Maya Marulanda, Mayra AlejandraMayra AlejandraMaya MarulandaCáceres Cordova, Leyvi KarinaLeyvi KarinaCáceres CordovaCampuzano, GabrielGarzón Vergara, Hernán SantiagoUnriza Puin, Sonia Rubiela2026-07-032026-07-032022-11-18https://repositorio.unicoc.edu.co/handle/SII-Unicoc/2925The paranasal sinuses are air-filled extensions of the nasal cavity, consisting of the ethmoid, frontal, sphenoid, and maxillary sinuses. They are lined by a very thin membrane called Schneider's membrane. The maxillary sinuses are cavities that occupy part of the body of the upper jaw and are located bilaterally. They are bounded by four walls, although they may also have internal septa. The medial wall of the maxillary sinus is the most complex, presenting a natural drainage opening (maxillary ostium). This medial wall may also present anatomical variations such as accessory ostia, which correspond to openings located at the sites of the nasal fontanelles. It has been noted that both the ethmoid infundibulum and the middle meatus are among the structures most affected by these variations, producing narrowing of these passages and, in turn, facilitating infectious processes (1). It is evident that the posterior maxillary region presents anatomical limitations when performing dental implant treatments, as there is frequently advanced resorption of the alveolar process. These situations cause a progressive reduction of the alveolar ridge, which indirectly increases the volume of the maxillary sinus (pneumatization) in cases of severe maxillary bone atrophy. In these cases, the remaining bone is insufficient to support implant treatment, making it necessary to perform a maxillary sinus lift to obtain adequate volume for implant placement (4,5). Currently, maxillary sinus lift techniques have been used for over 25 years. The Caldwell-Luc technique was described in 1893 by George Caldwell (United States) and a year later by Guy Luc in France (14) for the purpose of treating sinus tumors. In the late 1970s, the classic indication for the Caldwell-Luc technique was chronic maxillary sinusitis unresponsive to medical treatment. During the 1980s and 1990s, it was largely replaced in this role by functional endoscopic sinus surgery (FESS), and only rarely was chronic sinusitis treated with this classic technique (59). The sinus can be accessed with a hammer and chisel, using a burr, or by inserting a trocar for the initial puncture, followed by opening the bony window with Kerrison forceps. This provides excellent visualization of the sinus, allowing for complete removal of its mucosa, which, as will be discussed later, is the main advantage of this technique. Classically, an inferior antrostomy was performed, whose function, according to Caldwell's original concept, was to allow for irrigation and immediate postoperative management. Later, it was considered as a means of gravity drainage of the cavity. Tatum, at the Alabama meeting in 1976 and later presented with some modifications by Boyne in 1980, proposed a modification to the Caldwell-Luc technique, which he called "lateral approach maxillary sinus floor elevation." This involved partially fracturing the buccal plate into the maxillary sinus to elevate the sinus membrane, then placing an autologous bone graft, and finally, six months later, placing the endosseous implant. The lateral approach maxillary sinus floor elevation technique has two variations regarding implant placement. (59) When the height of the ridge to the sinus floor is less than 4 mm, primary implant stability cannot be achieved. In these cases, the first variation is applied, which consists of a lateral window maxillary sinus floor elevation followed by implant placement in a second stage. And the second variant is a ridge greater than 4 mm where primary stability can be obtained and the maxillary sinus lift can be performed 15 and simultaneously the placement of the implants (54-55) In this context Robert Summers in 1994, published a technique known as the transcrestal technique, which is characterized by an approach to the maxillary sinus from the crest of the alveolar ridge in a corono-apical direction, without the need to expose the lateral walls of the maxillary sinus; it is done with three instruments called blunt chisels, which are conical instruments graduated in length and thickness that are called osteotomes, these instruments are formers of the recipient alveolus of the implant that enter from the ridge of the alveolar ridge to establish the depth and direction of the placement of the new implant, they expand the bone towards the vestibular and palatal side, and compact it as the penetration is carried out. Based on pre-established parameters such as a distance of less than 10 mm between the maxillary crest and the sinus floor, and a minimum remaining bone height of 5 or 6 mm, Summers proposes another technique involving the use of osteotomes plus bone grafting.segunda variante es un reborde mayor a 4 mm donde se pueda obtener estabilidad primaria y se pueda realizar la elevación de seno 15 maxilar y simultáneamente la colocación de los implantes (54-55) En este contexto Robert Summers en 1994, publica una técnica conocida como técnica transcrestal, que se caracteriza por un abordaje del seno maxilar desde la cresta del reborde alveolar en sentido corono-apical, sin necesidad de realizar exposición de las paredes laterales del seno maxilar; se realiza con tres instrumentos llamados cinceles romos, los cuales son instrumentos cónicos graduados en longitud y grosor que se denominan osteótomos, estos instrumentos son formadores del alveolo receptor del implante que ingresan desde el reborde de la cresta alveolar para establecer la profundidad y dirección de la colocación del nuevo implante, expanden el hueso hacia vestibular y palatino, y lo compactan conforme se vaya realizando la penetración. Basados en los parámetros preestablecidos como una distancia menor de 10 mm entre la cresta del maxilar y el piso de seno, como mínimo una altura de hueso remanente de 5 o 6 mm. A su vez, Summers propone otra técnica, que consiste en la utilización de osteótomos más adición de hueso. Esta técnica empuja progresivamente el hueso remanente hacia arriba, al tiempo que van elevándose el seno maxilar, el periostio y la membrana, gracias a la masa ósea que se desliza. Summers registró un índice de éxito a los 5 años del 96 %, sobre 143 implantes colocados en 46 pacientes. Esta técnica es atraumática y menos invasiva (7). A través del tiempo se han generado diferentes variaciones a esta técnica, con el fin de mejorar los resultados y disminuir las complicaciones. Por lo anterior, la presente revisión permitirá recopilar la evidencia científica acerca de las variaciones a esta técnica, que en algunos casos son poco conocidas. Debido a que algunas variaciones hacen parte de experiencias particulares, la literatura científica incluida se constituye de diferentes tipos de evidencia con el fin de mostrar al clínico un abanico de posibilidades que pudiera llegar para tener en cuenta cuando deba realizar un procedimiento de este tipo.64 pp.application/pdfesTécnica transalveolar de SummerGanancia óseaMembrana de SchneiderElevación del seno maxilarEstudios primariostext::thesis::bachelor thesisTPR 128Summer's Transalveolar TechniqueSchneiderian MembraneMaxillary Sinus LiftBone GainopenAccess