Bilateral sinus lifts with Bio-Oss?

I would be curious to know how things look sagitally and how much height was created. 8 mm long implants or even a little osteotome may work if necessary.

In my opinion the graft should be corrected by moving it apically with an horizontal osteotomy in order to prevent membrane tearing

Maybe refer this one to someone who uses xenografts routinely as there are and the graft may be interesting . When using a Xenograft if you get 15 % host bone it is a good case I like materials that turn over so I can assess the case more clearly especially long term .... But the is a lot of cases done well with them . Peter

Sorry no edit facility and somehow first line did not come out as expected ....so maybe refer as xenografts have differing handling characteristics and moving the graft may be difficult was what I meant .. Regards

I think that if this graft is just Bio OSS it will be "grainy " not enough bone to allow an implant to osteointegrate.The sinus is not the problem but the quality of the bone is. An implant is a foreign body as is a xenograft.. I recommend a mix of the patient's own growth factors and an allograft. I use A very small amount of Bio OSS as a radio graphic marker. Prudent use of grafting materials is key Bio OSS along with everything else has its indications. In this case it would be helpful to revise the graft by re-entering, remove most of the Bio OSS and replace with some particulate with pgrf that's how I fix these, the sinus is already lifted it's the base bone which is suspect. Good discussion not one size fits all.

I completely agree. Judging by the radio opacity appearance of the graft, I suspect the bone quality will be poor and I would not feel comfortable for an implant to osseointegrate.

What makes you think it's Bio-oss? There are many other xenografts on the market which are both bovine and equine. Non have the research Bio-OSS has, especially in the sinus. It's been shown to have the best implant survival rate of any material in the sinus http://www.geistlich-na.com/fileadmin/content/Geistlich_USA/Documents/PDFs/Miscellaneous/Aghaloo-Moy-Summary-GBO.pdf I use it solely in the sinus and I've never had a failure. Maybe you should find out what the material is for sure and then make your decision on how to treat.

Why BioOss? It's toxic and does not resorb. It forms sclerotic bone. I would remove it and graft with a combination of PRP and OsteoGen or straight PRP/PRF. I just don't get it about the desire to use BioOss.

Bio oss does not resorb?

BioOss is widely use because it is heavily plugged by the manufacturers. I use it myself in selected cases but I suspect it has a much higher complication rate than the makers admit - partly because surgeons as a tribe seldom report their failures and there is no independent auditing of outcomes in the implant field. It is beguiling stuff because on x-ray it usually looks like normal bone and we delude ourselves it is bone. I suspect the lumps of gubbins this man has in his sinus floors are fine (0.25-1.0mm) granules which have become compacted down into an avascular lump with no normal bone ingrowth. One might as well have shovelled some sand into the site. We used to get the same problem when we used hydroxylapatite granules in a vain attempt to augment flat mandibular ridges in the early days of preprosthetic surgery. Anyone remember Proplast? This was the answer to a maiden's prayer in the maxillofacial world for zygomatic implants, orbital floor reconstruction, TMJ surgery,etc. The manufacturers could show you wonderful pictures showing amazing new bone and soft tissue growth into the interstices of this sponge like material in experimental animals. Did it work in real life? Not a hope - it became encapsulated with no evidence whatever of ingrowth, eventually became infected and had to be removed. Thankfully it has now been withdrawn from the market. I suspect a lot of the materials (and implant designs) promoted in the implant world would be withdrawn if their failure rate was properly audited.