Module 4: Sinus Augmentations

Added: 2026-05-15

[00:00:11]now what we're going to look at is sinus augmentation a lot is said about sinus augmentation i learned initially about 25 years ago lateral windows from my mentor who had been doing them in the mid-80s early 80s so it's been around with us for a long time and it's a very consistent very stable procedure initially conducted by hill tatum in in the early days but preferably it's important to learn about a lateral window access mainly because if you need to remove a root or an implant you need to be able to access the sinus from the lateral window i know there's a lot of newer techniques and i will show those being used with certain materials and certain protocols and certain tools we can do more crystal approaches now which generally mean less a surgery and also can lead to less post-operative swelling rather than making a lateral window but for the last 10 years i've used desk a lateral window for latch window access and it makes it consistent safe i think in 10 years i do one maybe two a week um i think i've torn probably three to four times that the lining is torn so it's very consistent very predictable very safe once you learn the techniques so this is you know a lot's changed since when i first started when i first started zoom sinus augmentation i used to sit on the edge of my chair with anxiety materials and protocols have changed this a lot and the materials that i feel have changed have been the synthetics and have been the materials like ethos especially ethos which is osteoinductive at turning over to host bone because this material also being biocompatible leads to reduced swelling and reduce pain in the sinus as well as if there's a small tear in the sinus it doesn't really matter that much the material stable it tends to stay in one place and the the lining just heals over the site we've done about 20 cases like that so essentially yes i'm using a lot less lateral windows than i used to because i'm developing my skills more using versa and internal lift techniques it's important to be able to do it just if you need it in emergency even one thing to watch out for watch out for a very well defined archery in the lateral wall you can get a bleed and if you do don't panic just deal with it using pressure so the case i'm going to sort of show here really is why the benefit of ethos over other materials you know it's well recorded that literally anything will work from prf to and even some people say nothing will work but i prefer to place something into a give a scaffold and b help help the host regenerate so but anything will work in the sinus it's just an ideal environment for bone regeneration when we actually are using a material that doesn't resolve say for example an aha or a xenograft we will get a better picture but we have considerably less bone the systematic reviews uh the most extensive one done in jeremy behold hominy chan suggests up to 40 percent less host bone so is the great picture an important aspect no i don't think so i want a true picture i want to know exactly really what is going on what i see must tell a good story the other good thing about using ethos is multi-factorial so we're not just grafting the sinus we're actually going to be we can use it to raise the platform so we've got a better platform we can graft adjacent teeth it seals the windows so what we can do is get the material to help us do many functions not just doing the sinus augmentation and that shows in this case in this video we're going to show and here we we've lost a lot of bone the sinus is right on the implant so we've got two millimeters of residual bone we've got a mobile tooth distal so we're going to stabilize the mobile teeth we're going to fix up defects we're going to do the sinus and we're going to do it all in one 20 30 minute procedure this is the benefits of using ethos in these situations so it allows me to merely clean the site raise the flap place the implant graft using ethos graft up against the adjacent tooth grafting through the lateral window and load it at nine weeks the other benefit as we see in all our cases that we get an improved keratinized attached keratinized soft tissue without doing any free gingival grafting so again this is an another benefit of the materials of helping regenerate host bone letting the host deal with the soft tissue itself and in this particular case we can see that we've got a nice keratinized cuff without doing any free gingival grafting case is loaded four years now and has got very good stability very good uh hard and soft tissue both in the sinus and up against the adjacent tooth which was periodontally involved so the whole idea is to not place the implant all the way in but to leave the implant two three threads out so that we can grow the bone vertically because an important aspect is not just regeneration of the implant it's raising the platform so that you have a good sized tooth you don't have a massive big molar because we want to get a level platform and that's just as important and also we want that soft tissue to improve so that we don't have pre-implantation so we don't have issues in the future because we've got nice attached keratinized tissue and the slides that we'll show will show how we routinely do this by raising the platform so we're growing vertical on the maxilla as the same time as we're grafting into the sinus and that can be taken even further so the case we will show this is where we had a recent extraction and i went to place the implants into the sinus and graft but there was only one millimeter of residual bone and while i was just placing a pilot i went into the sinus so i soccer grafted and just left the case for 10 weeks now i came back and as you could see in 10 weeks time we had six seven millimeters of high quality new host bone and this is important because this then allows me to use an internal technique because now i have enough bone to a get stability and b to be able to drive the bone and further graft material in using whatever technique you know whatever tool i want to use whether it be the desk internal or the verso which i'm using more and more of when we looked at the case after 10 weeks there was very good keratinized attached tissue as well and when we raised the flap we could see the quality of the bone the bone was very high quality very little residual graft material so this allowed me to use versa when we're using versa in ethos you must make a very dry mix and you just use a spatula or use the syringe to place it in the site and then just using the versa drive it in i i like using 150 in reverse some people like to use a little less but again it's important to make a slightly drier mix and then the great thing about is after placing the implant you can then grow help the host grow the bone vertical for a better platform and again so we don't put the implant all the way in we leave one or two threads out so that we can grow vertically to attain this improved platform as well and you can see in this particular case we've done that again the case was then loaded with a screw retained crown and always satisfactory so we've taken from a socket graft to being able to have enough bone to get very good primary and be able to use an internal systems and here it is loaded at two years and again you can see now we've got no residual graft you can see the great soft tissue the great keratinized tissue and you can see the new cortical plate where we've lifted the bone up internally as well as the new vertical growth of bone so this is going to be a really good long term stable procedure done very easily yes over two procedures because the lack of host bone prevented me placing the implant another thing whenever we're placing implants using a lateral window i think it's always best or i always try and actually get the placement of the implant at the time because what we're doing is effectively helping the host regenerate its own bone but the forces the pneumatic forces in the sinus can be very high and these forces can remodel the bone and this is why it's important to get the implants in at the same time of grafting if you possibly can yes if you do it the other way it will be fine but you may lose some volume but what you're gaining is bone quality and bone quality is something as dentists tend to ignore because we look at everything in radiographic images as something being radio opaque but it's important to have high bone quality because in the sinus this bone is constantly going to be turning over far better to not have any residual particles as i say greater picture but i think it's better not to have any residual material so these are my thoughts on sinus augmentation and i i do think that especially in the sinus it's nice to not have foreign material i've had a lot of cases come back with long-term issues involving residual graft materials somehow being left in the sinus or floating loose and this can create a lot of problems and i use an ent for this sometimes we have to get bits and pieces out of the through the osteum but the benefits of having a material that just upregulates the host healing turns over to bone but can be used to actually help the host regenerate vertically as well at the same time to get a better restorative platform is just an absolute benefit so this is why we were very very happy with the outcomes with sinus augmentation and ethos you