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28 Dental Tribune Middle East & Africa Edition | January-February 2016 implant tribune > Page 29 Sinus Lift. Don’t Dream It: Do It! ByDr.DominiqueCaron,UAE D o you know you are about to perform your- self your next sinus lift procedure? Once it is done, you will wonder why you have been waiting for so long. The issue that often fails is: one, two, three teeth missing, framed by no tooth, weak teeth, living teeth… What is the best option to be ethical and efficient? First option: a bridge. It means to damage several teeth, to do root canal treatments , to over- load several roots, as well, the pontics are hard to clean, and the cosmetic effect is not al- ways perfect… Never forget: PRIMUM NON NOCERE! First don’t harm! The smart way, of course, is to do implants: you will fix the problem where the problem is, without damaging the neigh- bors. This solution would be nice except that it cannot work like this. The sinus may “disagree” and will have no strength. What you dream of is that: “strong implants fit into a strong support”. Simple, except that you never did it! If you are ethical: - You will leave the bridge to stone age - You will manage to have the implants done in the best con- ditions. To do so you can subcontract the implants surgical step with a colleague who knows how to do it, it is safe and professional, but who can you fully trust? However, if you feel there is nothing beyond you and that you have learned, that you have been on training courses, you will need to take the plunge! I don’t know if you feel the same but during a lecture ev- erything seems easy, quick, simple, It is like magic! But now that you are alone without safety net, you don’t know where to begin. It is time for you to become your own specialist. All this is first a matter of state of mind: YES YOU CAN! Yes, all what we have to do in this dental case is simple: it is a matter of screw and plank. If you can assemble an IKEA cupboard, you can do implants. You should never lose the sight that what we do on every day basis is a matter of building and civil engineering works. It is just at a very smaller scale. Nevertheless, we have the same constraints and an addi- tional foe “the bacteria”. Don’t lose your common sense, consider the stair case step by step and “THINK SIMPLE”. You don’t have a plank thick enough for your screw, add a back plate! The idea is the same, may be some more de- tails to take into account, and the support is a living body you are supposed to “keep alive”… it is appreciated. (Joke) This must not scare you. It is a logical process and we will go through together step by step and in fifteen minutes, you will wonder why you never did it earlier. Go simply step by step: 1. Study the case with an accu- rate 3D image. 2. Open the way 3. Raise the “schneiderian membrane” 4. Fill the new empty space with the graft. 5. Set the implants through the bone and the graft 6. Cover the window 7. Stitch well 8. Have a coffee with the pa- tient 1. Study the Case Before going onto holidays, you are studding the place you will go, don’t you? Well it’s the same for any surgery. You need to know precisely the area you will drill. The first thing you need to know is what to avoid and what to keep safe: don’t play with the main arter- ies and nerves, they have “no sense of humor” and they don’t tolerate approximation. The second thing to know is where and how to drill and which im- plant to set. When you don’t have to focus on the tools, you can pay atten- tion to what you do. You don’t drive well if you look at the dashboard and not at the road. Good artist needs good tools to do a good job. What are the imaging tools matching with the needs? The most common is CT scan, easy to find but you will get many raw slides and you build the 3D in your mind. Keep this to the Stone Age due to the huge rate of radiation. The most accurate and safe in the market is the cone beam system. With a Cone Beam, you have: - Safety: 70 to 100 times less radiations than with a CT scan. - Accuracy: the image is much more detailed and you can navigate in 3D to lookout for the exact information you need. Then you will be able to set virtually your implants to stick perfectly with the needs. 2. Open the way You should always keep in mind that you are working on living tissues. Those you will open will have to be closed. “The best way you cut, the best way you will stitch”. On the crest, don’t stay exactly in the middle, but little on the palatal side. The buccal flap will protect the implants more efficiently. Extend your inci- sion at least one tooth front and one tooth back to have an easy access without a long vertical incision. Make sure the incisions will not be close to the graft. You need to see easily what you are doing, it is a priority. The more you peel off the gums, the less you cut, the better your patient will heal. So you should always be smooth! Detach the gums on 2-3 mm palatal side to stitch it easily later... Make the vertical incision on the distal side! A French friend of mine gave me the idea years ago and I practice that tech- nique since. You have then no issue with the blood supply be- cause it is coming from the top which means less inflamma- tion, a better cleaning, a bet- ter protection, and a quicker healing.