulting in adequate implant stability. We conclude that the protocol of MIAMBE results in an excellent success rate, low complication rate, minimal discomfort, and long-term safety and durability. Because it requires only basic equipment and a short learning curve, this clinical approach should be widely employed.Abstract

Case 1. (AI) Bone thickness under sinus membrane and septum. (AII) Maxillary sinus. (B) Pilot drill. (C) Expanding osteotomy (2.8 mm) and breaking the sinus floor. (DI) Balloon setup. (DII) Antral membrane elevation by balloon. (E) Following bone transplantation. (FI) Implant fixation and septal drilling. (FII) Second implant fixation. (FIII) Postprocedural follow up (3 weeks)

Case 2. (A) Before augmentation. (B) Antral membrane balloon elevation. (C) Postaugmentation (6 months)

Case 3. (A) Preprocedural panoramic X ray. (B) Antral membrane balloon elevation. (C) Follow up (6 months)

Case 4. (A) Preprocedural panoramic view. (B) Minimally invasive antral membrane balloon elevation. (C) Implant fixation. (D) Follow up (6 months)

Case 5. (A) Preprocedural X ray. (B) Minimally invasive antral membrane balloon elevation. (C) Implant fixation after bone transplantation

Case 6. (A) Preprocedural panoramic view. (B) Before minimally invasive antral membrane balloon elevation (MIAMBE) periapical X ray. (C) MIAMBE. (D) Implant fixation after bone transplantation

Case 7. (A) Preprocedural periapical X ray. (B) Minimally invasive antral membrane balloon elevation. (C) Implant fixation after bone transplantation. (D) Follow up (6 months)
Contributor Notes
Efraim Kfir, DMD, is from the Dental Clinic at Hanesihim Street 40 in Petah-Tikvah, Israel.
Vered Kfir, DMD, is from the Dental Clinic at Kupat Holim Clalit (Remez) in Rehovot, Israel.
Eitan Mijiritsky, DMD, is from the Oral Implant Center at The Hebrew University-Hadassah School of Dental Medicine in Jerusalem, Israel.
Ronen Rafaeloff, DMD, is from the Dental Clinic at Shprintzak Street 3 in Tel Aviv, Israel.
Edo Kaluski, MD, is from the Department Cardiology at Assaf Harofeh Medical Center in Zrifin and Sackler School of Medicine at the University of Tel Aviv in Israel. Address correspondence to Dr Kaluski, director of the Coronary Care Unit, Assaf Harofeh Cardiology Institute, Zrifin, DN Beer Yacov, 70300, Israel.