JIACD
The Journal of Implant & Advanced Clinical Dentistry
Complication during a Lateral Window Open Sinus: cut artery how do I control the bleeding?????
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control of arterial bleeding
Pressure bleeding point with wet gauze for 10 min.
And Bleeding will be controled. Do not mind weak bleeding after osteotomy. continue procedure.
Piezo devcie may help to prevent arterial bleeding. DS
Control of Arterial bleeding
If bleeding occurs during lateral window preparation pressure should be applied for several minutes(7-10).Eventually the bleeding will stop.In some situations electrosurge use can be applied.
In order to avoid heating the blood vessel piezosurgery device will help since it will not perforate the blood vessel.
Of course using the Miambe balloon will eliminate the potential risk of the arterial bleeding since we are talking about crestal approach.
contral bleeding from sinus lifting
dear Dr. but some time the bleeding from the bone not from membrane or soft tissue , can i use bone wax in this case now ?
i am bleeding
how do you deal with intra-operative complications, such as arterial bleeding, sinus perforation, soft tissue fenestration, etc.? you GET TRAINED APPROPRIATELY TO BEGIN WITH. That's why I'm an oral & maxillofacial surgeon. The public has given me privileges to perform these surgeries because I have 7 years of post-dental school education/residency under my belt. I have done hundreds of them. I have seen true arterial bleeds from branches of the maxillary artery during a sinus lift. This is serious stuff. Pressure will not work. You need to have electrocautery available. Piezosurgery might or might not protect the artery unless you know right where it's at - which isn't always possible.
I am fascinated by these little worlds created by dentists who are not trained surgeons - like this journal - where you try to learn pearls from others, and you talk about your problems. It's unbelievable to me that you are putting our professional reputation at risk by doing this stuff. It would be no different from me deciding I'm going to start doing radical neck dissections on patients where my biopsies turn up oral cancer. (I am not an OMS who trained extensively in cancer surgery... there are some who have). I leave that stuff to experienced experts.
Implants have enjoyed a great reputation and high success rate - I think - because specialists have primarily been doing them. This is changing and I wonder how it's going to turn out? I suspect it will be like cardiac catheterizations - the docs who do them routinely do them best.
Why don't you work with your surgical colleagues - whether they be a perio or OMS - and use them for their special skills? There's a ton of restorative information for you to master, why not focus on that?
I just do not get it!!!!!!!!!!
Hawk, I hear ya but...
Hawk, I hear exactly what you are saying. I am a periodontist and experience many of the same frustrations that you are speaking of. I think, however, the gen dens doing this kind of very advanced work are in the minority...they are just very vocal and show off ish (see what I can do). The thing that makes a good specialist is knowing how to deal with things when they go wrong.
Bleeding During Sinus lilfts and those naughty GP's
In the United states, when to touch the sinus was cause for being burnt at the stake, a general dentist, Hilt Tatum Jr, developed the Sinus lift. He has taught thousands the technique he pioneered. I think, he is a better surgeon / Implantologies than any specialist now alive. There are many GPs such as myself who have been doing sinus lifts for 15-20 years. There are many who taken the time for training and have long experience. The provide the service because they can, are consistently successful and they enjoy the work. Do you get it now?
In addition to the suggestions listed to deal with the bleeding, one could also expose more the the areteriol and ligate it or one could try to crush the bone where the arteriol exists.
Strongly worded, but I agree.
I have about 50 lateral widows under my belt. Not a lot, but enough. I still haven't had a "serious" bleeder. Perhaps I'm lucky. Maybe my preception of serious is different.
I agree with hawk's advice. If you aren't comfortable with the management of this area, don't do it. Farm it out!
Happy lifting!
Sinus Bleeders...a thing of the past
If you have stepped into the 21st century and own a piezo unit (I have an Acteon and love it), you know that sinus bleeders are a thing of the past.
I ROUTINELY dissect out the arterial branch in the lateral wall of the maxillary sinus. Back in the old days when I used a bur, sure you would occasionally cut the artery. It is a very humbling sight when streams of blood pump 2 feet across the room. No big deal...you simply extended your cut and most of the time the arterial branch would contract and seal itself. If not, you simply ligated the branch or cauterized.
With the piezo, you will not cut the artery (unless you are pushing with brute force)
I beg to differ on OMS as sinus lift kings
I am a periodontist and I have to respectfully differ with you Hawk on the OMS as king of the sinus lifts. Both OMS and Periodontists do a great job at sinus lifts, HOWEVER there seems to be a one big difference. Most OMS I know routinely perf the Schneiderian membrane. In fact, one guy told me it was IMPOSSIBLE to lift the membrane without perfing it. At the recent BMP course in Philly, one of the OMS (will not name names) was showing open sinus cases with BMP and darn near every case he showed had big perfs in the membrane.
I even know some GP's that do a great job with open lifts...and they rarely perf. I think it is a matter of patience. If you rush the lift, there is a good chance of perfing. The key, and I agree with SinusLifter on this statement, is do you know how to deal with a perf if you get one? If you do not, you should probably not be doing lifts. Same thing goes for dealing with bleeding complications.
Bleeders and sinus perf implants in general
Firstly, Implant dentistry was started by GP's. Any motivated GP can learn these techniques, skill and judgement. I have seen and reviewed cases that were botched by GP's and specialist alike. Just because one is a specialist, does not mean that they are "The Burning Bush". We all can learn from each other!
specialists
Easy, Mental Foramen. If you read my entire post, I did not show any bias against periodontal surgeons doing this stuff. I encouraged involving an OMS because that's what I am, but at the end of my post I make it clear that OMS & Perio are good sources for expertise.
Interesting that you felt the need to take a jab at oral surgeons brutalizing the sinus membrane. That's such BS to imply that OMSs routinely handle any soft tissue less adequately than a periodontist... but I guess that's just your insecurity getting the best of you. Take a look in the mirror, my friend. Say hello!
GP/SPECIALISTS
I appreciate & acknowledge the fact that some GPs can master this stuff. And I would never suggest that every OMS or Periodontist executes flawless surgery 100% of the time. But it's a simple truth that we specialists have additional years of focused training, and hopefully by limiting our practice to our given area we bring more to every case in every way (with our hands, with our residency guidance, with our experience, with relevant literature, etc.) than a GP possibly could.
The question that initiated this whole string of comments was posted by someone who, in my opinion, displayed by the caliber of questions he put out here, that he or she is not qualified to do sinus surgery. Bone wax? Please.
Hawk OMS, a compliment and question for you.
Hawk, first of all I would like to compliment you for taking the time to post on this message board. It is nice to have collegial interaction amongst our peers.
Second, I would like to ask if you are using any growth factors in your practice? I am using platelet rich fibrin quite a bit and have been very happy with the results. I was using PRP in the past, but have quit using it as the literature has shown it to be quite ineffective for most things other than soft tissue healing. I even tried to sell my PRP machine for $100 and no one would buy it! I ended up throwing it out in the trash.
I use some BMP, but not too much. Very expensive.
Bleeders,GP's,specialists and more..
We have quite an interesing conversations here..
I personally believe that today with the current knowledge,education opportunities and skills GP's can perform advanced procedures such as sinus lifts providing they know how to manage complications.We as periodontists or OMS can not stop the train that had already left the station.I know a lot of GP's which have better skills than some of my colleagues.
I personally educate and teach these procedures more than 15 years and do my best to bring the message with complications management.
as for arterial bleeding- for me and I hope for all of you it is a matter of the past and not because of the piezo but because of the minimally invasive antral membrane balloon elevation which is done via the crest avoiding any possible bleeders.
Growth Factors
I have added PRP into my bone graft material (1:1 Bio-Oss and allograft) for 5-6 years for conventional/lateral sinus lifts. I think the literature on PRP is weak, but I like the handling it gives the bone graft granules, and since we're set up to use it we use it (Harvest Technology is what we have). I do think it gives an advantage to the early healing graft, and I also have observed that these patients seem to complain of little or no pain post-op. I wouldn't recommend buying a setup, but I think it's somewhat helpful. Along the same lines, I think the Endoret setup by Biotechnology Institute looks similarly helpful & it's a cheaper alternative.
I generally use GEM-21 (which is r-PDGF) or Emdogain (from Straumann) in cases where I feel I'm pushing the envelope, or if I'm repairing a peri-implant defect (very rare). I sometimes use them on connective tissue grafts, but only if there's a reason such as compromised health/smoking, etc. I don't think we as a profession know enough yet about growth factors to incorporate them every day into our grafts: for example, what dose is best, what about sustained release vs. one time application, etc. I have no use for BMP given its current cost and available good bone graft materials, not to mention the post-op inflammation it causes.
Hawk Look into PRF much better then PRP.
Hawk Look into PRF much better then PRP. There are several articles on PRF in the issue archive. Much cheaper and easier to use then PRP.