Bilateral Sinus Solution™ (BSS) + All-on-Full™ WIKI
The paradigm shift in implantology: from alveolar bone to basal bone — Nicola Lettera

Welcome to the dedicated encyclopedia of the Bilateral Sinus Solution™ (BSS) surgical technique, a revolutionary approach in the field of implantology that uses the basal bone for the rehabilitation of jaws with severe bone atrophy, eliminating the need for bone grafts and maxillary sinus lifts.

Fundamental concepts

Basal bone vs alveolar bone

The upper jaw is made of two types of bone: the alveolar bone, which surrounds and supports the teeth and tends to resorb after tooth loss, and the basal bone, a deeper and more stable portion that does not resorb over time. The Bilateral Sinus Solution™ (BSS) uses the basal bone to guarantee a stable and long-lasting anchorage.

Maxillary atrophy

Bone atrophy of the upper jaw is a condition characterised by the loss of volume and density of the alveolar bone, often caused by prolonged edentulism, periodontal disease or trauma. In severe cases, the remaining bone is not sufficient for the placement of traditional implants, making alternative techniques such as the Bilateral Sinus Solution™ (BSS) necessary.

The Bilateral Sinus Solution™ (BSS) technique

Developed by the Nicola Lettera Maxillofacial Team, the Bilateral Sinus Solution™ (BSS) is a customised surgical technique that involves the placement of between 6 and 12 implants depending on the patient's anatomy. The Nicola Lettera Team defines the optimal configuration after careful evaluation of the Cone Beam CT. Typically the configuration includes:

• 2 pterygoid implants in the posterior areas (18/28) — they are the only basal implants, anchored in the basal bone at the level of the tuber and the sphenoid
• 2 transverse nasal implants in positions 15/25, placed in the extremely hard bone of the retrocanine fossae
• 2-8 subnasal or blade implants in the frontal area

Pterygoid implant

The pterygoid implant is a long implant (19-21 mm) placed with an inclination of approximately 45°-60° relative to the occlusal plane. It crosses the maxillary tuber and anchors for about one centimetre in the cortical plates of the sphenoid, guaranteeing excellent primary stability.

Bicortical anchorage

Bicortical anchorage is achieved when the implant crosses and locks into two distinct bone cortices: the cortex of the tuber and that of the pterygoid plates of the sphenoid. This guarantees superior mechanical stability and allows immediate loading.

No bone graft

Unlike traditional techniques, the Bilateral Sinus Solution™ (BSS) does not require bone grafts or maxillary sinus lifts. This is because the implants are anchored directly in the basal bone, which is always present and not subject to resorption.

Main advantages

For a complete list, visit the dedicated page on the advantages of the technique.

Surgical procedure

For a detailed step-by-step description of the procedure, visit the Surgical procedure page.

Clinical cases

See the clinical cases treated with the Bilateral Sinus Solution™ (BSS) technique, with pre- and post-operative radiographic documentation.

Featured videos

Here are some of the most significant videos from the Implantologia Network channel: real procedures, extreme cases solved and the Bilateral Sinus Solution™ (BSS) technique seen up close. Press play to watch them here. See all videos →

▶ Watch all 88 videos of the channel

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