EP2214584A2 - Method and device for carrying out a percrestale sinus lift - Google Patents

Abstract

The invention relates to a method for carrying out a percrestale sinus lift, wherein a bore channel is created with the aid of a boring, milling and/or hammering method, the Schneider membrane is lifted from the jaw bone using a flowable medium that is supplied via the opened bore channel, bone replacement material is introduced, a supply line is introduced into the bore channel prior to introducing the flowable liquid and is sealingly fixed in a detachable manner to the bore channel or onto the edge thereof and the flowable medium in introduced through the supply line. The invention also relates to a surgical instrument (1) for introducing a flowable medium for lifting the Schneider membrane from the jaw bone whilst carrying out a percrestale sinus lift. Said instrument comprises a supply line that can be introduced into the bore channel and that has at least one sealing element for sealing and detachably fixing the supply line to the bore channel or to the edge thereof, a displaceable sleeve (4) on the supply line is guided in the axial direction in relation to the supply line and the sealing element (7) is arranged between a front surface of the sleeve (4) and a surface, preferably a ring surface (6), protruding in the radial direction from the supply line, and can be deformed by axially pressing the sleeve (4) in the radial direction and can be pressed counter to the inner wall of the bore channel (3).

Description

Method and device for performing a percrestal sinus lift

The invention relates to a method for carrying out a percrestal sinus lift, in which a drilling channel is created by means of drilling, milling and / or impact method, the Schneidersche membrane lifted from the jaw bone using a flowable medium supplied via the opened drill channel and bone replacement material is introduced , Furthermore, the invention relates to a surgical instrument for introducing a flowable medium for lifting the Schneider's membrane from the jawbone when performing a percrestal sinus lift and a set of instruments for performing a percrestal sinus lift.

Due to the pneumatization of the maxillary sinus, there is usually a small amount of bone available for anchoring an endosseous dental implant. This bone deficiency can be overcome by a so-called sinus lift operation, which introduces bone substitute material between the bone and Schneider's membrane. For this surgical technique it is necessary to detach the Schneiderian membrane intact from the maxillary sinus to create a cavity for the bone material to be inserted. Here, the hole for the implant is advanced to close to the Schneiderian membrane and optionally with another instrument, such as an osteotome, the remaining bone lamella pierced, whereupon the Schneider's membrane can be detached, for example with the aid of a balloon catheter from the bottom of the antrum. However, this method involves a not inconsiderable risk of destroying the extremely sensitive Schneiderian membrane, so that it seems desirable to perform the lifting of the membrane even more gently and avoiding voltage spikes in the membrane. EP 1 362 561 A2 describes a device for detaching the maxillary sinus mucosa. The preparation device for a sinus floor elevation in this case has a controlled or regulated pump, which promotes a preparation means by a hose connection to an access opening to be performed in the jawbone, wherein the preparation device has a fastening means which by attaching a negative pressure in a kind of suction cup attachment of the hose on Jawbone allows. The jet of the preparation agent passing through the access opening is directed against the maxillary sinus mucosa to gently detach it from the jawbone. The access opening to the maxillary sinus mucosa is created here with conventional instruments. A disadvantage of this device and the corresponding method is, inter alia, that a considerable amount of equipment must be operated to fix the fastener on the jawbone by negative pressure and bring the spin finish, with a secure fit of the fastening means on the jawbone can not always be guaranteed , It is to be regarded as particularly disadvantageous that if the preparation agent is not at the same time the bone substitute material used for the subsequently occurring sinus elevation, it comes into contact with the cut surfaces in the jawbone to a significant extent and can penetrate into the spongy structure of the bone, which is especially true Co-use of an X-ray contrast agent in the spin finish is disadvantageous.

The invention now aims to provide a method for carrying out a percrestal sinus lift, in which the Schneiderian membrane gently lifted from the jawbone using a flowable medium supplied via the opened alveolar canal or the defined drill channel can be, with the above-mentioned disadvantages should be avoided.

To achieve this object, the method according to the invention for carrying out a percrestal sinus lift essentially consists in introducing a supply line into the drill channel before sealing the flowable medium and releasably securing it in the bore channel or at its edge, and allowing the flowable medium to pass through the supply line is introduced. Thereby, a supply line can be set with little expenditure on equipment, while ensuring at the same time that the cut surfaces of the jawbone do not come into contact with the flowable medium, so that it can not penetrate into the cancellous bone. The flowable medium for lifting the Schneiderian membrane from the jawbone here can be directly the bone substitute material or a different medium of this material, in the case of using a different medium from the bone substitute material this must be removed after the lifting process from the space between the jawbone and Schneider's membrane.

In this case, the method may preferably be developed such that the supply line is fixed by means of a flexible ring seal in the bore channel or at its edge, wherein the ring seal is preferably deformed or expanded in the radial direction and pressed against the inner wall of the drilling channel. In this way, on the one hand gentle and the initiation of force peaks in the jaw bone avoiding fixing of the supply while simultaneously optimally shielding the cancellous bone structure of the jawbone against the flowable material to be introduced succeeds. In particular, as a result of the fact that the supply line acquires its effective diameter only after insertion into the drill channel, an input can be made. break the possibly extremely thin maxillary bone structure can be avoided during insertion of the feed line.

In a preferred manner, the method can be further developed such that a ring seal designed as a hose or balloon seal is pressed by pressure supply against the inner wall of the drilling channel, which further reduces the stress loads in the drilling channel.

The method is advantageously carried out so that the supply line is sealed at its front end in the insertion direction in the drill channel. This makes it possible, on the one hand, as far as possible to protect the entire truncated area of the jawbone from undesired perfusion with the flowable medium and, on the other hand, to minimize the risk of damaging the Schneiderian membrane by areas of the supply line which extend distally beyond the ring seal.

Advantageously, a gel is used to lift the Schneiderian membrane from the bottom of the antrum as a flowable medium. The use of a gel in this context offers the advantage that a gel on the one hand ensures a uniform stress distribution in the Schneiderian membrane and thus largely avoids the occurrence of unwanted voltage peaks in the Schneider's membrane when lifted from the jaw bone, but on the other hand, the area in which the Schneidersche Membrane should be lifted from the bottom of the jaw height, relatively narrow compared to a less viscous medium. This provides optimal control of the lift's success based on the volume of fluid introduced. As already mentioned above, the method according to the invention can preferably be further developed such that a pasty bone substitute material is selected as the flowable medium, so that flushing out of the material used to lift the Schneiderian membrane from the bottom of the antrum can be dispensed with and the implant can be attached directly afterwards the sinus lift can be set.

The invention further relates to a surgical instrument for introducing a flowable medium for lifting the Schneiderian membrane from the jawbone when performing a percrestal sinus lift, which is particularly suitable for carrying out the method described. The instrument in this case has a feed line insertable into the drill channel with at least one sealing element for sealing and releasably fixing the feed line in the drill channel or at its edge and is characterized in that on the feed line in the axial direction relative to the feed line slidable sleeve is guided and that the sealing element between an end face of the sleeve and a projecting in the radial direction of the feed line surface, in particular annular surface, arranged and formed by axial pressing of the sleeve in the radial direction and formed against the inner wall of the drill channel pressable. In this way, the surgical instrument, without the jaw bone to claim, are brought into the desired position and then releasably fixed by moving the sleeve, resulting in a radial expansion of the ring seal, in the bore channel or at the edge.

Advantageously, the surgical instrument is preferably further developed such that the sealing element has at least one flexible ring seal, wherein the ring seal with advantage in the radial direction deformable and against the inner wall the drill channel is formed pressable. Such a sealing element can be brought into contact with the cut surface in the jawbone in a particularly gentle manner, so that optimal shielding of the cancellous structure of the jawbone can take place while simultaneously avoiding the introduction of force peaks into the bone.

Advantageously, the surgical instrument is preferably designed so that the annular surface has securing means for preventing the sealant from slipping off. Such securing means may be, for example, a proximally directed, circumferential elevation. It is also conceivable in this context to design the annular surface in such a way that it is inclined inward in the insertion direction so that the sealing means is held radially inward.

The surgical instrument is in this case preferably further developed in such a way that the end face of the sleeve facing the sealing element is designed as an inclined, in particular frusto-conical surface, whereby only a small force in the axial direction is applied by the surgeon to produce a sufficiently large radial force Sealing element is applied to the surrounding jawbone, while ensuring that the radial extent of the ring seal remains within reasonable limits and thus damage to the jawbone is prevented.

The surgical instrument can be advantageously developed such that the sleeve cooperates with a clamping and / or locking element for tensioning or fixing the sleeve in a position pressed against the sealing element, so that once the surgical instrument is in the desired position was brought without further action in the desired position remains. According to a preferred embodiment of the invention, the tensioning and / or locking element can be formed by a screw which can be screwed in the axial direction against the sleeve, which allows a particularly simple fixation of the surgical instrument in the drill channel or at its edge. According to a further preferred embodiment of the present invention, it is provided that the clamping or locking element is formed by a wedge-like slide whose relative to the axis of the sleeve inclined surface cooperates with the lateral insertion with a ramp surface of the sleeve to the sleeve to press in the axial direction against the sealing element. Such an embodiment of the clamping and / or locking element makes it possible to anchor the surgical instrument with only one hand in the drill channel. As a further possible embodiment of the clamping and / or locking element, an eccentric lever may be provided, which is fixed to a part of the body of the surgical instrument and moves the sleeve distally by folding.

According to a further preferred embodiment of the present invention, it is provided that the sealing element is arranged at the front end of the feed line in the insertion direction, which makes it possible to anchor the surgical instrument in close proximity to the Schneiderian membrane. The arrangement of the sealing element on the front end of the feed line in the insertion direction thus allows on the one hand the protection of the jaw bone over its entire truncated surface, while at the same time avoiding that areas of the surgical instrument which extend too far beyond the annular seal can damage the Schneiderian membrane , In order to protect the Schneiderian membrane optimally against perforation by the surgical instrument to be introduced, it is provided according to a preferred embodiment of the invention that the supply line and / or the sleeve has a stop for limiting the insertion depth into the drill channel. The stop for limiting the depth of insertion into the drill channel can in this case be arranged at a suitable distance from the sealing element and / or be defined with spacers such as washers, so that surgical instrument see safely into the drill channel until the interaction of the attack on the surgical instrument with the gums or an implantation rail can be inserted, whereupon the determination of the surgical instrument takes place in the drill channel or at the edge.

Alternatively, it can also be provided that the ring seal is designed as an inflatable tube or balloon seal, wherein a channel opening into a cavity of the seal is provided for the supply of a pressure medium, so that the ring seal is inflated at pressure supply and against the inner wall of the Bohrkanals is pressed. In this way, a particularly gentle sealing of the Sinusliftbereiches succeeds for introduction of the flowable medium.

The invention further relates to a set of instruments for performing a percrestal sinus lift. The instrument set comprises a drilling, milling and / or percussion instrument for providing access to the Schneiderian membrane, an instrument according to the invention as described above for delivering a flowable medium via the drill channel for lifting the Schneiderian membrane from the jawbone and one of the other instruments preferably a separate instrument for introducing a bone substitute material. Such a set offers optimal conditions for carrying out the described method. The instrument (s) for providing a drilling channel, the surgical instrument for introducing a flowable medium for lifting the Schneiderian membrane from the jawbone according to one of claims 8 to 17 and another, preferably separate from the other instruments Instrument to be provided for introducing bone replacement material.

In particular, when introducing the hole in the jaw bone and the breakthrough from the drill channel into the sinus tearing of the maxillary sinus mucosa is to be feared when the drill pierces the bone and is not discontinued in time.

In order to prevent injuries of the Schneiderian membrane, it has already been proposed to use for the surgical procedure not only a drill, but a drill set, in which a substantially hemispherical drill body has at least partially smooth surfaces, wherein the smooth part of the drill body dome or teilkugelmantelför - Mig may be formed and, where appropriate, may be kept stationary as a separate part relative to the drill body provided with a material-removing Oberflächenstrukturie-. Once with such a drill, the smooth part of the drill body comes into contact with the Schneiderian membrane, on the one hand to ensure that this part does not rotate further to avoid damage to the membrane, and on the other that drilling with the remaining areas with a material-removing surface structuring is still possible. Such drills are generally provided with devices for supplying and removing a cooling and / or rinsing liquid, such drills and drill sets being relatively expensive in terms of apparatus, since the drills are designed in several parts with only small dimensions, and on the other hand also with these drills a perforation of the tailors Membrane can not be excluded if the penetration of the jawbone is not recognized in time by the surgeon.

It is an object of the invention to provide a drill set, with which too far penetration of the drill into the antrum and thus a perforation of the Schneiderian membrane effectively avoided and thus the risk to the patient can be minimized.

To achieve this object, the subject of the invention is further a drill set for use in the implementation of a perc restalen sinus lift, which at least one drill of a first type, which is designed as a pilot drill, and at least a first drill of a second type, not one cutting cylindrical body having a diameter not exceeding the drilling diameter of the drill of the first type and a drill pin projecting from the distal end face of the cylindrical body by a defined length. Such a drill set offers the possibility of using the drill of the first type to set a hole in the jawbone just below the cutting edge membrane, after which a drill of the second type can be used to effect the actual breakthrough to the Schneiderian membrane. The second type of drill forms a stop on the non-cutting cylindrical body which cooperates with the bottom of the bore created by the first type drill so that the drill pin advances only by the defined length which the drill pin protrudes from the cylindrical body , is possible. It is possible with known imaging techniques to set the pilot hole, for example, to a planned area 2 mm in front of the Schneiderian membrane, so that when the drill pin projecting from the cylindrical body of the first drill of the second type, for example, having a length which is 2 mm less of the imaging error and evaluation, perforation of the Schneiderian membrane can be precluded because even if the first type of drill can not be accurately positioned in the jawbone due to the defect, it still can wide penetration into the antrum is safely excluded.

Advantageously, the drill set according to the invention is further developed such that at least one second drill of the second type has a drill pin projecting from the distal end face of the cylindrical body by a greater defined length than the length of the drill pin of the first drill of the second type. With such a drill set, in turn, a pilot bore as described above can be set and approached to the breakthrough to Schneider's membrane with a plurality of drills of the second type, wherein the non-cutting cylindrical body of the drill of the second type respectively with the bottom of the pilot hole in Effect occurs and the advance of the bore in each case via the incremental enlargement of the respective drill pins of the drill of the second type. As a result, in turn, the surgical instrument according to claims 8 to 17 can be used for introducing the flowable medium for lifting the Schneiderian membrane from the jawbone. Once the Schneiderian membrane has been lifted off, the Pilot Drill, without the risk of damaging the Schneiderian membrane, can expand the jawbone aperture to the actual desired diameter, then, if desired, using another instrument, add the desired amount of bone replacement material to the sinus can be introduced.

According to a preferred embodiment of the drill set according to the invention, the drills of the first and the second type In each case channels for the supply and / or discharge of cooling and / or rinsing liquid, wherein in a preferred manner, the channels for the supply of cooling and / or rinsing liquid open in the region of the drill pin. Cooling of the surgical site is in any case indispensable in the execution of such channels to avoid the necrotization of the bone tissue by heat, and on the other hand, when the channels for the supply of cooling and / or irrigation fluid in the area of the drill pin, at Breakthrough of the jawbone to the Schneider's membrane in front of the drill pin a floating water screen is formed, which keeps the membrane from the rotating drill pin.

Advantageously, the drill set according to the invention is further developed such that the drill pin of the at least one drill of the second type is designed as a cannon drill with a semicircular drill bit, this geometry of a semicircular drill bit already having proven itself in the field of the invention. It allows both precise and minimal traumatic removal of the bone material and satisfactory removal of the cut material.

Advantageously, the drill set is further developed such that the drill pin of the at least one drill of the second type is designed as a diamond-coated drill bit. Diamond-cut drill bits are characterized in the field of the invention in particular by the fact that they enable efficient cutting of bone material, with soft parts, in particular the Schneiderian membrane, being particularly spared.

The invention is explained in more detail below with reference to an embodiment schematically illustrated in the drawing. 1 shows a sectional view of a surgical instrument for introducing a flowable medium to the FIG. 2 shows an instrument according to FIG. 1, in which the sealing ring has been radially deformed in the bore channel for securing the instrument in the bore channel, FIGS. 3 and 4 show a removal of the Schneiderian membrane from the jawbone during the implementation of a percrestal sinus lift according to the present invention 5 and 6 a surgical instrument with a further alternative embodiment of the sealing element, FIGS. 7 and 8 a surgical instrument according to the invention in a side view with an alternative tensioning and / or locking element, FIG. 9 shows a drilling sequence in section using the drill set according to the invention, FIG. 10 shows a detailed view of FIG. 9C, FIGS. 11 and 12 show an alternative embodiment of the tensioning and / or locking element, and FIG. 13 shows a detailed view of an alternative embodiment of an inventive device chi rurgical instruments.

In Fig. 1, 1 shows a surgical instrument for introducing a flowable medium for lifting the Schneiderian membrane from the jawbone when performing a percrestal sinus lift. The instrument consists of a body 2, wherein a sleeve 4 extends around the elongate body 2 of the surgical instrument 1. At the distal end 5 of the body 2, an annular surface 6 is arranged, against which a sealing element or a ring seal 7 rests. Inside the body 2, a channel 9 for the supply of flowable medium is arranged, which is supplied via the terminal 10. Denoted by 11 is a fixing screw, which interacts with the thread 12. The depth of penetration of the surgical instrument into the drill channel 3 of the jaw bone 13 is limited by stops 14 and 15, wherein in use the stop 14 comes to lie on the gum and the stop 15 comes into effect when implantation rails during surgery be used in both cases with cylindrical discs to the planned depth fine tuned.

FIG. 2 shows the surgical instrument according to FIG. 1, wherein here the displaceable sleeve 4 has been displaced relative to the body 2 in the direction of the arrow 16, so that the annular seal 7, which rests against the annular surface 6, compresses and radially afterwards was deformed outside, so that the ring seal 7 at the cut surface 17 of the jaw bone 13 in Appendix arrived. This advanced position of the sleeve 4 can, as shown in Fig. 2, by means of the screw 11 which has been pre-screwed to the thread 12, fixed.

In Fig. 3, a surgical instrument according to the invention is shown in an alternative embodiment, wherein like parts are provided with the same reference numerals. In this embodiment, only the ring seal 7 has an alternative construction. According to the embodiment of FIG. 3, the ring seal 7 is not designed as an O-ring seal but as a sealing profile, which in turn can be compressed by displacing the sleeve 4 and deformed radially outward.

In Fig. 4, the surgical instrument of FIG. 3 is again shown in a stretched state, wherein the sleeve 4 is displaced relative to the body 2 in the direction of arrow 16, the annular seal or the sealing member 7 is deformed radially outward and at the cut surfaces 17 of the jaw bone 13 comes to rest.

In Fig. 5, an alternative embodiment of the surgical instrument according to the invention is shown, in which the sealing element is designed in the form of an inflatable balloon. In this embodiment, the sleeve may be omitted, in which case in the body 2 of the surgical instrument a channel 18 is arranged, which can be fed via a connection 19 with a medium which can fill a cavity 20 which is formed by a recess in the body 2 of the surgical instrument and a sheath 21.

FIG. 6 shows the surgical instrument according to FIG. 5 in a state fixed in the drill channel, wherein it can be seen that the medium is inflated in a balloon-like manner through the channel 18 into the cavity 20 by introducing a medium into the connection 19 and reaches the interface 17 of the jaw bone 13 to the plant. In this state, in turn, the flowable medium for lifting the Schneiderian membrane of jawbone 13 via the terminal 10 and the channel 9 can be introduced.

In the figures 7 and 8, an alternative embodiment is shown, in which for fixing the sleeve 4 in the cocked position instead of a screw, a slide 22 is provided, which has an obliquely arranged to the axis of the surgical instrument 1 stratum surface 23, which interacts with a corresponding surface 24 on the sleeve 4 of the surgical instrument 1, so that by sliding the slider in the direction of arrow 25, a displacement of the sleeve 4 in the direction of arrow 26, whereby the ring seal 10 is in a relaxed state. Upon displacement of the slider 22 in the direction of the arrow 27 in Fig. 8, the sleeve 4 is displaced in the direction of the arrow 28 relative to the body 2, whereby the ring seal 10 is compressed and deformed radially outwardly.

9, the drill set for use in the implementation of a percrestal sinus lift is shown, wherein it can be seen that a pilot bore by means of the drill of the first type 29 to almost to the sinusoidal end 30 of the Kie 13 is set. With a first drill bit of the second type 31, whose cylindrical body 32 is non-cutting, and which thus comes into abutment with the bottom of the bore 33, can now by means of the drill pin 34 without the risk of perforation of the Schneiderian membrane 35 close to this be drilled with sufficient length of the drill pin 34 in this step, the breakthrough to the membrane 35 can be done. Optionally, however, by means of another drill of the second type 36, the drill pin 37 has a greater length, the breakthrough by the jaw bone 13 done.

As shown in FIG. 10, a cooling and rinsing, for example with Ringer's solution 38, takes place at the tip of the drill pin 37 in a conventional manner, so that when the sinusoidal edge 30 of the jawbone 13 breaks through, a floating shield 39 is formed, which forms the Schneiderian membrane 35 protects against the rotating tip of the drill pin 37.

FIGS. 11 and 12 show the function of an eccentric lever as a tensioning and / or locking element. The eccentric lever 40 is rotatably fixed to the body 2 of the surgical instrument 1. When the lever is turned over, as shown in Fig. 12, the front portion of the eccentric lever 40 presses on the upper edge of the sleeve 4 so that it is displaced distally and relative to the body. This leads to the desired deformation of the sealing element 7.

Fig. 13 shows a detail of an alternative embodiment of the surgical instrument 1, in which the annular surface 6 has means for securing the sealing element 7 against slipping. In the radially outer region of the annular surface 6 in this case a circumferential elevation 41 is arranged, which holds the sealing element securely on the annular surface.

Claims

Claims: A method for performing a percrestal sinus lift, wherein a bore is created by means of drilling, milling and / or impact method, the Schneidersehe membrane lifted from the jawbone using a supplied via the opened drill channel flowable medium and bone replacement material is introduced, thereby characterized in that prior to supplying the flowable medium, a supply line is inserted into the drill channel and sealingly fixed in the drill channel or at its edge, and that the flowable medium is introduced through the supply line. 2. The method according to claim 1, characterized in that the supply line is fixed by means of a flexible ring seal in the drill channel or at its edge. 3. The method according to claim 1 or 2, characterized in that the annular seal is deformed or expanded in the radial direction and pressed against the inner wall of the drilling channel. 4. The method of claim 1, 2 or 3, characterized in that a designed as a hose or balloon seal ring seal is pressed by pressure against the inner wall of the drilling channel. 5. The method according to any one of claims 1 to 4, characterized in that the supply line is sealed at its front end in the insertion direction sealing in the drill channel. 6. The method according to any one of claims 1 to 5, characterized in that a gel is used as a flowable medium. 7. The method according to any one of claims 1 to 6, characterized in that as a flowable medium, a pasty bone substitute material is selected. 8. Surgical instrument for introducing a flowable medium for lifting the Schneiderian membrane from the jawbone when performing a percrestal sinus lift, wherein the instrument insertable into the bore channel feed line with at least one sealing element for sealing and releasable sets the supply line in the well or at the Having edge, characterized in that on the supply line in the axial direction relative to the feed line slidable sleeve (4) is guided and that the sealing element (7) between an end face of the sleeve and in the radial direction of the feed line projecting surface, in particular Ring surface (6), arranged and deformed by axial pressing of the sleeve (4) in the radial direction and formed against the inner wall of the drilling channel (3) pressable. 9. Surgical instrument according to claim 8, characterized in that the sealing element (7) has at least one flexible ring seal. 10. Surgical instrument according to claim 8 or 9, characterized in that the annular seal is deformable in the radial direction and formed against the inner wall of the drilling channel (3) pressable. 11. Surgical instrument according to claim 8, 9 or 10, character- ized in that the annular surface (6) securing means for preventing the slipping of the sealing element (7). 12. Surgical instrument according to one of claims 8 to 11, characterized in that the sealing element (7) facing the end face of the sleeve (4) is formed as pointing away from the feed line inclined, in particular frusto-conical surface. 13. Surgical instrument according to one of claims 8 to 12, characterized in that the sleeve (4) cooperates with a tensioning and / or locking element for tensioning or fixing the sleeve (4) in a position pressed against the sealing element (7). 14. A surgical instrument according to claim 13, characterized in that the clamping and / or locking element is formed by a screwable against the sleeve (4) in the axial direction screw (11). 15. A surgical instrument according to claim 13, characterized in that the clamping or locking element is formed by a wedge acting like a wedge slide (22) whose relative to the axis of the sleeve (4) inclined surface during lateral insertion with a ramp surface (24 ) of the sleeve (4) cooperates to push the sleeve (4) in the axial direction against the sealing element (7). 16. Surgical instrument according to one of claims 8 to 15, characterized in that the sealing element (7) is arranged at the front end of the feed line in the insertion direction. 17. Surgical instrument according to one of claims 8 to 16, characterized in that the supply line and / or the sleeve (4) has a stop (14) for limiting the insertion depth into the drill channel (3). 18. Instrument set for performing a percrestalen sinus lift, in particular for carrying out a method according to one of claims 1 to 7, comprising a drilling, milling and / or percussion instrument to provide a Bohrkanals (3), an instrument (1) according to any one of claims 8 to 17 for supplying a flowable medium via the drill channel for lifting the Schneiderian membrane from the jawbone and a separate from the other instruments instrument for introducing a bone substitute material. Drill bit set for use in the implementation of a percrestal sinus lift, characterized by at least one drill of a first type (29) designed as a pilot drill and at least one first drill of a second type (31) comprising a non-cutting cylindrical body (32 ) having a diameter not exceeding the bore diameter of the first type drill bit (29) and a drill pin projecting from the distal end surface of the cylindrical body (32) by a defined length. A drill set according to claim 19, characterized in that at least a second drill bit of the second type (36) has a drill pin (37) projecting from the distal end face of the cylindrical body by a greater defined length than that length of the drill pin (34). of the first drill of the second type (31). A drill set according to claim 19 or 20, characterized in that the drills of the first and second types (29, 31) respectively Have channels for the supply and / or discharge of cooling and / or rinsing liquid, wherein in a preferred manner, the channels for the supply of cooling and / or rinsing liquid in the region of the drill pin (34,37) open. 22. A drill set according to claim 19, 20 or 21, characterized in that the drill pin of the at least one drill of the second type (31) is designed as a cannon drill with a semi-circular drill bit. 23. Drill set according to one of claims 19 to 22, characterized in that the drill pin (34) of the at least one drill of the second type (31) is designed as a diamond drill bit.