Graft Material in Sinus during Sinus Lift: Requires Intervention?
Here is a the situation: Graft material is inadvertently pushed into the maxillary sinus because a perforation in the sinus membrane that was not detected during a Summer’s internal lift. Will this cause any complications that require intervention? What is the best way to manage this situation?
21 Comments on Graft Material in Sinus during Sinus Lift: Requires Intervention?
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PeterFairbairn
8/25/2015
A good reason to use a material that is fully bio-absorbed or PRF .....
Ron
8/25/2015
What was the graft material and how much was pushed into the sinus?
John T
8/25/2015
Any x-rays?
DrG
8/25/2015
What did they tell you in your post graduate residency program? I'm sure that your literature review during your 3-5 years of surgical rotations more than equipped you to answer this question. Oh wait, they didn't go over that in the weekend course at the Marriott?
Why do dentists without proper training do procedures they are comfortable with?
Wingman
8/25/2015
Wow remember pride goeth before a fall and there are many excellent implant surgeons out there that did not require 3-5 years of training to a grasp on placing implants, in fact I've seen some less trained do better than the so called trained experts. Please remember somthing unusual could happen in you hands that may require advice. If you don't have somthing positive to say, don't say it!
DrG
8/26/2015
Wingman you are correct. Pride is a dangerous thing, and so is greed . Think this question through, doesn't it concern you? It's a very basic concern. And the accurate answer lies in understanding the basic mechanism of the maxillary sinus.
We are not mechanics, we are surgeons. We need to think like doctors. We need to understand the concept of do no harm. We need to care enough about other human beings to follow traditional patterns of education to learn our trade, not online chat rooms. What if you found out your oncologist was having a discussion about which chemo regimen does the group online "feel" works best for melanoma. All along skipping his required yearly continuing education at the university level?
Once in awhile I post thiat same response when I come across a question so basic that it frightens me to think this doctor is drilling into a persons skull with such a lack of knowledge.
Yes there are non formally trained dentists out there who are better at placing implants than some surgeons. But that doesn't justify the first 50 patients that dentist learned on in his or her private practice at full fee without their knowledge of their lack of training.
VR
9/1/2015
Everyone must learn from errors. That's why even oral surgeons go through residencies: You work, learn, ask questions and get better. No one is perfect. So perhaps you could just help or keep quiet. The former would assist this dentist and others in learning; always to get better and help others!
DrG
9/1/2015
"That’s why even oral surgeons go through residencies: You work, learn, ask questions and get better."
Your words.
Here's my concern, when a patient sees a resident they understand that doctor is learning. When a patient sees a doctor in private practice they assume the doctor has had ample opportunity to learn, ask questions and get better.
When an untrained doctor practices with the basic understanding of the clearing mechanism of the maxillary sinus it weakens our credibility as a profession.
My advice for this doctor is stop doing things he or she doesn't understand. BTW the same doctor mentions that's why they use PRF instead of graft, PRF can block the ostium as easily or worse that granular graft material. Again a poor understanding of the basic anatomy of the maxillary sinus.
Dr B
8/25/2015
Dr G is a lot of help...NOT
arjumand
8/25/2015
Dear Doctors, Thank you for your comments. Such a situation has not occured yet as I use PRF for crestal sinus lifts. But this is a thought and I was hoping that expert doctors on this group would share their knowledge and experience.
andrew
8/26/2015
That is the reason why I never use grafts in my internal lift cases. I just tent the sinus up with the implant apex and the body fills in the space with bone from the blood clot. Has worked for me every time. Why do people use grafts in internal lifts anyway ......... studies show even with graft material covering implant apex initially sinus floor will over time lower to implant apex level. My 2 cents.
CRS
8/28/2015
In my experience some of the nicest bone grafts are the ones associated with sinus lifts. I use the anatomy to decide which technique to use for the easiest access. There is a point to knowing how to manage the clinical complications and understanding sinus anatomy and physiology. This simply is not covered in a weekend course usually an OMS residency ie Caudwell- luc. I think it is funny that perio developed the sinus lift tech I learn a lot from my perio colleagues and dental colleagues. I think it boils down to knowing ones skill set and limitations heck I refer to my ENT colleagues when I am unsure. Now if the sinus can clear the foreign body and the osteum is not blocked it will be fine. Sinus precautions, decongestants and antibiotics. I don't remember the clearing time 24 hours? If the graft gets caught in the lining it will most likely resorb or form some bone. I think the point of the graft is to provide more bone support and allow a longer implant to be used. Unfortunately clever techniques and materials don't make up for judgement and skill, know your limitations.
m cabianca
9/1/2015
"Before casting stone look in the mirror"
m cabianca
9/1/2015
One must also understand that some of the dentists that post their questions/problems live in countries where hands on advanced training is difficult to access or not available.
So one must offer assistance when asked.
There are no dumb questions only dumb answers.
Would you tell a person in a car accident why did you not take a deffensive driving course?
pascal valentini
9/2/2015
First you should check the sinus with a cone beam. In case some granules remained blocked within the osmium refer the patient to the net in order for him to perform an antrostomy . If there are no granules within the osmium they have been eliminated through the nose. Nothing to do
Raul Mena
9/2/2015
Dear Dr. (Graft in the Sinus)
I belong to other implant forums, and the purpose of a forum like this is to learn and exchange ideas from each other’s.
Your question is a valid question so don’t be intimidated by a Punitive, Arrogant and out place judgmental response.
There is no need to spend 4 or more years in OMS training to be competent in performing Sinus Grafting.
As a matter of fact the developer of the Sinus Grafting technic was a General Practitioner.
I have trained many GP’S and Specialists in the procedure and it can be properly and safely performed by any well trained Dentist in the subject.
What you are experiencing is an arrogant turf war response to your question.
There is no difference between training on a poor patient than on a paying patient, both need to be treated equally. As a matter of fact I wonder if those first 50 patients that the doctor trained in his residency knew the purpose of the procedure or had the choice of being treated in a private office. Going a step further, were those 50 patients treated by the almighty resident properly rehabilitated with fixed bridges or they felt through the cracks? Maybe they were abandoned since they had no money to pay for the prosthesis.
Let’s all be humble and try to share knowledge for the benefit of each other, the patients and out of respect to our profession.
Such attack to a colleague only exposes the mental component of an individual. God help the referring doctors.
Dr. CRS my previous comments are not directed to you at all, but a point of order regarding your posting that perio developed the Sinus Lift tech. is in order.
Sinus Elevation was developed by a General Dentist (Dr. Hilt Tatum) way before periodontists were even placing implants.
Raul R. Mena DMD
DrG
9/3/2015
Dr Mena,
This is not a turf war issue. I practice 5 days/week and place close to 1000 implants a year. What this discussion has become is an ethics issue. Have you ever heard the expression, "jack of all trades master of none"?
Dentistry has evolved to the point where it is finally getting the respect of our medical colleagues. When a poorly trained or let's say lightly trained dentist chooses to "try" implants or sinus grafting on a patient in their practice it impacts our credibility as a profession.
I'm glad you brought up Dr Tatum. In his day specialties were in their infancy. It was typical that general dentists performed these procedures because there were very few specialty residency programs, as well they were nowhere at the level of organization or training there is today. Dr Tatum was a pioneer in dentistry, he would be appalled to know a dentist was trying out the procedure he developed without understanding the mechanism of how a sinus clears a foreign body.
As a group we need to answer the deeper question, what are the minimal requirements needed a doctor should meet for training to place an implant?
Raul Mena
9/3/2015
Dr. G,
Thanks for a polite response,
Each one is entitle to an opinion as to the way dentistry should practice.
When you mention that as a group we need to answer the deeper question, what are the minimal requirements needed a doctor should meet for training to place an implant?
I agree that there should meet a minimal requirement to place and restore implants.
Were we disagree is that being a specialist provides the ideal training to place and restore implants.
In my opinion an Implantologist should be able to do both phases of Implantology the surgical and the prosthetic or at least have full knowledge of both.
I have high respect for OMS and many are friends of mine, that does not make them more qualified in Implantology that a Periodontist or a General Practitioner.
Over the years I have seen good and bad Implantology done by specialists and Gps.
It is my opinion that as a profession, we should strive to provide the best treatment available to our patients and adhere to practical, fair and safe standard of care.
Raul
PeterFairbairn
9/4/2015
Yes I remember when I started placing Implants very few or no specialists where involved , in fact a few OMS friends referred them to me as they were not really interested in them . They had more complex issues to deal with .
As for sinus augmentation all the dentists doing them then that I remember were all GDPs like Hilt .
Even today often if you ask an ENT about augmentation they are oblivious to the fact that Dentists are even doing it .
Implantology is a restorative arena with a little surgery needed .
Peter
naileshgandhi
9/8/2015
I believe that before attempting certain specialised work one must learn intricacies as much as one can.I have learned under Dr Tatum the sinus technique.I know he teaches in such a great length that after attending you realise it is most necessary to learn before attempting sinus cases.
mark lubitz
9/8/2015
Prob will be just fine if you do nothing, just let patient know, it happens.
