Saturday, 31 January 2015

#Tubuleslive Event: Sinus Augmentation with Dr Alan Sidi

This week saw the return of #Tubuleslive, with Dr Alan Sidi talking about sinus augmentation for implants. Here is a summary of Dr Sidi's talk.

The lateral window technique for sinus augmentation prior to implant placement.


Whilst I can't really apply what I've learnt during this week's #Tubuleslive to my work in practice yet, I can certainly inform those patients who are interested in having implants more of what might be involved if they require such a procedure. 

  • Sinus lifts are one of the most common pre-prosthetic surgical procedures carried out in the UK
  • The maxillary sinus (or antrum) is one of the 4 paranasal sinuses which enlarges with age and growth can be rapid following the loss of posterior teeth
  • Paranasal sinuses are all connected which means that infection originating in one sinus can spread to the others. 
  • The maxillary sinus is a quadrangular pyramid in shape and can vary in size significantly, even extending as anterior as the distal of the lateral incisor
  • Some vital structures associated with the maxillary sinus include the facial artery and nerve, internal maxillary artery and the sub-orbital nerve
  • Maxillary sinuses sometimes contain septa, which although they look like spikes on DPTs, are actually walls running that divide the sinus
  • The sinus membrane is very elastic and thin (although this can vary), and can thicken on response to chronic irritation e.g. sinusitis, chronic periapical infection of maxillary molars
  • Pathology of the maxillary sinuses include tumours e.g. ameloblastoma, or more commonly sinusitis
  • Sinusitis is caused by a chronic irritant and can be viral, bacterial or fungal in origin.
  • Contra-indications to sinus augmentation include: radiotherapy patients, drug addicts, smokers, presence of an oral-antral fistula, complex medical histories
  • Patient suitability must be assessed in several ways:
       1. Clinically e.g. perio status, vertical height available, assessment of posterior support, current prostheses
       2. Imaging  - DPT, intra-orals and CAT scans 
  • CAT scans can assess the thickness of the buccal walls as well as the width and height of the alveolar crest, the presence of teeth, roots or septa. 
  • There are 2 principle sinus augmentation techniques: INTERNAL LIFT or LATERAL WINDOW
  • Dr Sidi mainly performs the lateral window technique as he feels it is more predictable
  • Once the sinus lift is performed, implants can be placed simultaneously (there must be 5-8mm of existing bone) or delayed (up to 12 months after surgery)
  • The lateral window technique involves raising a 3-sided mucoperiosteal flap, performing a window osteotomy in the buccal wall, elevating the sinus membrane, packing the exposed cavity with a bone graft e.g. BioOss
  • A major complication during the surgery is the tearing the sinus membrane, which is more likely to happen in thickened membranes or those sinuses with septa
  • If a tear happens, the bone graft may escape into the sinus and then become infected and therefore cause the bone graft to fail
  • Tears can be managed with collagen membranes, sutures or with a collagen sock (a tube made from the collagen membrane stuffed with bone graft)
  • Post-operative complications following the surgery include swelling and bruising as well as nosebleeds, infections and oral-antral fistula (especially if there is a tear in the flap).
  • Patients are advised not to bend over, blow their nose or play sports for 1 week following the surgery to minimise the risk of nosebleeds and infections. 

I've hope you've found the summary useful and many thanks to Dr Sidi for such as charismatic presentation and well done to the new members of the #Tubuleslive team for delivering such as successful first event of 2015.

To see a previous post about the role of dental implants in practice see here

The next #Tubuleslive event will be next week the 5th of January where I will be hosting my first event: CEREC integration in practice with Dr Colin Campbell.

Why not attend the live audience where you can get FREE CPD! Register online and I hope to see you there!


Have you had experience performing sinus augmentation in practice? Please comment in the section below!

To see my other posts about previous #TubulesLive events see here


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