Implant prosthesis has become a useful and common treatment for the restoration of missing teeth. However, the implant placement and, consequently, an adeguate functional prosthetic rehabilitation in the maxillary molar region, requires further attention, because of potential bone quality and anatomical structure issues, related to masticatory pattern and occlusal load entity. In the maxillary molar area, the height of alveolar bone may be reduced due to acute or chronic periodontal disease, Sinus pneumatization or atrophy of the residual alveolar ridge after extraction. Thus, implant placement in this area can be difficult or even impossible. Besides, the reabsorption process, in edentulous posterior maxillary regions, could determine insufficient vertical dimensions for the implant positioning, often requiring additional surgical procedural steps. These involve the use of several different techniques: 1) Guided bone regeneration performed using bone substitutes often combined with autologous bone and reabsorbable or not-reabsorbable membranes; 2) Surgical expansion through Le Fort I Osteotomy with interposition of bone grafts; 3) Crestal Approach to sinus lift; 4) Lateral Approach to Sinus lift procedures with the contextual filling of the cavity by means of several graft materials. Among these techniques sinus lift is simple and widely used. Maxillary sinus floor augmentation became a routine preprosthetic treatment in recent years. Sinus floor elevation with autogenous bone grafts and/or bone substitutes is a generally accepted procedure that allows the insertion of implants. The technique of “sinus lift” consists in increasing vertically the alveolar ridge of maxillary posterior area by interposing different types of bone grafts between Schneider sinusal membrane and the floor of the maxillary sinus. The procedure is one of the most common preprosthetic surgical procedures performed in dentistry today.
Sinus lift is generally performed using the lateral window or crestal approach. Implants placement may be combined with sinus augmentation as a “one-stage” technique. Alternatively, sinus augmentation may be carried out sometime before implant placement as a “two-stage” technique, which requires an additional surgical stage. Worldwide consensus and guidelines related to sinus Procedure with lateral approach give us some alternatives used in surgical Procedings. First:The use of PiezoSurgery technologies: Providing sinus lateral window Approach by Piezosurgery technique is widely accepted as useful procedure. Second: Platelet Rich Plasma proceedings. Equally also PRP technology is widely used as support to promote, shortening and protect first step of wound healing and endosinusal bone regeneration. The PRF as a sole filling material for sinus lift with simultaneous implant placement is a simple technique with promising results. PRF membranes represent an easy and successful method to cover the sinus membrane or osteotomy window. Apart from these advantages, PRF allows to avoid the use of membranes and barriers, thus reducing the risk of possible exposure to the oral cavity and of the consequences that the bacterial contamination may have on the regenerative process. The adjunction of PRP allow for a 60 percent reduction of bone graft volume used for sinus floor elevation. The bone obtained with PRP had the same histologic and mechanical characteristics as the bone obtained by traditional graft. The quality of this bone was adapted to dental implant placement. All we know that Sinus lifting with lateral approach is a technique strictly operator-dependent. Experience, a good surgical hand and a well-balanced team, allow you to safely complete a surgical procedure that is universally recognized to be quite difficult. However, if there are technical variations that make the procedures simpler and safer for both operator and patient, it is advisable to take them into account. For that reason we thought to evaluate the efficacy of Piezosurgery and Prp in Sinus Procedure. Our decision become also from the Operator experience both with two techniques matured in several years of study and Surgical Application. If Schneider membrane elevation will be actually safer by Piezosurgery use and the use of PRP in bone augmentation phase and wound healing will be both demonstrated, than we’ll consider such technique as a valuable alternative in conventional procedure during Sinus operating moment.