Guided Lateral Window Osteotomy Using Dynamic Navigation for Maxillary Sinus Augmentation: A Novel Technique
The size and the position of the sinus antrostomy play a key role in making sinus grafting surgery more predictable and effective with less complications. A cone beam computed tomography and intraoral scan of the maxilla were taken for a patient who is missing maxillary first molar tooth with limited residual bone. Data were exported to the dynamic navigation (DN) system software. Sinus lateral window osteotomy position and dimensions were determined and planned using four 1.5 mm diameter implants placed on the maxillary sinus lateral wall. The osteotomy was initiated following the planned four 1.5 mm implants in a parallel motion to the bone surface using dynamic navigation guidance; thus, creating an outline for the lateral sinus window. Afterword's, the lateral sinus window was greenstick fractured and the membrane was lifted; first molar implant osteotomy done, implant placed, and bone graft material was placed. The flap was sutured, and post-operative instructions and medications were given. No post-operative complications noticed. The outline of the lateral window osteotomy along with implant osteotomy can be accurately planned and executed using DN technology, which may potentially reduce complications and insure accurate placement of the implant and the graft.

Defining panoramic curve using X-Nav software.

Defining surface refinement on X-NAV software including the lateral wall of the maxillary sinus. Yellow line represents structures identified by the dynamic navigation system to be used for registration process.

Planning a virtual implant position relative to the virtual maxillary first molar crown.

Cross sections of the narrow diameter implants positioned at the location corresponding to: (a) anterior window osteotomy line, (b) inferior window osteotomy line, (c) posterior window osteotomy line, and (d) superior window osteotomy line.

Overall planning of the lateral window osteotomy outline. Four narrow diameter implants planned and positioned on the lateral surface of the maxillary sinus wall corresponding to the shape, and dimensions of the lateral window osteotomy.

(a) Handpiece tracker. (b) Patient tracker. (c) Prob tool tracker. (d) X-Clip.

Measuring bur length using calibration plate.

Outlining the lateral sinus window according to the plan. Four lines of osteotomy corresponding to the four narrow planned implants.

Lateral window osteotomy fractured and Schneiderian membrane lifted.

Maxillary first molar implant placed along with graft material.
Contributor Notes