Calcium sulfate instead of bone graft materials for Summers Lift?

Use mfdba mixed with clinda encef use prf chunks for cushion Caso4 why!!!! It dissolves in no time. Sam Jain, DMD Center for Implant Dentistry Fremont, CA

The safest route , is to use Dask or SLA systems to enter the sinus crestally then be careful lifting the linning if it is "tight" as you can tear ( maybe a balloon ). As for graft materials I have used Caso4 and BTcp mixed together for a fuuly bio-absorbed material which is esential here to allow long term monitoring. As the Dask type systems use hydrolic pressure to protect the lining any tears become obvious as saline get to places it should not. But it is predictably safe i entering the sinus. Regards Peter

When pushing up the membrane you need a material that has some body to it and calcium sulphate does not. Beta TCP on the other hand does, and it is able to maintain the volume gained by the sinus lift a lot longer than calcium sulphate, which dissappears in about a month. The material is not indicated for a sinus lift unless it is in a mixture.

I thankyou gentleman for your knowledgeable advice and comments...all of which I take on board....will continue learning each day!!

Calcium sulfate (bonebond) should be mixed with another graft material, like puros. Gives the graft an extra ooomph.

Is Puros for grafting resorbable?

I believe Puross is a Xenograft. Xenografts do not resorb!

Puross is an allograft, gentleman. It is mineralized bone. It debates the demineralization process, which in a lot of doctors opinions, was the most important process in the allograft vs autograft argument. I use it on rare occasions and have had good succes with it. Why would you use anything other than bone in your sinus lift? It is safe, predictable and cost effective! Bv. Vinci Oral and Facial Surgery. Baton Rouge, La.

The decision on what type of graft to use is based on whether you plan to simultaneously place an implant or just graft first. If it is a simultaneous procedure, my best results have been using L-PRF. The implant apex tents the membrane and you get better bone more quickly than any other procedure. However, when grafting alone, you must use a graft that will not resorb too quickly or you will lose volume (not PRF alone). Virtually any of the allograft or alloplast products are sufficient. But you must wait considerably longer because you must go through a resorptive phase before bone growth occurs. Calcium sulphate is VERY technique sensitive. If you push unconsolidated CaSO4 into a sinus, it will usually fail to solidify because of bleeding under the membrane. Therefore, you should overgraft the site to account for shrinkage. Also, if you end up with a slurry, there is very little hydraulic force placed on the membrane. You can never be sure of the final position of the membrane from facial to medial wall. In other words, not the best choice. RJM

There is a good paper by Ralf Smeets ( 2009 Head Face medicine ) on sinus augmentation with a CaSo4 and BTcp Product showing the clear benefits of the CaSo4 element . These are as it sets it stabalizes the graft , it is Bacterio-static and can seal the window through this set. Its earlier resorbtion is of benefit as well as it leads to an increased dynamic porosty for further vascular ingrowth and hence improved angio-genesis. Regards Peter

I stand corrected as per Puross.

I agree with most comments about calcium sulfate as a poor graft material. Also why limit the amount of membrane lift with granules that if you perf they will roll around in the sinus and possibly result in infection. We have developed Regen Biocement Flow specifically for this type of hydraulic sinus lift with no need for balloons, granules etc. Greg Steiner Steiner Laboratories

Is Purosss as an allograft resorbable?

I think that in a Summers lift depending on the height required, puros or a cotical-cancellous allograft is fine. It is a matter of size, being able to place the graft to tent the membrane so that the implant won't perforate it. Bear in mind that a membrane will tolerate a 2-3mm perf and be able to grow around the blunt end of the implant. Zygomatic implants tranverse the sinus. Also in a Lefort osteotommy screws transverse the sinus. I think it is a matter of being able to place a longer implant with bone at the tip. I think that membrane perforations can be repaired with a collagen membrane to prevent graft material from becoming entrapped in the sinus lining. I understand the bone cells come from the sinus floor and bone of the sinus including the lateral wall. I usually don't lift that far I place the graft where the end of the implants are in simultanenous lifts. I think that the earlier Pikos techniques go the the lateral wall when the implants are placed later, might as well fill the sinus! I like to mix some xenograft in as a radiographic marker. Also allografts do resorb, become incorporated in new bone and turnover, xenografts hang around forever!! Hope these are helpful tips.

I think you need to do your own research, I will not dispute with you. You seem to have a private agenda and I don't care to get involved. I think this format is to aid clinicians in practical experience not sell your products.

When I perform the Summers Up Lift, I first up fracture the sinus floor restraining the osteotome. I place a small piece of collagen mambrane followed with OsteoGen (approximately 3 to 5 amalgam carriers of OsteoGen). I add in addition to OsteoGen, corticocalncellous bone to aid in the turn over. The OsteoGen is radio opaque at first. I then place the implant. The concave osteotome is beneficial in pushing fluids and bone material up into the sinus while lifting the membrane (Pascal's Law) . Note allografts do resorb to some extent. CaSO4 is ok but why use this when there are better products on the market.

Actually CaSo4 is a way better graft amterial than most reaslise ( it has been used by us since the 80s ) but as said above is technique sensitive. But so is Golf , lets enjoy the Ryder cup. Peter

CaSO4 has been used for some time. I believe orthopedist used it for bone grafting in the late 1800's. Dr. Linkow make reference to it in some of his text (must have for any serious implantologist). Yes, let's enjoy the Ryder Cup! Golf is a most enjoyable game.

Steiner, Please explain to us all how an allograft is NOT resorbable, that's news to me. Osteoclasts remove the material while osteoblast cells follow behind building new bone. Hence, the material acts as a scaffold and is removed

The original post asked about the use of Calcium Sulphate in the sinus. The many responses running off as they are always enoyable, especially for a non clinician or someone without a company bias such as myself. Calcium Sulphate is a bone graft substitute. It is licensed as such in at least 3 continents. It is used widely in ortho today, probably more so than it was in times gone past. Several dental companies have found ways in which Calcium Sulphate can be presented so it sets quickly and more predictably than in its pure phase. With skill a setting time can be tailored to the dentists skill and time/type of procedure. As Dr Fairbairn said Calcium Sulphate is bacteriostatic and its setting will allow a window to be sealed without additinal membranes. A cement will not travel through a tear in the lining like a particulate will which has additonal benefits. Dissolution is related to "flow" so resorption will be quicker when masticatory, saliva or blood are flowing. remove these and resorption can be extended. If bone regeneration is the target then resorption is a great thing. The key is giving the body the right conditions to regenerate new bone at the same time that the scaffold resorbs. We know that loading the implant at placement or soon after if P/S is achieved will accelerate the resorption and remodelling leading to vital new bone in a short time frame such as 12 weeks even in the sinus. Mixing other bone graft materials with Calcium Sulphate prolongs the resorption time and creates a matrix for the calcium ions from the dissolution process to re-precipitate onto and accelerate the differentiation process. Clinicians understandably want to support the product of their choice. Often we see statements that are almost lifted from the marketing catalogue. At a time when most "research" is sponosored it can sometimes be difficult to see through the trees. Robert

Fugazzato has shown case studies of implants placed into maxillary sinuses, using a thin layer of bone at the apex of the osteotomy to lift the sinus membrane. The implants are stable and successful (8-10 years out, I believe). Blood fills the space that the implant maintains, much as a tent pole holds up the tent, and bone fill results.