JIACD
The Journal of Implant & Advanced Clinical Dentistry
Open Sinus lifting Advice: I keep tearing the membrane and graft results are less then stella. Help please?
Fri, 04/29/2011 - 03:44 — Sam2493
I graduated from dental school 10 years ago and have taken Arun Gargs implant seminars maxi course to learn implants and his weekend seminar on grafting.
I have a piezo in my office but no matter what I do I tear the membrane over and over. I repair with a membrane but my patients usually have alot of pain and swelling. The overall graft results are usually poor with often having trouble placing the implants.
What can I DO TO IMPROVE????
Would the balloon help me avoid perfs?
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Comments
Sinus lifts
Sam, my friend, it's time to look in the mirror and ask yourself if you should perhaps focus on what you are good at, what works in your hands, what is truly in your comfort zone. You say you've torn the membrane over and over. As someone who has done dozens and dozens of sinus lift grafts, I can tell you that you're performing at a D or F level. Elevating the membrane intact should not be this difficult. As I've said in other posts, these grafts are routine and predictable. I love the bone I find at 6 months (I use PRP mixed with 1:1 bio-oss and straumann allograft and I usually cover the sinus access window with a bio-gide or something similar). Patients usually come back wondering how I did that without causing pain.
I guess you can do more hands-on continuing ed, but unless you're in the middle of nowhere, why not befriend an OMS or periodontist who loves doing this type of grafting and ask them if they will do the graft for you... and you can do the implant. Ask yourself: who would you go to if you needed this procedure? Call that person.
You know, this is why I no longer do naso-orbito-ethmoid trauma, zygomatic arch fractures, etc. It's because I don't do them enough to be as good as I was as a senior resident. This is why cardiologists who place the most stents have the best outcomes. It's ok to focus on what you happen to be great at.
Sinus lift complications: If first you dont succeed
If first you dont succeed try and try again. There are plenty of weekend courses you can take. Arun Garg, Misch, ICOI, etc.
The more eductaion you get the better you will get.
Dont give up
Ziv does the MIABE Balloon avoid these problems?
Ziv does the MIABE balloon avoid these problems? What is your latest research show? what are your current limitations of the balloon to date?
Any course updates, I still want to take the course.
Xavier
Balloon updates
Dear Xavier
There is no doubt that once you get familiar with the MIAMBE technique your complication rate goes down dramatically.I have been using the balloon almost in all sinus lift situations regardless of height.The system is designed to a range of 1-7mm of residual bone height.
Our next handson course on patients is scheduled for June 8-11th in the university of Bucharest Romania.The next one is in september.You can see details in www.handsoncourse.com
Two recent balloon studies are about to be published soon- one on single tooth sinus elevation and the other on "flapless sinus elevation" using the MIAMBE.
membrane tear
My recommendation is to complete a formal oral surgery residency and training. You can not become a surgeon by taking weekend courses. Successful sinus lifts and other surgical procedures requires extensive training that takes years to truly understand how to handle tissues in different circumstances. Team up with a surgeon in your area and work in collaboration. Then enjoy success and happy patients- they deserve it.
implants in paradise or Russo's course
Implants in Paradise in the Dominican Republic is a unique course I took. Dr. Brunner stands over your shouler and talks you through it. He also requires didactic ahead of time.
Also, Dr. John Russo, from Sarasota has that course in Charleston, S.C., in which you do fresh cadaveur dissections. He has a whole team of specialists to answer your questions.
I prefer PRGF from BTI, Spain,instead of PRP, because it eliminates the leukotrienes, and the white and red cells which cause more inflammation. We just use the actual growth factor (clear fluid) from the platelets.
piezo is the key like you said. Sounds like you aren't staying on the bone with your detachment. Your sinus instruments should always be on bone. Never off for a second or you'll tear the membrane. Don't push with the piezo, just remove bone with it.
Whoever said to do the oral surgery residency, etc. was being impractical and arrogant. He probably doesn't remember that a general dentist, Hilt Tatum, taught the OMS how to do the sinus lifts in the beginning.
American Academy of Implant Prosthodontics
The AAIP will meet October 1, 2011 in Care Free, Arizona. This is usually a good meeting!
Sinus lifts
I'm afraid that I have to echo what the OS above stated. It is just not safe, ethical or prudent to experiment on your patients. Have you disclosed to any of your prospective sinus lift patients your near-100% complication rate? I disagree that practice makes perfect when the trail is littered with unhappy, poorly-treated patients. Perhaps we, as a profession, need to reevaluate the value of a weekend course and how that properly trains one to operate at the level of a specialist that has spent years acquiring those skills under the constant scrutiny of others that have already mastered these procedures. The standard of care for specialty procedures is the standard established by the specialists; if you don't get there, you are not practicing at the standard. As a professional you have the duty to do so. I'm an OS and have had two perfs in over 100 lifts, all without piezo or balloons. Not bragging but it's not always a matter of numbers to achieve proficiency. Best of luck and do what you think is right.
sinus lift
If you don't have a formal hospital based training program ( not necessarily OS) where you have done these surgeries with proper supervision, had the opportunity to interact with ENT and learned how to deal with complications then you should not keep trying this. This is not furniture construction. These patients place their trust in you and you basically abuse them, and worse then that, you actually admit to it. The sinus is not a routine place to mess around. I presume you are awaiting a really good complication or a letter from an attorny before reevaluating your training. Good luck
Sinus Lift
If you are having trouble, I suggest that you receive training from Tatum Surgical 888-360-5550. I received my sinus lift training from Hilt Tatum and Joel Rosenlicht. Both are excellent.
SINUS ELEVATION
If I am correct the technic was developed by Dr.Hilt Tatum a GP.
What does having a formal OS Residency has to do with performing Sinus elevation?
Are we to sugest that the procedure should be done by an ENT?
DentalXP.com has Wallace, Mazor, Salama & Lee on Sinus Lifts!
With all the discussions on Sinus and education some of the people we mention most and who have published in the literature are available to view on www.dentalxp.com. They feature Wallace, Mazor, Salama & Lee on Sinus Lifts in particular to this thread. Also, they also offer Hands-on Live programs with Ziv, Salama and Samuel Lee on models and Cadaver programs.
So why are you guys still not posting there???
Sam
Membrane tear
An interessting response was posted by Dr Peter Fairbairn (UK) on an alternative blog site. Dr Farbairn commented on the use of a setting synthetic composite graft (Vital) which supported the lining even when torn.
See http://www.osseonews.com/tore-sinus-membrane/
may be you should get some
may be you should get some fresh goat or sheep head from a butcher and try to elevate the membrane on the heads.
Sinus Lift
Raul, you are correct. The lateral window sinus lift was developed by Dr; O. Hilt Tatum, a GP dentist. Also, Osteogen is an excellent synthetic graft material. I have sent specimens of sites grafted with Osteogen to an academic center. Osteogen turns over to yield 90% lamellar bone. That is as about as good as it gets.
sinus lift
dear sam2493
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et the more visual imformation on YOUTUBE.good luck to you.