The lost art of the lateral wall sinus augmentation

Dr. Justin Moody explains how to turn lateral wall sinus augmentation from a daunting to a satisfying and supportive procedure for dentists and patients.

Dr. Justin D. Moody discusses reliable and predictable bone growth

Since the beginning of implant dentistry, we have been on a quest to rebuild and restore lost bone from previously extracted molar sites. The mandible presents a greater challenge due to the inferior alveolar nerve position and the difficulty in horizontal/vertical bone grafting. Unlike its lower cousin, the maxillary molar, when lost has the maxillary sinus as a potential grafting site. This area is one of the most reliable and predictable places in the human body to grow bone.

Figures 1-3: 1. Using the ACTEON Piezotome Cube to create the window into the maxillary sinus. 2. Sinus curettes are used to elevate the membrane to create the space for the graft material. 3. Placement of a BioHorizons® dental implant at the same time of sinus grafting

The lateral wall sinus augmentation graft technique was first introduced to us at least 45 years ago by Dr. Hilt Tatum and others. I am sure that he was first viewed as a crazy or cowboy-like, but today the science is clear on its success, and many of today’s leading surgeons perform these procedures routinely, such as Dr. Michael Pikos, who has written an entire textbook on the subject.

Figure 4 (left): CBCT scan taken with the ACTEON X-Mind Prime; Figure 5 (right): AIS software from ACTEON is used to properly treatment plan the case

Dental school would have you believe that if you are ever in the maxillary sinus with a root tip, dental implant, or grafting, your life will end along with the patients’. It is my favorite procedure to do as well as to teach for a number of reasons. First, technically it is not a difficult procedure at all. With the use of piezo technology, such as the Acteon® Piezotome® Cube, the access through the lateral wall and elevation of the membrane can be done safely and predictably. Second, with the use of the patient’s own growth factors obtained from a simple blood draw and the use of the IntraSpin® from BioHorizons®, we can have clinical results that allow for implant placement and ultimately tooth replacement solutions otherwise not possible.

Figure 6 (left): Postoperative CBCT taken with the ACTEON X-Mind Prime; Figure 7 (right): Postoperative CBCT slice using the AIS software to view position of the dental implant as well as graft placement

Adding this procedure to your practice will open up so many more implant sites and the ability to help many more patients. Find a course that offers live surgery training so that you can gain the experience needed to return with the confidence and skill set to serve your patients.

Figure 8: Using BioHorizons IntraSpin machine to harvest the patient’s own growth factors and mixing it with BioHorizons MinerOss® to create “sticky” bone to be placed into the sinus

Read more from Drs. Gregori M. Kurtzman and Douglas F. Dompkowski on lateral wall sinus augmentation in their article, “Lateral sinus augmentation: a safer technique,” here: https://implantpracticeus.com/lateral-sinus-augmentation-a-safer-technique/

Justin D. Moody, DDS, DABOI, DICOI, is a Diplomate in the American Board of Oral Implantology, Diplomate in the International Congress of Oral Implantologists, Honored Fellow, Fellow, and Associate Fellow in the American Academy of Implant Dentistry, and Adjunct Faculty at the University of Nebraska Medical Center. He is an internationally known speaker, founder of the New Horizon Dental Center (nonprofit clinic), and Director of Implant Education for Implant Pathway. You can reach him at justin@justinmoodydds.com.

Disclosure: Dr. Moody has no contract or financial interest in Acteon®.

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