Multidisciplinary approach to optimize sinus grafting

Sinus grafting has become common practice in last decades to allow implant placement and related imlant-supported prosthetic restoration of the atrophic edentulous posterior maxilla. Recent literature reviews demonstrated that long-term survival of implants placed in grafted sinuses is very high. However, despite the very favorable results of this procedure, it must be underlined that sinus grafting might be an inappropriate solution to correct a lack of bone in the posterior maxilla. In fact, it has been shown that insufficient alveolar bone in this area may be related to sinus expansion, but also to vertical and/or horizontal bone resorption of the alveolar crest. In these latter situations, guided bone regeneration or bone grafting procedures, in association with or without sinus grafting may be a more appropriate solution to recreate not only adequate bone volume for implant placement, but also to correct intermaxillary discrepancies which may compromise the final prosthwtic result. Finally, the maxillary sinus may present pathoses which amy contraindicate sinus grafting. The aims of this lecture are to present updated surgical protcols in order to optimize the treatment of the atrophic edentulius maxilla with a multidisciplinary approach which involves not only prosthodontists and dentists, but also oral and maxillo-facial surgeons as well as ENT surgeons. OBJECTIVES The objectives of this lecture are to present rational surgical protocols for the restoration of the atrophic edentulous posterior maxilla. These protocols may significantly differ according to initial clinical situation and may need not only sinus grafting but also reconstruction/regeneration of the deficient alveolar bone as well as treatment of sinusal pathoses which might contraindicate sinus grafting. The protocols presented will allow oral surgeons to optimize the final outcome from a functional and esthetic point of view