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Dental Tribune U.S. Edition | November 2012 A19 Safe, accurate, simplified sinus lift technique for general practitioners In 1974 Dr. Hilt Tatum Jr. performed the first sinus lift in the world. His technique became known as the “lateral window” approach and has been mastered by oral surgeons, periodontist and trained general practitioners. Twenty years later, in 1994 Dr. R. Sum- mers introduced a less invasive sinus lift technique that did not require opening a lateral window and could be easily learned by general practitioners. This technique quickly became popular, known as the “Summers osteotomes intracrestal sinus lift” technique. In the next decade, many prominent clinicians, such as Jaime Loza- da, Eduardo Anitua, Leon Chen and others have developed variations of the Summers crestal lift and proved scientifically the va- lidity of this technique. As a result we can nowperformacrestalliftusingtheballoon approach lift, drilling systems by various implant manufacturers and hydraulic si- nus condensing technique. Thepurposeofthisarticleistointroduce an innovative sinus lift that can be mas- tered by the general practitioner in a safe, predictable and simple manner. This technique utilizes a crestal sinus ap- proach (CAS kit by Hiossen, Philadelphia) (Fig. 1). The specific indication for the CAS lift is when a patient has 4 mm to 7 mm of residual (Fig. 2). It is important to point out that patients with more atrophic ridges with 3 mm or less must be treated with a lateral window technique. The CAS lift uses Dr. Anitua's biological drillingprotocolof50RPMandspecialCAS drills designed to push (not cut) the sinus (Fig. 3). The initial drilling sequence is done INDUSTRY NEWS Part 1: Crestal sinus approach innovation By virgilio Mongalo, DMD 2 mm short of the sinus and verified radio- graphically. The length of the CAS drill is increased until the cortex of the sinus floor is broken (Fig. 4). At this point, we stop drilling and use a 3 cc syringe filled with saline fluid, which is injected slowly over a period of three minutes; each cc of saline will elevate 1 mm of sinus membrane. The saline cre- ateshydraulicinternalpressurethatcauses the membrane to lift without the need of curettes, thus creating a safe, simple and accurate technique. This technique has proven to reduce the percentage of sinus perforations. The ob- jective is to safely lift 3 mm to 5 mm. Once this objective is accomplished, we pack the site with 0.5 cc of synthetic bone (Osteo- gen by Impladent). Figure 5 shows a lift on the site where the implant will be placed. vIrGILIo MonGALo, DMD, is a general practitioner in private practice exclusive to implant dentistry in South Florida since 1991. He is a pioneer in the field of implant education, introducing live surgical courses to U.S. dentists. He is an associate profes- sor of implant surgeries at Georgia Health Science University, department of oral maxillofacial sur- gery. For more information on the Mongalo Im- plant Institute and live implant surgery courses, visit www.liveimplants.com. Fig. 1: Crestal sinus approach kit by Hiossen. Photos/Provided by Dr. Virgilio Mongalo Fig. 2: Specific indication for CAS lift is when a patient has 4 mm to 7 mm of residual. Fig. 3: Biological drilling protocol of 50 RPM with special CAS drills that push the sinus. Fig. 4: Length of the CAS drill is increased until the cortex of the sinus floor is broken. Fig. 5: Lift on the site where the implant will be placed. Fig. 6: Now able to place a taper 4 mm x 10 mm implant. Now we are able to place a taper 4 mm x 10 mm implant (Hiossen, USA) (Fig. 6). Most research studies have shown that elevat- ing the membranes past the 10 mm mark increases the chances of sinus perforations. A retrospective study is being performed by myself and Dr. Jae W. Chang, analyzing 250 intracrestal hydraulic lifts that were performed by general dentists from the United States in seven-day, intensive, live- surgical training. The dentists learned innovative implant techniques while operating on patients under direct supervision of board certi- fied oral and maxillofacial surgeons who are professors at Georgia Health Science University. The study's initial result are in- teresting in that we are seeing less than 5 percent of sinus lift perforations using this technique. Studies performed by Univer- sity of Michigan and Loma Linda implant departments show 10 to 20 percent of per- forations using other proven techniques. Editorial note: Dr. Mongalo is developing a computer-guided hydraulic lift that will be the focus of Part 2 of this article, to be pub- lished in an upcoming edition of Dental Tri- bune U.S. Advances in teeth whitening By William Simon, DMD Dentistry’s primary con- cerns are establishing and maintaining optimal patient oral health. Our responsibilities include identification and control of disease, patient education, clinical and ra- diographicexamination,healthandfamily history evaluations, risk factors, bacterial identification and a constellation of treat- ment modalities. How does whitening fit into our professional responsibilities? The ADA refers to in-office whitening as “pro- fessionally applied whitening” where the higher concentration of gels are used for shorter periods of time, and preferred by patients who want results immediately. Patients who prefer same day in-office w h it e n i n g are being treated with light-activat- ed whitening gels of varying concentrations. A body of research has demonstrated the efficacy of a supplementar y light source; some studies demonstrated enhanced whitening with light sources, but indicated the importance of shade guides to measure changes in tooth color.1 Other studies have demonstrated improvement in whitening outcomes of 35–48 percent measured by spectrophotometer and vi- sual methods, compared with non-light activated whitening gels. The safety of light-activated whitening gels is of primary importance. Philips Zoom gel has a pH of 8.0, which does not demineralize teeth. It provides faster diffusion through enamel and dentin, hastening the whitening reac- tion.Deleteriouseffectsonenamelandden- tinreportedinsomestudiesmayhavebeen due to the acidic pH level of the in-office gels in the study.2 There have also been con- WILLIAM SIMon, DMD, is a general den- tist with two practices in Chicago. He received his doctor of dental medicine degree from Southern Illinois University in 1983 and has lectured and consulted on various topics that relate to the pri- vate practice of dentistry. Fig. 1: Philips Zoom WhiteSpeed Photo/Provided by Philips ” See WHITENING, page A20 Philips Zoom WhiteSpeed has variable intensity settings to maximize sensitivity management GNYDM BOOTH NO. 3600 cerns regarding the safety of light-activated in-office whitening treatments on dental materials. Studies have shown the use of high concentrations of hydrogen peroxide do not affect the surface finish or hardness of restorations.3,4 Early whitening preparations created high incidences of sensitivity — in some