الفهرس 
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Abstract
This academic work was aimed to compare the use of Densah burs versus osteotome for transcrestal maxillary sinus lifting with simultaneous implant placement regarding stability, bone height and bone density around the implant.
Twelve Patients in need for implant placement for their lost posterior maxillary teeth (premolars and molars) with limited bone height below the floor of the maxillary sinus were selected from the outpatient clinic of the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University.
Preoperative assessment
Full personal history was taken, patients were examined clinically to exclude any medical condition that affect the implant success. Also Panoramic x-ray was taken first to indicate whether the patient needs sinus lifting or not, if needs sinus lifting CBCT was taken.The residual bone height and bone width were measured accurately to choose the most appropriate implant size.
Surgical procedure
All patients were treated under local anaesthesia using maxillary vestibular and palatal infiltration. A full mucoperiosteal flap was elevated with crestal incision using blade no.15, flap reflection with periosteal elevator.
Patients were divided into 2 groups: group A received osseodensification sinus lifting and group B received osteotome sinus lifting.
group A: The implant motor was adjusted on reverse mode with 800 to 1200 rpm. According to the desired implant dimension, we started with the smallest densah bur ex: 3.3
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bur. The first densah bur was advanced in densifying mode with bouncing motion in and out movement with copious irrigation until the haptic feedback of the sinus cortex was felt. The second densah bur was used to pass through the sinus cortex in the same motion.
group B: The intermediate drill (2.7 mm) was used to the same level as the pilot reached. The first osteotome (3.2 mm) was then inserted in a wedging motion, pushed apically in an in and out motion with 1 mm increments until the sinus floor was breached. The second osteotome (3.8 mm) was inserted in the same motion with gentle pressure apically until the desired length was reached. The desired width was prepared with the corresponding osteotome size.
Clinical and Radiographic Follow Up Parameters
Postoperative pain was examined using pain intensity scale (PIS) in the first 10 days, the mean pain score in the osseodensification group was 3.00 ±2.28, while in the osteotome group the mean postoperative pain was 4.17 ± 2.31. The pain was mild to moderate in the 2 group.
Postoperative edema was measured by pitting in the first 10 days, the mean edema score for osseodensification group was 1.33 ± 0.51, while for the osteotome group the mean edema score was 2.17 ±0.98. In both groups there was mild postoperative edema. There was no significant difference in pain and edema in the 2 groups.
The operation time in both groups was measured starting after x ray checking of pilot drill position, the operation time for densah bur cases was much lesser than osteotome cases.
The mean primary stability in the densah bur group was 66.17 ±9.57, the mean in osteotome group was 54.83 ±7.19.There was a significant difference between the two groups in favour of the osseodensification group.
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There was also a significant difference in secondary stability between the two groups.
There was increase in bone height within both groups,however no significant difference was detected between the 2 groups.
In both groups, there was an increase in bone density at the implant sides in the immediately postoperative CBCT. Also this increase in bone density was higher in the osseodensification group. The bone density in osseodensification group in the elevated part of the sinus was higher than that of osteotome but not to the level of significance.
Conclusion
Both techniques are successful techniques for transcrestal sinus lifting with some benefits of osseodensification group over osteotome group including implant stability, operation time and bone density around the implant.