today GNYDM 25 Nov

exhibitors20 Greater New York Dental Meeting — Nov. 25, 2012 AD By Andrew Kelly, DDS n When Dr. O. Hilt Tatum performed his sinus lift technique in 1975, I wonder if he had any idea of how it would evolve or the controversies that would surround this procedure. I can say there exist as many tech- niques as there are opinions on how the procedure should be performed and who should perform it. A sinus lift is a surgery that adds bone to the maxilla in the area of the molars and premolars. It’s sometimes called a sinus augmentation. The bone is added between the floor of the maxillary sinus and the Schnei- derian membrane. To make room for the bone, the sinus membrane has to be moved upward, or “lifted.” Any dentist who is trained to do it can do a sinus lift. Tatum, the originator of the procedure, is a general dentist. There are two basic methods for performing the sinus lift technique. The first is the Lateral window tech- nique, which Boyne described in 1960. Boyne used the procedure to achieve an optimal intercrestal dis- tance needed for denture making. The sinus lift techniques have undergone numerous modifications through the years. In 1975, Tatum was the first to perform the lateral window technique in conjunction with autogenous bone grafting for the purpose of placing dental implants in the newly formed bone. Although the lateral window technique is highly invasive, it is a necessary procedure. In 1994, Summers, in pursuit of a less invasive method, made the surgical protocol easier by offering the crestal approach or osteotome technique. Initially, the osteotome technique was used for compressing the soft maxillary bone to improve primary stability of implants and to increase successratesofimplantsplacedinthe posterior maxilla. After a period of success using the technique for bone compression, Summers started floor dilatation of the sinus, thus increas- ing the length of his implants. When the osteotome technique was first introduced, there were two significant disadvantages that lim- ited its indications. The first was the limited height that the sinus could be raised. Initially, Summers was able to lift the membrane 1–3 mms. The second limitation was the inability to directly visualize the membrane. The technique was ini- tially performed with convex oste- otomes by using the sinus floor to lift the membrane. After the membrane was lifted, bone-grafting material wasthenusedtohydraulicallyliftthe Schneiderian membrane. Today, using modern technologies such as piezoelectric units and bal- loons,aswellascrestalapproachkits, which use saline, we are now able to achieve height gains that rival those of the lateral window technique, with little concern for membrane perfora- tion. So where are we today? Very few practitioners, including Tatum, routinely use autogenous bone for sinus augmentation. One of the main reasons is there are several excellent alternative bone-grafting materials available that don’t require a second- ary surgical site and provide very similar results to autogenous bone. So one question that is being asked a lot lately is: Is autogenous bone the “gold standard”? The jury is still out, but thereisalotofevidenceouttherethat suggests it is not. Only time will tell. The lateral window technique is beingusedmoresparinglythesedays. There are several methods available that have allowed us to effectively raise the Schneiderian membrane 5–7 mms or more and place the implant simultaneously, as long as we have enough crestal bone to get primary stability. This technique is safer for the patient, and it reduces the chance an infection will occur. Lastly, with the evolution of safer and more predictable sinus lift meth- ods, more dentists are able to success- fully perform the procedure, which allowsmorepatientstohaveimplants in the posterior maxilla. Implant dentistry requires the practitionertopossessawiderangeof skills. As technology improves, it will open the door to a wider dissemina- tion of implant dentistry into our soci- ety and help to increase the quality of life for many patients who need our help. Technology will never replace knowledge and skill; however, it can and will lower the learning curve and helpmorepractitionersprovidestate- of-the-art services to their patients. The evolution of sinus lift techniques Contact To attend an educational seminar by Andrew Kelly, DDS, visit www. dentalofficesolutions.com.