The use of the initial bur combined with the respective shell prevents the special bur from slipping. If required, the allport bur or one of the ablative burs can refresh and smooth the bone.
Depending on the existing bone and the size of the implant to be inserted at a later date, now is the time to choose the guidance shell, the special bur and the osteotome with the larger (6.0 mm) or smaller (3.8 mm) diameter. Now the appropriate guidance shell is fastened onto the guidance tool, which is then held in front of the prepared alveolar crest.
Subsequently and in order to thin the sinus floor you use the special bur to drill through the guidance shell into the alveolar crest until the thickness of the remaining bone measures 1 mm. The perfectly matching tools ensure that this pre-determined height of the remaining bone is maintained.
Afterwards, the pointed tip of the osteotome is evenly positioned in the pre-shaped canal and the mandrin is inserted. By slightly tapping on the mandrin grip, the compacta on the maxillary sinus side is fractured in a controlled fashion. Prior to this, the part of the mandrin that is now rising above the top of the shaft was accurately adjusted to the height of the remaining bone.
Removal of the mandrin from the osteotome. Prior to inserting the balloon catheter the air must be evacuated i.e. it must be pre-filled with fluid (see the detailed description of the balloon catheter), then it is inserted into the guiding canal of the osteotome as far as it will go. In doing so, the blue extension at the end of the catheter shaft is pushed right down into the deepening of the osteotome grip.
This is followed by a repeated (carried out at least 5 times) slow and controlled extension of the balloon with a maximum of approximately 3 ml of fluid (Ultravist® 240 or physiological, 0.9 % NaCI solution). This procedure ensures the stripping and lifting of the maxillary sinus mucosa. If required, a respective X-ray image can be generated with the extended balloon positioned in situ.
At the end, the balloon is emptied again and removed with the osteotome. Then a spoon is used to insert the exact volume of the augmentation, which before served as the fluid to extend the balloon, step by step through the drilled hole into the newly established sinus area. By the application of the Osteotoms with the diameter of 3.8 mm, a direct implantation is possible.