Sinus Lift Technique Research Articles

TÉCNICA CIRÚRGICA EM LEVANTAMENTO DE SEIO MAXILAR

In contemporary implantology, we observe high rates of success and predictability, however, bone availability, or the amount of bone or lack of it in height and width, can limit the technique of installing bone-integrating implants. Rehabilitation of the maxilla in the posterior region, in cases where there was loss of the posterior dental elements of the maxilla, and in cases where the sinuses are pneumatized, a factor that limits the installation of integrable bone implants in these regions, it has been proposed and used techniques of maxillary sinus lift. In those cases, with insufficient bone quantity, rehabilitation with dental implants when the all on four technique is not used, it is only possible through bone reconstitution in place through the nasal sinus lifting technique.

Long-Term Effects of Sinus Floor Elevation with and Without Bone Graft: A Systematic Analysis of Randomized Clinical Trials.

Background and Objective: The aim of this systematic review was to assess clinical trials on the efficiency of sinus lift techniques with and without bone grafting in the atrophic posterior maxilla. Materials and Methods: This article was written under the PRISMA and the Cochrane Handbook for Systematic Reviews of Interventions guidelines. PubMed, Scopus, and Web of Science databases were electronically searched until December 2023. The risk of bias was assessed according to Cochrane Risk of Bias tool guidelines. Statistical analysis was performed for implant survival rate (ISR), marginal bone loss (MBL), and endo-sinus bone gain (ESBG). Results: At the end of the electronic search, 5 clinical trials were considered eligible. Statistical analysis was achieved for osteotome sinus floor elevation. The ISR at 3 years had a risk ratio (RR) of 0.98 [0.90, 1.07] (CI 95%), p = 0.7, and at 5 years, RR 1.02 [0.93, 1.11] (CI 95%), p = 0.68. The MBL, at 3 years, indicated a weighted mean difference (WMD) of 0.01 [-0.15, 0.16] (CI 95%), p = 0.93, and at 5 years, WMD of -0.08 [-0.53, 0.37] (CI 95%), p = 0.73. ESBG at 3 years had a WMD of -0.44 [-1.05, 0.17] (CI 95%), p = 0.16, and at 5 years, WMD of -0.61 [-1.63, 0.41] (CI 95%), p = 0.24. Conclusions: The available evidence underlines that the osteotome sinus floor elevation technique without bone graft may be used.

Comparative Clinical Outcomes of Two Different Zygomatic Implant Protocols for the Rehabilitation of Severely Atrophic Maxillae: A Retrospective Analysis.

This retrospective study aimed to compare extended sinus lift and extramaxilla surgical protocols for restoring severely atrophic maxillae with zygomatic implants (ZIs) and evaluate their clinical effectiveness. The study includes patients who were treated at a dental clinic in Italy from 2012 to 2022. These patients received fixed screw-retained complete dentures supported by either two or four zygomatic implants (ZIs). The patients underwent a minimum one-year follow-up post-loading, following two protocols: the hybrid and the quad protocol. Digital planning incorporated CBCT scans, intraoral scans, and digital prosthetic plans within implant planning software. Surgical techniques involved extended sinus lift and extramaxilla techniques methods, utilizing the ZAGA approach for ZI placement. The results showed that out of 19 patients with a mean age of 65.3, a total of 56 zygomatic implants (ZIs) and 20 standard implants were used, with no failures observed in either the implants or the definitive prostheses, resulting in a 100% survival rate. According to the ORIS criteria, overall success was achieved in terms of implant stability, sinus health, peri-implant soft tissue condition, and prosthetic function. Only two ZIs (3.6%) exhibited minor gingival recession and moderate thread exposure, which were closely monitored through professional hygiene maintenance. Both the extended sinus lift and extramaxilla protocols demonstrated comparable clinical outcomes and minimal complications in the restoration of severely atrophic maxillae with Zygomatic Implants (ZIs). However, further extensive studies involving larger, multicenter designs and longer follow-up periods are needed to validate and refine these outcomes.

Long-Term Comparative Outcomes of Short Implants Versus Maxillary Sinus Elevation in Posterior Maxilla Rehabilitation.

Background: Vertical atrophy of the maxilla has traditionally been treated with sinus lift procedures and implant placement, performed in one or two surgical stages. Subsequently, the transcrestal sinus lift technique was introduced, offering distinct advantages in terms of indications and reduced morbidity. Most recently, short implants have emerged as a valid alternative to these procedures, even in cases of severe horizontal resorption, allowing for direct placement in many cases. This study was designed to assess the clinical outcomes of short implant placement in alveolar ridges with severe bone atrophy, compared with conventional-length implants placed in areas undergoing conventional sinus elevation. Methods: A retrospective split-mouth study was conducted to compare conventional sinus elevation with standard-length implants versus short implants for addressing vertical bone atrophy in the posterior maxilla. The primary variable was the variation in the marginal bone level. The secondary variables were implant survival and complications. The evaluation of the statistical significance of the difference in categorical variables was accomplished by Chi-squared test or Fisher's exact test. The comparison between the study groups in continuous variables was performed using Wilcoxon test. The statistical significance was set at p-value < 0.05. Results: The study sample consisted of 24 patients and a total of 73 dental implants. The lateral sinus elevation group (LSEG) included 39 implants, while the short implants group (SIG) included 32 implants. All prostheses were screw-retained. Changes in marginal bone levels indicated a marginal bone loss of less than 0.5 mm in both groups, with no statistically significant difference. In the LSEG, two cases of mucositis were identified, attributed to improper use of an interdental brush. Additionally, two cases of prosthetic screw fracture were reported in the LSEG as technical complications. Conclusions: Long-term outcome data have provided evidence that the use of short implants is comparable to a state-of-the-art procedure (sinus grafting and placement of implants) regarding implant survival, marginal bone remodeling, and complication rates.

Open and closed sinus lift techniques

Open and closed sinus lift techniques

Complications and risk factors associated with zygomatic implants: retrospective analysis with 73 consecutive patients followed for 3.5 years.

This retrospective study analyzed zygomatic implant (ZI) survival and implant success (based on ORIS criteria) in patients treated for maxilla atrophy or after reconstruction failure. Implants were placed as quads (4 ZIs) or hybrids (ZIs and conventional implants in premaxilla) in edentulous patients using various surgical approaches, evolving from the sinus slot to Chow's extended sinus lift technique with or without Bichat fat pad. The procedure was followed by immediate loading, while clinical and radiographic evaluations spanned at least 1 year after implantation. The primary outcome was the implant survival at follow-up, and the secondary was the implant success, assessed as complications according to ORIS criteria: prosthetic offset, sinus status, peri-implant soft tissue health, and implant stability. A total of 73 consecutive patients, treated with 217 ZIs and 76 conventional implants, were included, with mean follow-up of 3.5 years (range, 1-9.8 years). Four ZIs failed in 3 patients, including 1 patient with a zygomatic bone fracture. The cumulative survival rate was 98.16%. Although in 2 additional cases, implants lost stability, they achieved delayed osseointegration. Other complications included 21 sinus reactions (excluding the 4 failures) and 28 peri-implant inflammatory reactions. ZIs offered a predictable treatment option for extreme upper jawbone atrophy with a relatively low complication rate and no severe injuries. The Chow technique with the Bichat fat pad positively impacted ZI success and survival, whereas smoking, implantation in fresh sockets, and the limited experience of the surgeon negatively affected the outcomes.

Antral membrane balloon technique versus Densah bur in crestal sinus lift with simultaneous implant placement: a randomized clinical trial

BackgroundThe posterior maxilla presents challenges for implant insertion because of the poor bone quality as well as the loss of vertical bone height. Indirect transcrestal sinus lift techniques are advised when a few millimeters of additional height are needed. This study aimed to evaluate the clinical and radiographic outcomes of antral membrane balloon technique versus Densah burs for transcrestal maxillary sinus lifting with simultaneous implant placement.Materials and methodsThis randomized clinical trial was conducted on 22 patients received 32 dental implants for replacement of missed maxillary posterior teeth after crestal maxillary sinus lifting. The patients were randomly divided into two groups. Group 1, patients underwent crestal sinus floor elevation with simultaneous implant placement using antral membrane balloon technique. Group 2, patients underwent crestal sinus floor elevation with simultaneous implant placement using Densah burs. Patients were evaluated clinically and radiographically using cone beam computed tomography (CBCT) at regular time intervals immediately, 6 months and 12 months after surgery. All clinical and radiographic parameters were statistically analyzed.ResultsAll dental implants were successful for 12 months of follow up. Regarding implant primary stability, there was a statistical significant difference between the study groups in favor of Densah group (P = 0.004), while there was no significant difference after 6 months (P = 0.07). Radiographically, balloon group showed a statistically significant immediate postoperative vertical bone height (P < 0.0001), and significant reduction in vertical bone height after 6 months (P < 0.0001). Densah group showed significant increase in bone density (P ≤ 0.05).ConclusionBoth techniques demonstrated successful clinical and radiographic outcomes for crestal sinus lift. The antral membrane balloon group demonstrated better immediate postoperative vertical bone gain, while Densah burs had higher implant primary stability and bone density.Trial registrationThis study was registered in Clinical-Trials.gov PRS (https://register.clinicaltrials.gov) under identification number NCT05922592 on 28/06/2023.

Effectiveness of Autologous Platelet Concentrates in the Sinus Lift Surgery: Findings from Systematic Reviews and Meta-Analyses.

Maxillary sinus augmentation is one of the most predictable procedures for the rehabilitation of the posterior maxilla. The current overview aimed to summarize the findings provided by systematic reviews (SRs) and meta-analyses on the effectiveness of autologous platelet concentrates (APCs) in sinus lift and to assess the methodological quality of the included SRs. Three electronic databases have been explored. SRs and meta-analyses addressing the effectiveness of APCs in sinus lift technique were included. Clinical, radiographic and histomorphometric findings were considered for APCs as solely grafting materials and APCs in combination with biomaterials. Outcomes were implant survival rate (ISR), implant stability (IS), implant failure (IF), postoperative complications, histomorphometric findings, radiographic bone gain, bone volume and bone density. The methodological quality of the included SRs was assessed using the updated version of "A Measurement Tool to Assess Systematic Review" (AMSTAR-2). Thirty SRs were included. The methodological quality of the included reviews ranged from critically low (3 studies) to high (9 studies). The included SRs showed favorable clinical outcomes, short-term new bone formation and no biological complications when APCs were used both as solely graft material or in combination with other biomaterials. However, no significant additional effects in the long-term period were observed. APCs did not add any further positive effects compared to the physiological healing derived by the natural blood clot. The current overview of SRs highlighted the need for high-quality SRs evaluating the role of APCs in sinus lift though network meta-analyses, in order to identify the most powerful material for sinus lift augmentation. The use of APCs improves the healing of soft tissues and the postoperative quality of life in the short-term period. Thus, its application can be recommended.

Mini Crestal Sinus Lift With Bone Grafting and Simultaneous Insertion of Implants in Severe Maxillary Conditions as an Alternative to Lateral Sinus Lift: Multicase Study Report of Different Techniques.

The present study evaluates the efficacy and clinical outcomes of crestal sinus lift techniques used to elevate the sinus floor simultaneously with bone grafting and implant placement as a possible and reproducible alternative to lateral sinus lift. Patients underwent different crestal sinus elevation techniques. The heterologous biomaterial was used as graft material, and multiple implants were placed simultaneously after sinus augmentation. Radiographic and clinical examinations were performed during follow-up. All procedures were successfully performed without any apparent perforation of the Schneider membrane. The sinus floor was augmented with an average height of 5mm (range: 2.8-7.4mm). The implants healed smoothly with healing screws. Peri-implant marginal bone was stable with a mean follow-up of 50 months (range: 33-71mo). No complications were observed during the follow-up. Based on the limited data collected in this study, the new crestal sinus elevation approach can effectively raise the sinus floor and reduce the incidence of postoperative complications. Other cases with long-term follow-up are needed to confirm and improve this crestal sinus lift technique.

Versatility of the Osseodensified Crestal Sinus Lifting Technique as Alternative Procedure for the Lateral Sinus Technique with Simultaneous Implant Placement

Versatility of the Osseodensified Crestal Sinus Lifting Technique as Alternative Procedure for the Lateral Sinus Technique with Simultaneous Implant Placement

Effect of Different Crestal Sinus Lift Techniques for Implant Placement in the Posterior Maxilla of Deficient Height: A Randomized Clinical Trial

This study evaluated dental implant stability, vertical bone gain, bone density, and crestal bone loss using different crestal sinus lift techniques (osteotomy, Densah burs, and piezosurgery). A total of 21 patients were randomly divided into three groups: Group 1: patients were treated using a Densah drill crestal sinus lift, Group 2: patients were treated using a piezoelectric crestal sinus lift and Group 3: patients were treated using an osteotome crestal sinus lift. The patients in all three groups underwent bone grafting and implant placement. An Osstell device was used to determine the implant stability by recording the values of the implant stability quotient (ISQ). CBCT was performed before and 6 months after implant placement for radiographic evaluation and comparison among the groups. All dental implants were completely successful, and statistically significant differences from baseline to 6 months were noted in all groups (p &lt; 0.05). The Densah burs technique resulted in the best implant stability of all groups, while the osteotome technique demonstrated better vertical bone augmentation. However, the values for bone density and crestal bone loss showed no significant difference among all treated groups (p &gt; 0.05). All three techniques were successful for crestal sinus lifts with good clinical outcomes at a 6-month follow-up. The Densah group demonstrated better implant stability, shorter surgery time, and fewer complications; however, the vertical bone gain was greater with the osteotome technique.

Awareness and attitude of ENT surgeons towards various dental implants or oral surgery procedures: a cross-sectional survey in the UK.

To assess the level of awareness and attitude of ENT surgeons towards dental implants and oral surgery procedures that involve the maxillary sinus. A cross-sectional survey was conducted using a closed-ended questionnaire on 40 UK-based ENT surgeons. Within the study population, 45 per cent of ENT surgeons were not aware of sinus lift augmentation in implant dentistry. Only 25 per cent of respondents were aware of the two subtypes of sinus lift techniques. Thirty per cent of the respondents were aware of or had heard of benign positional paroxysmal vertigo following dental treatment. Fifty-two per cent of respondents came across a dental foreign body, most commonly a tooth that had been displaced into the maxillary sinus. It was also reported that 82.5 per cent of respondents had liaised with an oral surgeon for an oroantral communication problem or a dental infection. Dental awareness among ENT surgeons needs to be raised for optimum interdisciplinary communication and patient safety.

A New Simplified Autogenous Sinus Lift Technique.

Oral maxillofacial rehabilitation of the atrophic maxilla with or without pneumatization of the maxillary sinuses routinely presents limited bone availability. This indicates the need for vertical and horizontal bone augmentation. The standard and most used technique is maxillary sinus augmentation using distinct techniques. These techniques may or may not rupture the sinus membrane. Rupture of the sinus membrane increases the risk of acute or chronic contamination of the graft, implant, and maxillary sinus. The surgical procedure for maxillary sinus autograft involves two stages: removal of the autograft and preparation of the bone site for the graft. A third stage is often added to place the osseointegrated implants. This is because it was not possible to do this at the same time as the graft surgery. A new bioactive kinetic screw (BKS) bone implant model is presented that simplifies and effectively performs autogenous grafting, sinus augmentation, and implant fixation in a single step. In the absence of a minimum vertical bone height of 4 mm in the region to be implanted, an additional surgical procedure is performed to harvest bone from the retro-molar trigone region of the mandible to provide additional bone. The feasibility and simplicity of the proposed technique were demonstrated in experimental studies in synthetic maxillary bone and sinus. A digital torque meter was used to measure MIT and MRT during implant insertion and removal. The amount of bone graft was determined by weighing the bone material collected by the new BKS implant. The technique proposed here demonstrated the benefits and limitations of the new BKS implant for maxillary sinus augmentation and installation of dental implants simultaneously.

A Comparative Study Between Graftless and Grafted Maxillary Sinus Lift Procedures for Implant Placement

Dental implant survival requires the presence of peri-implant bone for complete and stable osseointegration. Grafted sinus lift procedures are predictable methods to augment deficient ridges, but may give rise to complications, comorbidities, and additional costs. Recent evidence showed positive outcomes of the graft-less sinus lift technique. However, studies comparing the outcome of the grafted and graft-less sinus lift procedures are still lacking. This study aims to compare the implant stability, bone density, and pocket depth outcomes between grafted and graft less sinus lift procedures for implant placement.

Healing of particulate allografts mixed with platelet concentrates in ridge preservation and sinus lift: a prospective histomorphometric study

The objective of the present study was to evaluate the bone quality of sinus and alveolar grafts following filling with particulate allogenous bone (DFDBA 300-500μm) and platelet concentrate (platelet-rich fibrin, PRF). A prospective interventional clinical study was carried out. A total of 40 bone cores, 2mm in diameter, were taken from 21 patients: 22 from grafted alveoli, 7 from grafted sinus sites, and 11 from native bone used as a control. Fixed, paraffin-embedded samples were subjected to histological staining with hematoxylin-eosin and Masson's trichrome. Bone maturity of the samples was evaluated by two independent operators using histomorphometric analysis. There existed a greater proportion of lamellar neoformed bone than woven neoformed bone as the healing time increased. Moreover, there was also an increasing proportion of newly formed bone in the grafted sockets as a function of healing time (average: 41.22%≤5 months, 55.89%˃5 months). Resorption of DFDBA particles also appears to be correlated with healing time in the grafted socket (average: 15.43≤5 months, 13.72%˃5 months). In conclusion, performing sinus lift and alveolar socket preservation techniques using DFDBA and PRF results in high quality, mature bone tissue according to histological criteria.

Evaluation of trephine osteotomy technique in direct sinus lifting with simultaneous implant placement

BackgroundRecently, in implant dentistry, trephine drills have been used instead of conventional drills to conserve the bone during osteotomy. Aim of the studyTo evaluate the effectiveness of trephine osteotomy for lateral sinus lifting technique associated with sinus floor augmentation using the autogenous bone resulting from implant drilling using specialized trephine drills. Materials and method12 Patients were included and have been subjected to lateral sinus lifting using trephine osteotomy with simultaneous implant placement with delay loading. A bone graft used in sinus floor augmentation has been prepared using autogenous bone resulting from implant site preparation in addition to β-tricalcium phosphate. ResultsAfter 6 months, the difference between the primary stability and implant stability was statistically significant p-value ≤ 0.05. After 6 months, the mean vertical bone height reached 11.71 ± 0.72 mm. The mean volume of the newly formed bone of the grafted area recorded after 6 months was 1126.7 ± 82.94 mm3. ConclusionTrephine osteotomy technique in both lateral approach of sinus lifting, and implant site preparation allows preservation of autogenous bone. Moreover, the trephine osteotomy technique in the lateral approach of sinus lifting eliminates the use of an absorbable membrane.

Short and Ultra-Short Implants, in Association with Simultaneous Internal Sinus Lift in the Atrophic Posterior Maxilla: A Five-Year Retrospective Study.

Recent short-term studies suggested the use of short and ultra-short implants in association with a modified osteotome sinus floor elevation (internal sinus lift) technique for the treatment of edentulous resorbed posterior maxilla. The aim of this retrospective study was to investigate this hypothesis in locking-taper implants with a mid-term follow-up of 5 years. Overall, 155 implants (32, 100, and 23 of, respectively, 5.0 mm, 6.0 mm, and 8.0 mm length) were positioned in the atrophic upper maxilla of 79 patients, and 151 implants were loaded with single crowns. Overall implant survival after 5 years was 94.84%. Implant survival for each length group was 93.75%, 94%, and 100% for 5.0, 6.0, and 8.0 mm length, respectively. Preoperative residual crestal bone height of 4.45 (1.3) mm increased to 9.25 (2.13) mm after implant placement and settled at 6.35 (1.73) mm after loading and at 5.25 (1.68) mm at follow-up. Elevation of the Schneiderian membrane was 4.8 (2.46) mm after implant placement, 3.06 (1.3) mm after loading, and 1.46 (1.06) mm at follow-up. Mean variations of peri-implant crestal bone loss and first bone-to-implant contact point were, respectively, -0.36 (1.3) mm and -0.62 (1.15) mm. It can be confirmed that internal sinus lift procedure revealed stable bone gain and negligible resorption at mid-term follow-up for atrophic upper crests with reduced height.

Short versus standard implants at sinus augmented sites: a systematic review and meta-analysis

BackgroundShort implants are proposed as a less invasive alternative with fewer complications than standard implants in combination with sinus lift. The aim of this systematic review and meta-analysis was to state the efficacy of placing short implants (≤ 6 mm) compared to standard-length implants (≥ 8 mm) performing sinus lift techniques in patients with edentulous posterior atrophic jaws. Efficacy will be evaluated through analyzing implant survival (IS) and maintenance of peri-implant bone (MBL).MethodsScreening process was done using the National Library of Medicine (MEDLINE by PubMed), EMBASE, the Cochrane Oral Health, and Web of Science (WOS). The articles included were randomized controlled trials. Risk of bias was evaluated according to The Cochrane Collaboration’s tool. Weighted means were calculated. Heterogeneity was determined using Higgins (I2). A random-effects model was applied. Secondary outcomes such as surgical time, patient satisfaction, mucositis and peri-implantitis, pain, and swelling were analyzed.ResultsFourteen studies (597 patients and 901 implants) were evaluated. IS was 1.02 risk ratio, ranging from 1.00 to 1.05 (CI 95%) (p = 0.09), suggesting that IS was similar when both techniques were used. MBL was higher in patients with standard-length implants plus sinus lift elevation (p = 0.03). MBL was 0.11 (0.01–0.20) mm (p = 0.03) and 0.23 (0.07–0.39) mm (p = 0.005) before and after 1 year of follow-up, respectively, indicating that the marginal bone loss is greater for standard-length implants.DiscussionWithin the limitations of the present study, as relatively small sample size, short dental implants can be used as an alternative to standard-length implants plus sinus elevation in cases of atrophic posterior maxilla. Higher MBL was observed in the groups where standard-length implants were used, but implant survival was similar in both groups. Moreover, with short implants, it was observed a reduced postoperative discomfort, minimal invasiveness, shorter treatment time, and reduced costs.Clinical Clinical relevanceThe low MBL promoted by short implants does contribute to a paradigm shift from sinus grafting with long implants to short implants. Further high-quality long-term studies are required to confirm these findings.

Osteotomy in lateral sinus augmentation: A comparative study of rotary technique and Lateral Approach Sinus Kit®.

Various sinus lift techniques have been tried to minimize the rate of perforations, especially in Type I and Type II sinus membrane thickness. The aim and objectives of this study was to present our own experience compare and the efficacy of conventional direct sinus lift technique and direct sinus lift using LAS Kit. Our study included 14 patients in which seven patients in conventional technique and seven patients in Lateral Approach Sinus (LAS) Kit®. The results showed that the sinus membrane perforation rate, using LAS Kit® with specially designed drills, is less than that of the conventional technique, especially in Type I and II sinus membrane with the added benefit of reduced operative time. The mean operative time in conventional technique was 28.29 ± 2.21min and in LAS Kit®, it was 19.43 ± 2.88min which was statistically significantly less than the conventional technique group (P < 0.001). In both the groups, 100% implant integrity was achieved (measured using reverse torque technique) after 6 months of follow-up. It was observed that there was no statistically significant difference between the groups in pain, swelling, flap dehiscence, and infection at different time intervals. We conclude that the use of LAS Kit® for sinus lift procedure in atrophied maxilla with Type I and II sinus membrane is a much safer approach over the conventional technique. Further, the results obtained also showed that blood coagulum gave better gain in bone height over a period of 6 months.

Complications of Conventional Sinus Augmentation Techniques Versus Modified Osteotome Techniques in Dental Implant Surgery: A 3-Year Retrospective Clinical Study.

Sinus Augmentation has proven to be a predictable and popular approach to overcome bone volume deficiency in the posterior maxilla for patients seeking dental implants. The most common surgical methods utilized for maxillary sinus augmentations are the lateral window approach and crestal osteotome technique, which may cause many complications like sinus membrane tear, bleeding, sinusitis, etc. the purpose of this study is to compare complications rates of different sinus lift techniques in dental implant surgery. To assess the intraoperative and postoperative complications between the conventional direct or indirect method with alternative sinus lift techniques using Modified Crestal and Lateral (CAS & LAS KIT) ®method (Osstem/Hiossen). This is a retrospective study where in all the sinus lift cases done during 3year duration in the center data was collected and analyzed a total of 61 sinus lift procedure was done and all the data is tabulated and analyzed. Results show of the total 61 cases 25 (40%) male patients and 36(59%)female patients traditional techniques like summers osteotome and conventional direct or indirect method had 7 cases (33.3%-37.5%) complication rates compared to Modified Lateral osteotome had 2 complications (14.2%) & Modified Crestal osteotome had only 3 case(3.7%) infections, wound dehiscence, membrane tear etc. Modified Crestal & Lateral Osteotome (CAS KIT & LAS KIT) ® technique does reduce the incidence of complications like sinus membrane tear compared to conventional Direct and Indirect techniques, because of stopper system used in hydraulic lift and the special design of drill head of these instruments.