CAS KIT – Safe and Superior for Maxillary Sinus Lifts

Comparison of three different methods of internal sinus lifting for elevation heights of 7mm : an ex vivo study

By: Aghiad Yassin Alsabbagh, Mohammed Monzer Alsabbagh, Batol Darjazini Nahas and Salam Rajih


Various techniques are available for elevating the sinus membrane. The aim of this study is to evaluate three methods of indirect sinus floor elevation regarding elevation heights of 7mm on the outcomes of membrane perforation, length of perforation, and time required to perform the procedure.

Materials & Methods

  • Bone added osteotome sinus floor elevation (BAOSFE), sinus floor elevation with an inflatable balloon, and crestal approach system (CAS kit) were assessed for their ability to lift the sinus without causing laceration of the Schneiderian membrane.
  • 18 freshly slaughtered sheep heads(36 sinus lifts, 12 for each method).
  • CBCT images of the heads were taken to assess the best location for the sinus lift. Then, the heads were bisected and the membrane was exposed from the medial aspect. After that, each method was performed. The intended elevation height was 7mm. If the 7mm were not reached, the maximum height of elevation was measured.


  • The method used was significantly associated with the occurrence of perforation (p value = 0.014) where BAOSFE was associated with the largest number of perforations (58.4%, n=7) compared to 8.3% and 8.3% for the balloon and CAS kit methods, respectively.
  • The odds ratio for perforation occurrence from BAOSFE compared to the CAS kit was significant (OR = 0.091, p = .022). No significant odds ratio was found for the balloon method compared to CAS kit.
  • Additionally, the method used was significantly associated with time of operation and with the length of perforation (p value < 0.001) where CAS kit required the longest time and BAOSFE caused the biggest perforations.

Table 1. The results of logistic regression of method used on the occurrence of perforation

Number of Cases 12 12 12
Number of Perforations 7 1 1
Percentage 58.40% 8.30% 8.30%
Comparison of methods regarding perforations (odds ratio) Balloon\BOAFSE Balloon\BOAFSE CAS kit\BAOFSE
Odds ratio 0.091 1 0.091
p value 0.022 1   0.022
Confidence interval Lower Upper Lower  Upper Lower  Upper
  1.437 160.972 0.55 18.085 1.437 160.972

Abbreviations: NH, new hydrophilic; SA, sandblasted and acid-etched.
*Two implants were left to heal submerged and were not measured (n = 12).


 The study shows that both the balloon and the CAS kit were superior to the BAOSFE in terms of safety in elevating the sinus membrane. Further, in vivo studies have to prove these findings.



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