FAQ

FAQ


  1. How do you know whether you can proceed with the insertion of the balloon harboring device (BHD)? 

    After sinus floor fracturing with the osteotome and subsequent screw- tapping and assessment of the antral (sinus) membrane integrity the metal sleeve of the balloon harboring device (BHD) should be inserted into the osteotomy and advanced 1mm beyond the sinus floor (based on CT measurements). 

    Prior to inserting the metal sleeve of the BHD one should carefully inspect and confirm circumferential (360°) sinus floor fracturing using the suction syringe or other blunt instrument. Non-circumferential sinus floor fracturing may result inability to inflate the MIAMBE balloon. 
     
  2. How do you know when the balloon emerged from the metal sleeve and started to inflate? 

    When injecting the contrast material with the barometric indeflator through the plastic tubing into the balloon at first pressure will raise up to 2 bars because the balloon is confined to a rigid (metal) space of the BHD. As the balloon emerges from the confined space of the BHD pressure will drop to 0.5 bars. 
     
  3. How do you know when to stop inflating the balloon?

    After the pressure in the system dropped to 0.5 bars the balloon is starting to inflate (approximately 4mm in diameter at that point). Usually one should inject an additional 1-1.5 ml of contrast fluid in order to raise the membrane by 11-13mm. 
     
  4. What to do in case when the pressure rises to more then 2.5 bars?

    Stop injecting and withdraw the contrast from the balloon into the indeflator.
    After injecting additional bone substitute into the osteotomy and repeating the screw- tapping (however increasing the working length of the screw tap by 1mm) confirm membrane integrity and circumferential sinus floor fracture employing the suction device. Only after these steps reinsert the BHD and re-attempt to inflate the MIAMBE balloon. 

     
  5. What to do in case when the pressure drops to 0 burs?

    If there is no leak of contrast from the tubing this will suggest that the balloon has been perforated by tiny bone fragments which remained within the osteotomy. Remove the balloon from the osteotomy reinsert the screw tap and tap again(alsaw increasing the working length of the screw tap by 1mm). Then after replacing the perforated balloon with new one insert the BHD into the osteotomy and inflate the balloon as per protocol.  
     
  6. How do you know that you didn't rupture the sinus membrane? 

    With the MIAMBE technique the membrane integrity is assessed by:
    1) By VAL SALVA maneuver.
    2) Respiratory movement of blood within the osteotomy.
    3) By direct visualizations assisted by applying suction syringe into the sinus.
    4) By injecting saline with 5 cc syringe into the sinus asking the patient to breathe through the nose.
     
  7. How do you know whether you raised the membrane in the lateral and medial wall of the sinus?

    Actually, it is difficult to confirm however the balloon expands uniformly in 360° around the osteotomy and subsequently elevates or lifts the membrane circumferentially.   
    We can expect to have better membrane elevation than with the osteotome technique. We know from the literature that there are almost no complications when using the osteotome method. Therefore, we may assume that we'll have even less problems when using the balloon.
     
  8. How do you know that you condensed the bone enough?

    What is enough condensation? We do not want the bone substitute particles to be too condensed, in order to allow the blood clot to fill the space between particles to promote new bone formation. Moreover, we know from the literature (Lundgren et al, Periodontology 2000, 2008) that even if we do not fill the sinus with a bone graft particles, the elevation of the membrane and the blood clot will induce new bone formation.
     
  9. What are you doing if you perforate the membrane?

    It depends on the size of the perforation If it is a small perforation and a single implant placement is planned, you disconnect the membrane with the suction tip around the bottom of the osteotomy insert PRF membrane or other collagen membrane and inflate the balloon and continue the procedure In a case of a bigger tear and single implant abort the procedure.

    If more than one implant is planned drill the second osteotomy and perform the membrane elevation, after disconnecting the membrane with the balloon the surplus of the membrane will seal the adjacent perforation. In addition you can insert a collagen or PRF membrane into the osteotomy underneath the torn sinus membrane.
     
  10. When you insert the implant?

    In order to obtain a good primary stability you need a minimum of 4-5mm of residual bone height below the sinus floor.
     
  11. What quantity of bone do you graft?

    Bone graft volume should be identical to the volume (in milliliters) that you inflate the balloon with.  Hence, if you injected 1 ml of contrast fluid to inflate the balloon you should inject a total of 1cc. of bone substitute.
     
  12. Haw do you know when to stop inflating the balloon?

    The balloon by design tends to expand symmetrically If no rigid barriers are encountered (septum) symmetrical and uniform sinus elevation is the rule. 
    1ml of fluid should inflate the balloon to 11 mm diameter 
    1.5 of fluid should inflate the balloon to 13 mm diameter
    There is no need to inflate the balloon more then 1-1.5 ml because it may increase the risk of membrane rupture without providing any meaningful benefit.
     
  13. How to perform MIAMBE in case of a septum presentation?

    In case of a septum it is recommended to enter the sinus in the middle of the compartment and not in the angle which can lead to balloon perforation membrane rupture or create a barrier that can potentially block or restrict the balloon inflation. Additionally, one should inject only 0.5 ml of contrast fluid because the compartment walls restricted the balloon expansion laterally and allow balloon inflation only cranially or upwards.