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EIS – ENDOSCOPICALLY ASSISTED INTERNAL SINUS LIFT

Peter SCHLEIER, D.M.D.

Stavanger University Hospital Department of Oral Surgery

Stavanger, Norway

EIS – Endoscopically Assisted Internal Sinus Lift4

EIS – Endoscopically Assisted Internal Sinus LiftPeter SCHLEIER, D.M.D.Stavanger University Hospital, Department of Oral Surgery, Stavanger, Norway

Corresponding author:Peter Schleier, D.M.D Stavanger Universitetssjukehus (SUS)Helse Stavanger HF, Klinikk for spesialmedisin, Oralkirurgisk avdelingArmauer Hansensvei 20 4068 Stavanger, Norway Phone: +47 51518555Fax: +47 51519934E-mail: [email protected]

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EIS – Endoscopically Assisted Internal Sinus Lift 5

Contents

1.0 Introduction ....................................................................................................................................... 6

1.1 Problem ...................................................................................................................................... 6

1.2 Anatomical Principles ............................................................................................................... 6

2.0 Diagnostic Evaluation ...................................................................................................................... 7

3.0 Criteria for Success.......................................................................................................................... 9

4.0 Contraindications ............................................................................................................................. 9

5.0 Bone Structure .................................................................................................................................. 10

5.1 Methods of Bone Augmentation .............................................................................................. 10

5.2 Augmentation Materials ........................................................................................................... 11

5.3 Bone Healing ............................................................................................................................. 11

5.4 Donor Areas for Autologous Grafts ......................................................................................... 11

6.0 Sinus Lift Operation.......................................................................................................................... 12

6.1 Indirect Sinus Lift ...................................................................................................................... 14

6.2 Complications ............................................................................................................................ 16

6.3 Advantages of Endoscopic Control ......................................................................................... 17

6.4 Factors that Affect Implant Healing ........................................................................................ 17

6.5 Resumption of Functional Loading ......................................................................................... 18

6.6 Technique of the EIS Procedure .............................................................................................. 18

6.7 Current Clinical Studies I .......................................................................................................... 20

6.8 Clinical Studies II ...................................................................................................................... 20

References ............................................................................................................................................. 21

Instrumentation for Endoscopically Assisted Internal Sinus Lift

Endoscopes, Instruments, and Accessoriess .................................................................................... 23


1.0 Introduction

1.1 Problem

Tooth loss – whether due to periodontal disease, caries, trauma, or neoplasia – is an indication for appropriate restorative treatment. For patients, wearing a mucosa-supported denture carries a stigma of aging and social disability. Restora-tion means establishing normal masticatory func-tion, speech, aesthetics, and a subjective sense of

well-being. During the past 20 years, dental implan-tation has become an established alternative to conventional prosthodontics. In addition to their high functionality, endosteal implants permit the stable, long-term, bone-conserving rehabilitation of masti-catory function.

connective-tissue graft to restore the interdental papilla between the central and lateral incisors (b).

Figs. 1a, bClinical intraoral photographs from a patient who lost the upper left lateral incisor. View immediately after implant insertion (a) andafter integration of the prosthetic superstructure and a free

a b

1.2 Anatomical Principles

When teeth have been lost, the bone starts to be resorbed from the maxillary ridge. The remodeling and breakdown of the empty alveoli and maxillary bone are related to a change in masticatory forces. This is due in part to altered stress on the alveolar bone resulting from the loss of periodontal structures.

The loss of alveolar bone height due to resorption proceeds at a rate of approximately 0.1 mm per month. The cancellous bone of the maxilla has a lower trabecular density than in the mandible. It has a relatively loose structure and is surrounded by a thin layer of compact bone. The cancellous bone has a markedly porous appearance in edentulous, atrophic regions of the maxilla.

Additionally, the maxillary sinus tends to expand after tooth loss and with aging as pneumatization encroaches upon nonfunctioning areas of the maxilla (alveolar process).

In place of dental roots, the lateral alveolar ridge then contains maxillary sinus expansions that may extend lower than the floor of the nasal cavity1.

Fig. 2Transverse section through a human maxillary specimen demonstrates marked atrophy of the alveolar bone due to maxillary sinus encroachment combined with resorption of the alveolar process (arrow). (Department of Anatomy, Friedrich Schiller University, Jena, Germany, Dr. R. Fröber).1 Nasal cavity 4 Maxillary sinus mucosa2 Hard palate 5 Atrophic alveolar bone3 Alveolar recessus 6 Fibrotic mucosa of the alveolar ridge

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Fig. 3Panoramic tomogram (orthopantomogram) with radiographic template in place. The spheres are 5 mm in diameter. The extent of the horizontal bone defect is easily determined.

2.0 Diagnostic Evaluation

Meticulous planning is a necessary prelude to any implantation procedure. Key elements of the preope-rative diagnostic workup are clinical evaluation, ima-ging, and study model analysis. Following a clinical profile analysis and bite registration on articulated models, the extent of the bone deficit is determined and it is decided whether any profile correction is needed in addition to restoring masticatory function.

Whereas implant positioning was still based lar-gely on the patient‘s existing bony anatomy a mere 10 years ago, the current concept of implant planning is geared mainly toward prosthetic require-ments. Prosthetic planning determines the necessary number of implants and their positioning.

The preoperative workup is based on a combina-tion of clinical evaluation and surgical diagnosis consis ting of extraoral and intraoral inspection and palpation.

Attention should be given to the following points during preoperative clinical assessment and during extraoral and intraoral inspection and palpation:

● Status of the remaining dentition (teeth, fillings, gingiva, vitality, loose teeth, unerupted teeth) and the nature and condition of existing restorations.

● Clinical exclusion of oral mucosal pathology and radiographic exclusion of diseases of the alveo-lar process.

● Exclusion of unphysiologic loads and articulation disorders.

● The inclination of the alveolar processes, the interalveolar connecting line, and the course and width of the attached gingiva (especially in pati-ents with more than a 1-year history of tooth loss or hypodontia).

Radiographic studies are essential for evaluating the bony implant bed and excluding diseases of the maxillary bone and neighboring structures (maxillary sinus). The basic workup should always include a dental panoramic tomogram2.

An individual radiographic template is used to estimate approximately how much bone stock is available in the vertical dimension.

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Figs. 4a–dThree-dimensional reconstructions from CT data in the frontal (a) and lateral view (c) and clinical photographs in the frontal (b) and profile view (d) in a 52-year-old woman. These images illustrate

a b

c d

the altered relation between the maxilla and mandible and the associated change in facial profile (with dentures removed).

The following imaging adjuncts are frequently obtained3:

● Cross-sectional images in anatomically complex cases, e.g., to define the relationship of the alveolar process to the maxillary sinus or nasal cavity.

● A dental x-ray for more accurate visualization of the alveolar process. This x-ray is particularly useful during the first 3 years after surgery to exclude vertical and horizontal bone resorption.

● Computed tomography in anatomically complex cases that require comprehensive augmentation.

● A lateral chephalogram can provide a cross- sectional survey of the symphyseal portion of the maxillary ridge and yield important information on the maxillomandibular relation.

Selected cases may require investigation by imaging modalities that do not involve exposure to ionizing radiation:

● Magnetic resonance imaging to demonstrate soft-tissue structures such as the inferior alveolar nerve or maxillary sinus mucosa4.

● Ultrasonography to visualize the crestal bone, marginal mucosa, and maxillary sinus mucosa5.


3.0 Criteria for Success

Besides known individual risk factors such as hema-tologic diseases, diabetes mellitus, parafunctions and smoking, the long-term success of a sinus lift procedure

depends on having a bone stock of sufficient quantity and quality for the placement of implants6.

An implant procedure is considered successful when the following criteria are met7:

● Functional competence of the implant super-structuren.

● Intact tissue physiology (maintenance of osseointegration).

● Absence of pain and other complaints.

● Subjective satisfaction, aesthetics, and well-being.

● Absolute immobility.

● Absence of osteolytic changes.

● Less than 0.2 mm of vertical bone loss 1 year after resumption of loading.

● Absence of neuropathy.

● Absence of bleeding pockets with a probing depth less than 5 mm.

Besides adequate bone stock, good primary stabi-lity, and absence of inflammation in the peri-implant tissue, a successful implantation depends on proper

patient selection, detailed prosthetic planning, and timing the resumption of functional loading8.

4.0 Contraindications

The following are considered absolute contraindica-tions to a sinus lift procedure: myocardial infarction less than 6 months before the procedure, anticipa-tion of further maxillary bone growth, or the presence of untreated inflammatory or neoplastic disease.A sinus lift is also contraindicated in patients with

poor oral hygiene, an inability to cooperate, or psychiatric illness.Smoking is a relative contraindication. The fact that smoking reduces success rates should be disclosed during informed consent, regardless of whether the patient is a light or heavy smoker9.


5.0 Bone Structure

The bone structure of the jaw depends chiefly on age, gender, and previous therapies. It also varies considerably in different segments of the jaw. While maxillary bone consists mainly of loose cancellous bone covered by a thin cortex, mandibular bone has a thicker cortex surrounding a smaller cancellous core.In the classification of Lekholm and Zarb, bone quality is classified into four categories designated D1 through D4:

D1 D2 D3 D4

Fig. 5Four-part classification of bone quality according to Lekholm and Zarb.

According to the classification of Lekholm and Zarb, the bone quality in the premolar and molar region of the maxilla is in the range of D3 to D4. As a result, this region is relatively unfavorable for the secure anchoring of endosteal implants10.

5.1 Methods of Bone Augmentation

The following measures are currently preferred for augmenting bone volume in the premolar and molar region of the maxilla:

● Autologous, allogeneic, or alloplastic bone augmentation

● Bone splitting● Tatum sinus lift● Summer sinus lift● Callus distraction

Experience is also available on the use of a Le Fort I osteotomy combined with a lateral iliac crest augmentation in cases with severe reduction of bone volume.

Direct sinus floor augmentation with fenestration of the facial antral wall is currently the most widely practiced technique of sinus floor elevation.

D1: Consists almost entirely of compact bone.D2: Dense cancellous bone surrounded by a

thick cortex.D3: Dense cancellous bone surrounded by a

thin cortex.D4: Loose cancellous bone with a thin

surrounding cortex.

The different bone qualities are illustrated in Fig. 5.


5.2 Augmentation Materials

A variety of materials are available for sinus augmen-tation. Besides autologous bone, current options include various combinations of autologous bone and synthetic substitutes, allografts and allo plastic materials, the use of growth proteins (bone morpho-genetic proteins), and laboratory- cultured autolo-gous bone grafts (tissue engineering)11.

Autologous bone augmentation is considered the current “gold standard.”

Tab. 1Classification of bone augmentation materials, grouped accor-ding to their origin.

Type Synonym Origin Specification

Autologous Auto- Same individual Cortex, genous cancellous bone

Allogeneic Allograft Different individual Banked bone

Xenogeneic Hetero- Different species Collagen, gelatins, logous various bone, xenograft augmentation material

Alloplastic Synthetic Metals, ceramics, plastics, various bone augmen tation materials

5.3 Bone Healing

Integration of the autologous bone proceeds in several phases, starting with the ingrowth of blood vessels from the surrounding tissue bed. The process of osteoneogenesis is initiated by osteoblasts, which are supplied with blood by diffusion from surrounding vascularized tissue.In the second phase of bone healing, osteoclastic bone cells enter the graft from the invading vessels and resorb the grafted bone. Growth factors such as platelet-derived growth factor and transforming

growth factor are released, stimulating the prolife-ration of stem cells to preosteoblasts and activate macrophages. This process results in the formation of woven bone. When functional loading is resumed, the woven bone undergoes a conversion to functionally oriented lamellar bone. This process is completed by the end of the third postoperative month. Today it is believed that this remodeling process (resorption and new bone formation) can be stimulated by the earlier resumption of functional loading12.

5.4 Donor Areas for Autologous Grafts

Bone harvested from the anterior and posterior iliac crest (spongious, corticospongious grafts, microvas-cular graft) have structural and regenerative properties that are favorable for bilateral augmen tation. The disa-dvantage of iliac grafts is their rapid rate of resorption.

Possible complications of harves ting bone from the iliac crest include hematoma formation, postoperative pain, sensorineural deficits, painful postoperative gait, and hip deformity13.


Other extraoral donor sites:

● Calvarium (cancellous bone, corticocancellous grafts

● Upper tibia (cancellous bone, corticocancellous grafts)

● Fibula (microvascular grafts)

● Rib (corticocancellous grafts)

Fig. 6Diagrammatic representation of possible intraoral donor sites (green) for autologous bone grafts used to augment the atrophic maxilla. A horizontal bone defect (red) is shown in the area of the missing canine tooth. This area should be augmented before implant insertion to achieve an optimum functional and aesthetic result. Suitable donor sites are located in the retromolar or mental region.

Fig. 7Principle of the Tatum one-stage sinus lift (transgingival healing).1 Bone flap from the facial antral wall2 Bone block3 Residual alveolar process4 Implant

Intraoral donor sites (Fig. 6) are located in the chin region (mental symphysis, cortical or corticocancellous grafts), the mandibular angle region (retromolar region, cortico-cancellous grafts), the maxillary tuberosity (cancellous bone), and the anterior nasal spine (corticocancellous grafts).

Possible risks of graft harvest in the chin region include numbness of the lower anterior teeth and sensory impairment in the distribution of the inferior alveolar nerve consisting of hyper-, hypo- and anesthesia14.

Lesions of the lingual nerve or inferior alveolar nerve may result from harvesting retromolar bone grafts from the mandible.

6.0 Sinus Lift Operation

Two main types of sinus lift operation are distinguis-hed: direct (open) and indirect (closed).

A direct sinus lift with cancellous bone augmentation from the iliac crest was first described by Boyne and James in 198015.

In this technique, the vestibular wall of the maxillary sinus is osteotomized with a round bur, taking care to preserve the continuity of the sinus mucosa. After careful mobilization of the sinus mucosa, the bone flap created by the osteotomy is rotated inward with the mucosa into the maxillary sinus lumen. This creates a space that is packed with autologous bone or synthetic material to create a stable bed for imp-lant placement (one-stage technique).

For this technique to be used, the local bone should have a minimum height of 4 mm and a minimum width of 5 mm to ensure adequate primary stability of the implant.

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Fig. 8A corticocancellous bone block (retromolar block from the right mandibular angle) has been placed to augment the floor of the maxillary sinus.1 Bone block2 Residual alveolar process3 Implant

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Fig. 9Postoperative radiograph of the patient in Fig. 8 after implant placement and apical root resection of the second premolar.1 Bone block2 Residual alveolar process3 Implant

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3

Figs. 10a, bEndoscopic views of the natural ostium with a mucus track from the maxillary sinus. The sinus mucosa appears slightly congestedin a due to irritation. The mucosa in (b) is pale and appears heal-thy.

a b

In cases with less bone height that require a one-stage implantation, a bone block can be placed into the floor of the maxillary sinus to stabilize the implant (Figs. 8 and 9), or the implant can be splinted with a special miniplate system.Another option is a two-stage approach in which the augmentation is allowed to heal before the implant

is placed in a second operation. In the two-stage procedure using autologous bone, a healing period of 12 weeks should elapse between augmentation and implantation.Reported success rates of the direct sinus lift range from 75 %16 to 93 %17. Advantages are its relative technical simplicity and the clear visibility of the field.


Fig. 11Principle of the Summers internal sinus lift (subperiosteal healing).

6.1 Indirect Sinus Lift

The indirect sinus lift technique can be used in cases where the horizontal and vertical bone dimensions are greater than 5 mm18. After the implant bed has been prepared to within about 1 mm of the maxil-lary sinus floor, the basal bone layer is fractured and mobilized with the use of osteotomes and elevated into the sinus. The space thus created can be packed with augmentation material.

The implant can be placed in the same procedure (one-stage procedure), or it may be placed 3 months after cancellous bone augmentation or 6 months after allogeneic or alloplastic augmentation (two-stage procedure). The principle of the Summers internal sinus lift is shown in Fig. 11.

Since the maxillary sinus mucosa is elevated through the implant alveolus, it cannot be visually controlled by conventional means. While this technique offers low invasiveness and short operating times, it has the same disadvantages as the direct technique.

Engelke described an endoscopically controlled internal sinus lift in 1997.

In a clinical study, 8 patients from 38 to 63 years of age with 4–8 mm of bone height were treated under endoscopic control to evaluate the efficacy of the method.

Following preoperative local anesthesia, the maxil-lary sinus was burred open in the area of the canine fossa and endoscopically examined (HOPKINS® rod-lens telescope, endoscopy unit 487 B, KARL STORZ Tuttlingen, Germany).

… and after completion (b) of an approximately 6 mm internal sinus lift.

Figs. 12a, bEndoscopic view into the alveolar recessus of the left maxillary sinus at the start (a) …

a b


Figs. 13a, bDetail from the panoramic radiograph of the patient in Fig. 12 shows the right alveolar process before (a) …

a b

… and after completion (b) of an approximately 8 mm internal sinus lift in the region of the right first molar.

Figs. 14a, bEndoscopic view into the alveolar recessus of the right maxillary sinus at the start (a) …

a b

After confirmation of healthy-appearing sinus mucosa and an intact communication between the antrum and nasal cavity, a paracrestal palatal inci-sion was made at the proposed implant site, and a mucoperiosteal flap was developed.

Following a laterobasal osteotomy of the alveolar process, the sinus mucosa was carefully raised with an elevator. This created space for augmentation, into which bone from an intraoral donor site was grafted under continuous videoendoscopic control.

This technique avoided extensive mobilization of the sinus membrane, allowing for secure placement of the augmentation material. Then the implantation was carried out. When the implants were later expo-sed and endoscopy was repeated, the sinus mucosa was found to be in a healthy, noninflamed condition. Functional loading of the implants was resumed at 6 months. The success rate was 95 %. The authors concluded that their endoscopically controlled inter-nal sinus lift was an effective procedure in patients with 4–8 mm of initial bone height.

… and after (b) the implantation.


Follow-up radiograph at 2 years (b) confirms the clinical impression and documents normal peri-implant conditions.

Figs. 15a, bDetail from a panoramic radiograph (a) of the patient in Fig. 14 shows a residual bone height of approximately 5 mm above the upper first molar.

a b

6.2 Complications

The main threat to a successful augmentation is peri-implant infection caused by contamination from the oral cavity. This may lead to fibrous healing rather than osseointegration, resulting in a shortened life-span or postoperative loss of the implant.

Inflammation of the maxillary sinus may result from perforation of the sinus membrane or from the migra-tion of augmentation material and/or bone into the sinus lumen, culminating in loss of the implant.

Perforation of the sinus membrane occurs in up to 35 % of conventional sinus lift procedures19.

Fig. 16Detail from a panoramic radiograph shows an implant at the upper first molar position that has perforated into the maxillary sinus.

Fig. 17Endoscopic view into the alveolar recessus of the right maxillary sinus confirms implant perforation into the sinus lumen. Marked redness and congestion of the mucosa indicate an inflammatory reaction. A displaced bone fragment is visible anterolateral to the implant (arrow).

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6.3 Advantages of Endoscopic Control

Performing an internal sinus lift under endoscopic guidance offers significant advantages compared to the direct technique. Some principal advantages are listed below:

● Minimally invasive procedure even in patients with very little residual bone height.

● Ability to inspect the maxillary sinus prior to implantation.

● Ability to assess the integrity of the sinus mucosa.

● Allows for surgical revision of perforations under optical control.

Additionally, the minimal invasiveness of endoscopic control can almost completely eliminate postopera-tive scarring. Another advantage is the preservation of blood flow by leaving the facial and palatal muco-periosteal flaps on the bone. Branches of the maxil-lary artery runs horizontally through the facial wall of the maxillary sinus20. The osteotomy of the facial antral wall that is done in conventional sinus lifts may injure the vessel and compromise the blood supply to the bone and mucosa in the alveolar recessus.Introducing endoscopes through an anatomical

approach or stab incision avoids having to win-dow the facial part of the maxillary sinus and helps preserve the blood supply to the implant region.

Even with optical control, there is still a risk of membrane perforation when this method is used. But endoscopic control offers a special advantage over conventional technique in this regard. Aided by endoscopy, the surgeon can accurately detect the perforation and even repair it, depending on the nature and size of the lesion. It can be decided under endoscopic vision whether the membrane can be patched or the leak can be sealed by introducing a shorter implant. When these options are available, a membrane perforation will not necessarily increase the risk of implant failure21, 22.

For an uneventful postoperative course, it is impor-tant to confirm that the sinus mucosa is free of inflam-mation prior to implant placement and that the sinus lift does not obstruct or occlude the natural ostium by which the sinus communicates with the nasal cavity23. This can be accomplished and documented by endoscopic control of the sinus lift procedure.

6.4 Factors that Affect Implant Healing

Healing is critically influenced by the following factors, regardless of the technique employed:● The primary stability of the implant, which is deter-

mined by bone density, implant design, and place-ment technique.

● Clinical evidence of favorable bone density. This is assessed clinically by the bone resistance that is felt during site preparation and can be objectively confirmed by torque measurements > 40 Ncm or resonance frequency analysis with ISQ > 60.

● The absence of inflammation in peri-implant soft tissues (maxillary sinus mucosa). This can be con-firmed by preoperative radiographs, endoscopy, ultrasound imaging and Magnetic Resonance Ima-ging.

● Stabilization and loading of the implants during the remodeling phase24.


6.5 Resumption of Functional Loading

Healing period of up to 6 months have been recom-mended to maximize the success rate of implant procedures in the structurally weak premolar and molar region of the maxilla25.

Today this concept of delayed loading must be weig-hed against alternative concepts of immediate loa-ding or delayed immediate loading.

Based on the details that are known about the time course of bone healing, it is reasonable to resume

functional loading at 6 weeks postimplantation. It is still uncertain what degree of implant loading will have the most favorable effect on osseointegration. The shorter rehabilitation time promotes greater pati-ent acceptance for this form of therapy.

At present, the clinical efficacy of immediate loading in the premolar and molar region of the maxilla has not been adequately investigated in clinical studies.

6.6 Technique of the EIS Procedure

Surgery is preceded by a 2-min topical oral rinse with a 2 % chlorhexidine solution (Chlorhexamed, GlaxoSmithKline, Munich, Germany). Local anesthe-sia consists of greater palatine and infraorbital nerve blocks, injecting approximately 0.5 ml of Lidocaine at each site, and vestibular infiltration anesthesia with approximately 1 ml of Articaine (Ultracain DS, Aventis Pharma, Frankfurt am Main, Germany). Then a muco-periosteal flap is carefully developed at the proposed implantation site, preserving the interdental papilla (Gomez-Roman, 2001). Implant positioning is aided by the use of a custom-fabricated surgical template. The mucosa is incised approximately 5 mm cranial and distal to the apex of the canine tooth. The canine fossa is opened with a back-and-forth twisting motion of the trocar sheath, the stylet is removed, and the endoscope is inserted.

For endoscopy, we use a 3-mm sinuscope with a 70º viewing angle (KARL STORZ Tuttlingen) combined with the KARL STORZ endoscopy unit (type 487 B).

Under videoendoscopic control, the implant bed is prepared by drilling through the bone at a maximum speed of 300 rpm, stopping approximately 1 mm short of the sinus membrane (Fig. 18 b). Next the bone flap is outlined with an osteotome of appropri-ate size and elevated into the sinus lumen (Fig. 18 c), creating space for the insertion of standard implants 12 mm long.

The implants are tested for primary stability, and the wound is closed.

The basic steps in the internal sinus lift are shown diagrammatically in Figs. 18 a–d.


Fig. 18aParacrestal incision.

Fig. 18cBone flap osteotomy.

Fig. 18dElevation of the sinus membrane.

Fig. 18bDrilling of the implant bed.


6.7 Current Clinical Studies I

In 2000, Wiltfang et al. compared the endoscopically controlled internal sinus lift with the direct technique of sinus floor augmentation26. They investigated a total of 132 implants in 62 clinically healthy pati-ents. The Tatum direct sinus lift was performed in 45 patients, and the endoscopically controlled inter-nal sinus lift was performed in 18 patients. Patients with sinusitis or other pathology were excluded from the study. The preoperative workup included a pano-ramic tomogram, ultrasound imaging of the maxillary sinus, and a dental CT scan to evaluate the implan-tation site. The authors compared both procedures based on ultrasound images of the maxillary sinus (7.5-MHz Tosbee transducer, Toshiba medical Sys-tems, Nuess, Germany) at 7 days postoperatively and also when the implants were exposed 6 months later. If any abnormalities were noted at 7 days, they added a panoramic tomogram. While no complica-tions were found in any of the patients who under-went the endoscopically controlled internal sinus lift,

radiographic sinus opacities and ultrasound shadow-ing were found in 40 of the 45 patients 7 days after doing lateral windows procedures. The authors attri-buted these changes to mucosal swelling and hema-toma formation. In 4 cases these changes were still detectable more than 6 months postoperatively.Two patients developed maxillary sinusitis culmi-nating in implant loss, and one of these patients required a maxillary sinus revision. The success rate for both methods was 95 %, and 8 of the implant failures were referable to sinusitis.Three additional implants were lost due to poor primary stability, and 2 implants failed after the resumption of functional loading.Wiltfang et al. (2000) conclude from their results that the endoscopically controlled one-stage sinus floor augmentation and implantation can significantly red-uce the complication rate in patients with 4–8 mm of maxillary bone height, and that the high success rate justifies a one-stage procedure.

6.8 Clinical Studies II

In another clinical study, Schleier et al. (2006) placed a total of 52 implants in 30 patients (14 men, 16 women) using the endoscopically controlled i nternal sinus lift technique. The patients were followed for at least 24 months after the procedure27.The average preoperative height of the maxillary alveolar process at the implantation site was 8 mm in the premolar region and 7 mm in the molar region. The average amount of maxillary sinus lift was 3.5 mm in the premolar region and 4.5 mm in the molar region.Satisfactory implant stability (ISQ > 60) was confirmed clinically and by resonance frequency analysis at 4 and 12 weeks postoperatively.A total of 3 implants were lost during the healing period, resulting in a success rate of 94 %.No further adverse events were noted at exposure or during the subsequent functional loading phase (2-year follow-up), and so the success rate at the end of the follow-up period was 100 %. It is concluded

that resonance frequency analysis is a simple and effective method of implant stability assessment in patients undergoing a sinus lift, especially during the healing period and the initial resumption of functio-nal loading. Its use should not be limited to a sin-gle measurement, however. The progression of the ISQ values of an implant over time is an important indicator of relative stability. Consequently, multiple measurements should be taken at intervals so that a serial evaluation can be made28.Endoscopic control offers a special advantage over conventional techniques. Visual control is the most reliable method available for detecting a membrane perforation. It also allows for appropriate primary closure, depending on the nature and size of the lesion. This will prevent augmentation material from migrating into the maxillary sinus and reducing the augmentation height.


References

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2. DGZMK: 2005. Implantologie in der Zahnheil-kunde. URL:http://www.dgzmk.de/set 5.htm.

3. STRIETZEL FP: 2002. Planung und Diagnostik vor implantatprothetischer Rehabilitation. In: Reichard P, Hausamen JE, Becker J, Neukam FW, Schliephake H, Schmelzeisen R, Hrsg. Curriculum Zahnärztliche Chirurgie, erster Band. Erste Aufl. Berlin, Quintessenz-Verlag, 404–405.

4. BACH G, BACH M, DÜKER J: 1997. Kernspin-tomographie – ein nicht mit ionisierender Strahlung arbeitendes Verfahren zur präimplantologischen Diagnostik. Quintessenz, 48(4):1111–1116.

5. LUDWIG A, MERTEN HA, WILTFANG J, ENGELKE W, WIESE KG: 2002. Evaluation of B-scan ultrasound, roentgen diagnosis and sinus endoscopy in follow-up assessment of the maxillary sinus after sinus floor elevation. Mund Kiefer Gesichtschir, 6(5):341–345.

6. ENGELKE W: 1997. Endoscopically controlled sinus floor augmentation. A preliminary report. Clin Oral Impl Res, 8(6):527–531.

7. WATZEK G, MAILATH-POKORNY C: 2000. Zahn ärztliche Implantologie. In: Schwenzer N, Ehrenfeld M, Hrsg. ZMK-Heilkunde. Lehrbuch zur Aus- und Weiterbildung, dritter Band, Zahnärztliche Chirurgie. Dritte Aufl. Stuttgart: Thieme-Verlag, 138–139.

8. MEREDITH N, BOOK K, FRIBERG B, JEMT T, SENNERBY L: 1997. Resonance frequency measurements of implant stability in vivo. A cross-sectional and longitudinal study of resonance frequency measurements on implants in the edentulous and partially dentated maxilla. Clin Oral Impl Res, 8(3):226–233.

9. KAN JY, RUNGCHARASSAENG K, LOZADA JL, GOODACRE CHJ: 1999. Effects of smoking on implant success in grafted maxillary sinuses. J Prosthet Dent, 82:307–311.

10. JENSEN J, SINDET-PEDERSEN S, OLIVER A, OLIVER AJ: 1994. Varying treatment strategies for reconstruction of maxillary atrophy with implants: Results in 98 patients. J Oral Maxillofac Surg, 52(3):210–216.

11. TERHEYDEN H, JEPSEN S, MÖLLER B, RUEGER D: 2001. Sinusbodenaugmentation mit simultaner Implantatinsertion unter Verwendung von rekombinantem humanem osteogenic Protein-1. Laryngorhinootologie, 80(1):47–51.

12. SCHLEGEL KA, KLOSS FR, KESSLER P, SCHULTZE-MOSGAU S, NKENKE E, WILTFANG J: 2003. Bone conditioning to enhance implant osseointegration: An experimental study in pigs. Int J Oral Maxillofac Implants, 18(4):505–511.

13. KESSLER P, THORWARTH M, BLOCH- BIRKHOLZ A, NKENKE E, NEUKAM FW: 2005. Harvesting of bone from the iliac crest- comparison of the anterior, posterior sites. Br J Oral Maxillofac Surg, 43:51–56.

14. NKENKE E, RADESPIEL-TROGER M, WILTFANG J, SCHULTZE-MOSGAU S, WINKLER G, NEUKAM FW: 2002b. Morbidity of harvesting of retromolar bone grafts: A prospec-tive study. Clin Oral Impl Res, 23(5):514–521.

15. BOYNE PJ, JAMES RA: 1980. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg, 38:613–616.

16. TIDWELL JK, BLIJDORP PA, STOELINGA PJW, BROUNS JB, HINDERKS F: 1992. Composite grafting of the maxillary sinus for placement of endosteal implants: A preliminary report of 48 patients. Int J Oral Maxillofac Surg, 21(4):204–209.

17. JENSEN J, SINDET-PEDERSEN S, OLIVER A, OLIVER AJ: 1994. Varying treatment strategies for reconstruction of maxillary atrophy with implants: Results in 98 patients. J Oral Maxillofac Surg, 52(3):210–216.

18. SUMMERS RB: 1994. A new concept in maxillar implant surgery: The osteome technique. Compend Educ Dent, 15(2):152–162.

19. LUDWIG A, MERTEN HA, WILTFANG J, ENGELKE W, WIESE KG: 2002. Evaluation of B-scan ultrasound, roentgen diagnosis and sinus endoscopy in follow-up assessment of the maxillary sinus after sinus floor elevation. Mund Kiefer Gesichtschir, 6(5):341–345.

20. ELIAN N, WALLACE S, CHO SC, JALBOUT ZN, FROUM S: Distribution of the maxillary artery as it relates to sinus floor augmentation. Int J Oral Maxillofac Implants 2005;20:784–7.


21. GRAZIANI F, DONOS N, NEEDLEMAN I, GABRIELE M, TONETTI M: Comparison of imp-lant survival following sinus floor augmentation procedures with implants placed in pristine pos-terior maxillary bone: a systematic review. Clin Oral Implants Res 2004;15:677–82.

22. KÜBLER AC, NEUGEBAUER J, KARAPETIAN V, OH JH, SCHEER M, ZOLLER JE: The use of a resorbable, synthetic membrane for the elevation of the sinus floor: Mund Kiefer Gesichtschir 2004;8:256–60.

23. van den BERGH JP, ten BRUGGENKATE CM, DISCH FJ, TUINZING DB: Anatomical aspects of sinus floor elevations. Clin Oral Implants Res 2000;11:256–65.

24. ROMANOS GE: 2004. Surgical and prosthetic concepts for predictable immediate loading of oral implants. J Calif Dent Assoc, 12:991–1001.

25. BRÅNEMARK PI: 1983. Osseointegration and it’s experimental background. J Prosthet Dent, (50):399–410.

26. WILTFANG J, SCHULTZE-MOSGAU S, MERTEN HA, KESSLER P, LUDWIG A, ENGELKE W: 2000. Endoscopic and ultrasono-graphic evaluation of the maxillary sinus after combined sinus floor augmentation and implant insertion. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 89(3):288–291.

27. SCHLEIER P, BIERFREUND G, RABE U, VOLLANDT R, MOLDENHAUER F, KÜPPER H, SCHULTZE-MOSGAU S: 2006. Die endoskopisch kontrollierte interne Sinuselevation mit simultaner Implantation. Verlaufsbeobachtung über einen Zeitraum von zwei Jahren nach Beginn der prothetischen Belastung. Implantologie, 2:123–139.

28. SENNERBY L, PERSSON LG, BERGLUNDH T, WENNERBERG A, LINDHE J: 2005. Implant stability during initiation and resolution of experimental Periimplantitis: an experimental study in the dog. Clin Implant Dent Relat Res, 7:136–40.


Instrumentation for Endoscopically Assisted Internal Sinus Lift

Endoscopes, Instruments, and Accessoriess

6


7230 CA H® Lateral Telescope 70°,

autoclavable,

color code: yellow

7230 CA

Recommended Set by Dr. SCHLEIER

11301 D4

11301 D4 LED Battery Light Source for Endoscopes, with fast screw thread, endo scopes,

brightness > 50,000 lux, burning time > 120 min, ready for use, suitable for surface disinfection,

11301 DE LED Battery Light Source for Endoscopes, rechargeable, with click connection, can be connected to all

lithium-ion batteries, charging time 60 min, burning time at

suitable for surface disinfection

11301 DF Same, with fast screw thread

Overview

094129 Battery Charger Li-Ion, for charging the rechargeable battery box with Mains Cord 094127, power supply 100 – 240, 50/60 Hz

094127 Mains Cord, for Battery Charger 094129, length 150 cm

For all rechargeable models

HOPKINS II® EndoscopesBasic Set for Dental Surgery

Energy sourcerechargeable

battery

Endoscope connection

click-connection

fast screw thread

11301 DE 11301 DF 11301 D4

● ●

– – ●

● – –

– ● ●


Basic-Set for Dental SurgeryRecommended Set by Dr. SCHLEIER

208000 Surgical Handle, Fig. 3, length 12.5 cm, for Blades 208010 – 19, 208210 – 19

792603 Dressing Forceps, narrow width, length 16 cm

793603 Tissue Forceps,

58180 KELLY Scissors, sharp-sharp, curved, length 15.5 cm

798418 HEGAR Needle Holder,

586031 v. EICKEN Antrum Cannula, LUER-Lock, with cut-off hole,

655016 Elevator for Sinuslift, double-ended,

655018 Elevator for Sinuslift, double-ended,

working length 4 cm

474200 FREER-JOSEPH Elevator, double-ended, slender, semisharp and sharp, length 20 cm

239728 S Metal Tray, for sterilization, perforated, lid with silicone bridges,

1

2

3

4

5

6

7

8

9

n

1 2 3 4 5 6 7 8 9


EIS InstrumentsRecommended Set by Dr. SCHLEIER

n

58940 BK

58940 BK Elevator, bayonet-shaped, with scale, concave distal end, conical 2 mm/3.3 mm, working length 2.5 cm, total length 18 cm

58941 BK Same, conical 2.3 mm/4.1 mm

58942 BK Same, conical 3 mm/4.8 mm

58940 BV Elevator, bayonet-shaped, with scale, convex distal end, conical 2 mm/3.3 mm, working length 2.5 cm, total length 18 cm

58941 BV Same, conical 2.3 mm/4.1 mm

58942 BV Same, conical 3 mm/4.8 mm

58940 GK Elevator, straight, 2.5 mm, working length 2.5 cm, total length 18 cm

58941 GK Same, 3.5 mm

58942 GK Same, 4.5 mm

58944 M Chisel, width 4.5 mm, working length 2.5 cm, total length 18 cm

58944 HM Gouge, width 4.5 mm, working length 2.5 cm, total length 18 cm

58944 O Osteotome, width 4.5 mm, working length 2.5 cm, total length 18 cm

58960 ZR Dental Explorer, fine, flexible, with round handle, length 15.5 cm

58944 M



58962

174700

525510

723005 B

58962 R HEMINGWAY Dental Curette, size 1, length 18.5 cm


58958 R HEIDEMANN Spatula,

174700 Mallet, with NYLON replacement, small,

525510 CASTROVIEJO Skin Measurement Caliper, measurement range 0 – 15 mm, length 8 cm

723005 B Trocar and Cannula for Sinoscopy,

for use with h®

n

n

n


58940 EIS Metal Tray for sterilisation and storage, of 19 Instruments from the oral surgery


58940 EIS


Instruments for Root ResectionRecommended Set by Dr. SCHLEIER

58944 M

58944 M Chisel, width 4.5 mm, working length 2.5 cm, total length 18 cm

58944 HM Gouge, width 4.5 mm, working length 2.5 cm, total length 18 cm

58944 O Osteotome, width 4.5 mm, working length 2.5 cm, total length 18 cm

58960 ZR Dental Explorer, fine, flexible, with round handle, length 15.5 cm

58962


58963


n



535212 HALSTEAD “Mosquito” Artery Forceps,

586415 v. EICKEN Antrum Cannula, LUER-Lock,

length 12.5 cm

535212

586415

174700

174700 Mallet, with NYLON replacement, small,



58940 WSR Metal Tray for sterilisation and storage, of 9 Instruments from the oral surgery, universal Tray

58940 WSR


TELE PACK™Documentation Terminal, Compact, Mobile

TELE PACK™ is a comprehensive, multi functional and compact documen tation terminal that can be used in the emergency room, as a compact system

in the doctor’s office, or as a secondary system in the ope r ating room. TELE PACK™ consists of the following components:

Input Unit

● Inbuilt, high-quality membrane keyboard

● Smooth surface for convenient wipe disinfection

●

Documentation

● Flexible, all-purpose PCMCIA memory card

●

● Still image capture

● Freeze frame function

● Easy transfer of data to AIDA and PC

● Activiation of image capture function also possible via footswitch

● 2 outputs for controlling peripheral units such as video printers

● Composite video input

Camera Control Unit

● Ergonomically designed endoscopy camera TELECAM® for detail imaging

● Integrated, digital Image Processing Module with enhancement and filter functions

● Digital filter for flexible and semirigid endo scopes

Illumination

● HiLux high performance light source

● Natural daylight coloration with 5600 K color temperature

● Long lamp life

● Low noise level

● Adaptor for standard light cables

Image Display

● Foldaway 12“ LCD color monitor

● High-resolution image display with 800 x 600 pixels

● 16-bit color depth for high-fidelity color images


20 0430 02-020 PAL TELE PACK™

color system PAL, with integrated digital Image Processing Module, power supply 100 – 240 VAC, 50/60 Hz

consisting of:

20 0430 20-020 TELE PACK™ Control Unit, with integrated digital Image Processing Module

20 2120 34 TELECAM® C-MOUNT One-Chip Camera Head, PAL, 2 freely programmable camera head buttons

20 2000 42 C-MOUNT Lens, f = 30 mm, soakable

TELE PACK™Sample Configuration

● Camera Control Unit compatible with: – TELECAM® camera heads – DCI® systems without autorotation function – HEADCAM

● Camera Head The TELECAM® Camera Head used for video documentation fits standard eyepieces of rigid and flexible endoscopes as well as microscopes without additional adaptors.

Additional special features:

● Transportable

● World power supply 100 – 240 VAC, 50/60 Hz

● ®

20 0430 01-020/20 0431 01-020), a large image is displayed on the monitor, independently of the telescope used.

● Anti-grid and anti-moiré filter integrated

20 0430 01-020 PAL TELE PACK™

color system PAL, with integrated digital Image Processing Module, power supply 100 – 240 VAC, 50/60 Hz

consisting of:

20 0430 20-020 TELE PACK™ Control Unit, with integrated digital Image Processing Module

20 2120 30 TELECAM® One-Chip Camera Head, PAL,

programmable camera head buttons


22 2010 11U102 IMAGE1™ HD hub Camera Control Unit (CCU)

for use with IMAGE1™ HD and standard one- and three-chip camera heads, max. resolution 1920 x 1080 pixels, with integrated ® and integrated Image Processing Module, color system PAL/NTSC,

consisting of:

22 2010 20U102 IMAGE1™

400 A Mains Cord

3 x 536 MK BNC/BNC Video Cable, length 180 cm

547 S

20 2032 70 Special RGB Connecting Cable

2x 20 2210 70 Connecting Cable, length 180 cm

20 0400 86 DVI Connecting Cable, length 180 cm

20 0901 70 SCB Connecting Cable, length 100 cm

20 2001 30U Keyboard, with English character set

IMAGE1™ HD hubHD hub Camera Control Unit

n

IMAGE1™ Three-chip camera systems � 60 dB

Signal-to-noise ratio AGC Video output Input

Microprocessor-controlled

- Composite signal to BNC socket- S-Video signal to 4-pin Mini DIN socket (2x)- RGB signal to D-Sub socket

- - HD signal to DVI-D socket (2x)

Keyboard for title generator, 5-pin DIN socket

Specifications:

Control output /inputDimensions

Power supply Certified to:

- KARL STORZ-SCB® at 6-pin Mini DIN socket (2x)

- 3.5 mm stereo jack plug (ACC 1, ACC 2),- Serial port at RJ-11

2.95 100-240 VAC, 50/60 Hz

IEC 601-1, 601-2-18, CSA 22.2

MDD, protection class 1/CF

22 2010 11U102

● by a maximum resolution and the consistent use of the native 16:9 aspect ratio throughout the entire image chain, from image capture, signal transmission to display.

● HD-compatible endoscopic video camera systems must be equipped with a CCD chip supporting the 16:9 input format and require that image capture is performed at a resolution of 1920 x 1080 pixels.

for medical applications are:

● 5 times higher input resolution of the camera delivers more detail and depth of focus.

● Using 16:9 format during image acquisition enlarges the field of vision.

● The 16:9/16:10 format of the widescreen monitor supports ergonomic viewing.

● Enhanced color brilliance for optimal diagnosis.

● Progressive scan technology provides a steady, flicker-free display and helps eliminate eyestrain and fatigue.


IMAGE1™ HDHD Camera Head

n

IMAGE1™ Three-Chip Camera Head 3x 1/3 CCD chip

Specifications:

Image sensor Pixels Dimensions Weight Lens

1920 (H) x 1080 (V) pixels per chip

31 x 114 x 48 mm (w x h x d)

210 g Integrated Parfocal Zoom Lens,

22 2200 50-3/22 2201 50-3

22 2200 50-3 50 Hz IMAGE1™ H3, Three-Chip HD Camera Head

max. resolution 1920 x 1080 pixel, Progressive Scan, 50 Hz, with 2 freely programmable Camera Head buttons, with integrated Parfocal-Zoom focal length f = 14 – 30 mm (2x)

22 220150-3 60 Hz IMAGE1™ H3, Three-Chip HD Camera Head

max. resolution 1920 x 1080 pixel, Progressive Scan, 60 Hz, with 2 freely programmable Camera Head buttons, with integrated Parfocal-Zoom focal length f = 14 – 30 mm (2x)

Standard IMAGE1TM camera heads may also be connected to IMAGE1TM


IMAGE1™ HDHD Flat Screen

n

58.5 cm (23“)

RG

B t

o

5x

BN

C s

ocket

HD Flat Screens

Color systems PAL/NTSC

Wall mounted

100-adaption

Desktop with pedestal

Order No.Version

Screen diagonal

Max. screen resolution Video input

9523 NB

9523 N

● ● ●● ●

VG

A t

o 1

5-p

in

HD

-D-S

ub

so

cket

HD

-SD

I to

BN

C s

ocket

●C

om

po

site

sig

nal

to B

NC

so

cket

S-V

ideo

to

4-p

in

Min

i DIN

so

cket

●

SD

I to

B

NC

so

cket

DV

I to

DV

I-D

so

cket

●

1920 x 1200

●

Specifications:

Brightness Max. viewing angle Video input Pixel distance Contrast ratio Input signal level

400 cd/m2 0.258 mm 700:1 0.7 Vpp

80 Watt

Rated power Operating conditions Storage Relative humidityDimensions

Power supply Certified to:

5-85 %, non-condensing

546 x 366 x 98 100-240 VAC EN 60601-1, protection class IPX 1

- Composite signal to BNC socket- S-Video signal to 4-pin Mini DIN socket- RGB signal to 5 x BNC sockets- SDI signal to BNC socket- HD-SDI signal to BNC socket- DVI signal to DVI-D socket

9523 NB image format 16:10, wall-mounted with VESA 100-adaption, color systems PAL/NTSC, max. screen resolution 1920 x 1200, video inputs: composite, S-Video, RGB, VGA, SDI, and DVI, brightness 400 cd/m2, contrast ratio 700:1, power supply 100 – 240 VAC, 50/60 Hz consisting of: 9523 NG 23“ HD Flat Screen 9523 PS External 24 VDC Power Supply 400 A Mains Cord

9523 N image format 16:10, desktop with pedestal, color systems PAL/NTSC, max. screen resolution 1920 x 1200, video inputs: composite, S-Video, RGB, VGA, SDI, and DVI, brightness 400 cd/m2, contrast ratio 700:1, power supply 100 – 240 VAC, 50/60 Hz consisting of: 9523 NG 23“ HD Flat Screen 9523 PS External 24VDC Power Supply 400 A Mains Cord 9419 NSF Pedestal


Accessories for Video Documentation

495 NT Fiber Optic Light Cable, diameter 2.5 mm, length 180 cm

495 NA Same, diameter 3.5 mm, length 230 cm

20 1133 20 Cold Light Fountain 250 twin, Power Supply: 100/120/230/240 VAC, 50/60 Hz consisting of: 400 A Mains Cord

105 Halogen-Spare Lamp, 250 watt, 24 volt

Cold Light Fountain HALOGEN 250 twin

20 1610 01 Cold Light Fountain LED NOVA 100, with one LED lamp and one KARL STORZ light outlet Power Supply: 230 VAC, 50/60 Hz consisting of: 20 1610 20 LED NOVA 100 400 A Mains Cord

Cold Light Fountain LED NOVA 100

20131501 Cold Light Fountain XENON NOVA® 175, Power Supply: 100 –125 VAC/220 –240 VAC, 50/60 Hz, consisting of: 400 A Mains Cord

20132026 Xenon-Spare-Lamp, 175 watt, 15 volt

Cold Light Fountain XENON NOVA® 175


AIDA compact HD: Automatic creation of standard reports

AIDA compact HD: Review screen

AIDA compact HD:

AIDA compact HD: Voice control

Data Acquisition

AIDA compact HD records still images, video sequences and spoken

comments of findings and intraoperative procedures directly from the

sterile area. Recordings are activated via touch screen, voice control,

footswitch or camera head buttons.

Live display of camera images on the touch screen enables immediate

monitoring and selection of the recorded data.

Flexible Review

Before final archiving, the saved data can be viewed or listened to on

the review screen. Data no longer required can be simply deleted.

Individual images, video and audio sequences can be renamed and

given more meaningful names. A pre-defined selection list with key-

field is available for entering relevant details of an intervention.

A voice entry of the case report can yet be recorded while viewing

video and image files.

Efficient data archiving

After a procedure has been completed, KARL STORZ AIDA® compact HD

saves all captured data efficiently on DVD, CD-ROM, USB stick, external

hard-drive, internal hard-drive and /or network respective on the FTP

server. Furthermore the possibility exists to store the data directly on the

PACS respective HIS server, over the interface package AIDA communication

HL7/DICOM.

Multisession and Multipatient

Efficient data archiving is assured as several treatments can be saved

on one DVD, CD-ROM or on an USB stick.

KARL STORZ AIDA® compact HD combines all the required functions for integrated and precise

documentation of endoscopic procedures and open surgeries in a single system.

Data Management and Documentation® compact HD


Special features of AIDA compact HD:

● Digital storage of still images with a resolution of 1920 x 1080, video sequences in 720p and audio files

● Interface package DICOM/HL7

● Sterile, ergonomic operation via touch screen, voice control, camera head buttons and /or foot switches

● Auto detection of the connected camera system on HD-SDI /SD-SDI input

● Efficient archiving on DVD, CD-ROM or USB stick, multisession and multipatient

● Possibility of saving on the network

● Optional connection to the PACS, RIS and HIS

● Automatic generation of standard reports

● Approved use of computers and monitors in the OR environment as per EN 60601-1

●

® compact HD is an attractive, digital alternative to video printers, video recorders and dictaphones

● PAL ● NTSC

● S-Video (Y/C) ● Composite● DVI-D● HD-SDI, SD-SDI● RGBS

● JPG● BMP

● MPEG2 ● WAV ● DVD+R ● DVD+RW ● DVD-R ● DVD-RW ● CD-R ● CD-RW ● USB Stick

Video Systems Signal Inputs Image Formats Video Formats Audio Formats Storage Media

Specifications:

20 0406 05U ® compact HD System, documentation system for digital storage of still images, video sequences and audio files

consisting of:

20 0460 20 with integrated DVD/CD writer

20 0405 77 AIDA compact II HD Frame Grabber Card

20 0902 34 U PS/2 Compact Keyboard, English, with cover

20 0404 02-15 AIDA compact II Software, with voice control and software protection

20 0402 75 with 1 GB

20 2210 70 Connecting Cable (2x)

536 MK BNC Connecting Cable, length 180cm

536 MKD BNC Connecting Cable, length 30cm

536 MKE BNC Connecting Cable, length 50cm

20 0400 86 DVI Cable, length 180cm

400 A Mains Cord

20 0400 87 Cable MiniDIN-male to BNC-female


® DVD-MIndependent “all-in-one” System

Special features:

● Digital storage of still images, video and audio files

FULL HD quality 1920 x 1080)

● Digital alternative to video printers, video recorders and dictaphone

● Compact design

● Simple and intuitive operation

● Allows storage on DVD, CD-ROM, USB Stick or Network, multisession and multipatient

●

● All video signals are through-patchable to the video monitor

● Printing of still images with ink jet printers possible

● EN 60601-1

● Compatible to the

20 2045 01-140 ® color system PAL/NTSC, power supply 100 240 VAC, 50/60 Hz, consisting of:

20 204020-140 AIDA DVD-M with integrated DVD/CD recorder and integrated touch screen 400 A Mains Cord 400 B Mains Cord, US version 536 MK BNC Connecting Cables, length 180 cm 547 S length 180 cm 2x 20 0400 83 Adaptor, BNC-Cinch 20 0400 84 Serial Interface Cable, length 20 cm 20 0400 85 DVI Connecting Cable, length 20 cm

20 0400 88 USB Extension Cable, length 7.5 m

20 2045 20-1 ® color system PAL/NTSC, power supply 100 240 VAC, 50/60 Hz, consisting of:

20 204020-140 AIDA DVD-M with integrated DVD/CD recorder 400 A Mains Cord 400 B Mains Cord, US version 536 MK BNC Connecting Cables, length 180 cm 547 S length 180 cm 2x 20 0400 83 Adaptor, BNC-Cinch

20 2000 75 ® DVD-M HD Kit Option, power supply 100 240 VAC, 50/60 Hz, consisting of:

20 2000 72 AIDA DVD-M HD Box, incl. power supply unit and mains cord

20 2000 73 USB Connecting Cable, length180 cm 536 MK BNC Connecting Cable, length 180 cm 20 0400 86 DVI-D Connecting Cable, length 180 cm 20 2000 74 USB Hub 20 204077-01 AIDA DVD-M Software Upgrade for HD compatibility 2x 28003 TE Power Cord Adapter


Mobile Videocart

29003 NA Mobile Videocart, consisting of: 29003 NAG Basic Mobile Cart, rides on

4 antistatic double-casters, 2 equipped with locking brakes, 1 shelf fixed, 1 shelf with mains switch, 1 shelf inclinable, 1 drawer unit with lock, 1 push bar, with large lumen cable

channels integrated in both columns, 1 set of non-sliding stands,

1 camera mount

29003 PB Power Box with electrical supply terminal strip with 12 plugs, 12 equipotential plugs

Dimensions: Mobile Cart: 700 mm x 1280 mm x 686 mm (w x h x d) shelf: 630 mm x 480 mm (w x d) caster diameter: 125 mm

29003 NA


Notes:

WITH COMPLIMENTS OFKARL STORZ––ENDOSKOPE

eis - karl storz endoskope | united states€¦ · bone covered by a thin cortex, mandibular bone...

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