Development in sinus augmentation techniques in recent years has been remarkable, and practitioners have to work hard to stay ahead of the curve. Various techniques enable clinicians to build a sound foundation for implant treatment among edentulous patients with impressive success rates. Maxillary sinus augmentation procedures have become increasingly popular before placement of dental implants in posterior maxillae that have suffered severe bone loss due to sinus pneumatisation, alveolar bone atrophy, or trauma.
The Association of Dental Implantology (ADI) recently presented a masterclass on the topic, featuring a number of internationally renowned speakers. Expert speakers gave engaging and informative talks about the latest methods for achieving predictable results.
Anatomical considerations to mitigate risk
The event kicked off with a discussion on important anatomical considerations in sinus augmentation. Gabriele Rosano, scientific director at the Academy of Craniofacial Anatomy (ACA), outlined the importance of thorough CBCT scanning to mitigate against potentially damaging delicate adjacent structures. Gabriele discussed the complexities of managing maxillary sinus wall fenestration, pathological membranes not identifiable by CBCT scan, and the importance of identifying septa height. Finally, Gabriele introduced some of the possible complications that must be considered by surgeons due to the extensiveness of the maxillary vascular network.
Predictable reconstruction
Guillermo Escobar Ruiz continued the masterclass with an introduction to the autogenous bone graft workflow. His lecture, ‘Sinus Lift and 3D Bone Reconstruction’, covered rebuilding areas affected by 3D bone atrophy using autologous bone – usually from the mandibular ramus. He specified the proper surgical techniques that result in less autologous bone loss, achieving “fully predictable results”.
State of the art sub crestal sinus augmentation
World-renowned periodontologist, Professor Ziv Mazor, provided historical context of various sinus augmentation techniques, with a particular focus on the benefits of sub-crestal sinus floor elevation. Professor Mazor cited the perforation rate ranges in the literature of the lateral approach to the sinus membrane, to give context for the newer techniques discussed in his lecture.
Since 2014, a revolutionary new concept for osteotomy called osseodensification (OD) has been at the forefront of changes in surgical site preparation in implantology. This process requires trabecular bone, and so instrumentation needed to be rethought to prevent fractures that require long remodelling time and delayed secondary implant stability.
Ziv detailed how OD sinus protocols can result in predictable, reproducible results in any ridge, for any implant in any jaw. He showed how he avoids sinus membrane perforation, as well as retention cysts, and referred to some other anomalous cases where these new protocols reduce risks. He ended his lecture with a call to look out for a new multicentre study coming soon, and highlighted the importance of maintaining a close awareness of clinical research as a practitioner.
Prevention and management of complications
Eminent surgeon Pascal Valentini, is the president of European Association for Osseointegration (2012-2014), and among many other honours, is a is a programme director for European Post Graduate Oral Implantology at the University of Corsica (Corte, France) and for the University of Liege in Belgium. Pascal identified the three main techniques for treating an atrophic maxilla with advice on how to avoid complications.
The palatal approach
Radoslaw Jadach is an internationally renowned expert on microsurgery techniques and extensive soft tissue reconstructive surgery for the purpose of alveolar implantology. He concluded the masterclass with a lecture on the rationale behind palatal approaches to sinus grafts, as well as indications and classifications of use to practitioners.
The ADI is the UK’s independent network for implant dentistry, which connects members to the best minds working in the field today. Through education, mentoring and access to the latest research, members receive support at every stage in their career. Rapid advances in technology and protocols associated with procedures like sinus augmentation, require constant updates to the knowledge and expertise of practitioners. There is no better way to remain current in this complex field than to secure membership of a world[1]class organisation. Doing so not only provides you with access to a network of like-minded and knowledgeable peers, but enables you to remain at the forefront of your practice.