Lateral window sinus graft: preferences?

The protocol I stated is what I currently do in my practice, in fact 4 sinuses in the past week. Is there something you can cite to contradict anything I’ve written? The literature supports my protocol. PRF used in sinus grafting has plenty of citations. Allograft and xenograft are also well documented. Wallace has multiple papers on the use of bovine xenograft, along with the suggestion for collagen membrane when using xenograft particulate to prevent soft tissue invagination. Personally, I see the same problem with allograft. Particle size is my personal preference for handling. PRF exudate may lack scientific basis, but is not harmful, and contains growth factors which can’t hurt. Adding IV antibiotic with anaerobic coverage is mentioned by Choukroun, et al. Deep apical mattress suture is a mechanical alternative to bone tacks. Hope this helps.

What’s wrong with cook books? Also, are you accusing me of proclaiming to be a guru?

Cook Book? I was one of Carl Misch's grads. He might have not known it all but he was the worlds formost authority. His program was like post grad only without the daily insult and demeanor. By the way that method does work!

Agree.. thank you. If it weren’t for dr Misch 90% of us would not be placing today and another 5% would be causing harm.

I agree with your general premise, however, most of our colleagues will always be better clinicians than scientists. While I would love to see doctors opening more books than flaps, this is just not the real world. As you know, no individual step of the procedures we do is particularly difficult, yet neglecting any one of them will significantly increase the odds of failure. Thus, I prefer to teach a cook book starting point, to encourage them to get in a checklist mindset. Over time, most begin to see the importance of reviewing the literature, or at least investing in a well edited book, but in the mean time, it helps them provide some semblance of predictability for their patients, who would otherwise suffer from their inexperience. Having said that, we should all view the claims of the experts in our field with some degree of skepticism, recognizing the inherent limitations of the art and science of this field, which is plagued by practical limitations such as tiny sample sizes, a dearth of prospective studies, short follow up periods, and significant corporate sponsorship. It is wise to ask ourselves if the information we are hearing is directly benefiting the person who is promoting it.

Dr. Kim thank you for your post. Fantastic responses! It is a great profession! We are blessed to be helping patients daily. I do have follow ups with my patients because I place and restore the implants. My first lateral sinus elevation utilizing perioglas was my mother! Eight years ago! She was 72 years old at the time. She is doing great with three implants #2,3 and 4 . We all have different protocols because we all have trained under different doctors in different countries! So I believe if you have had success with your technique then keep using it. Our education never stops, with new technology we must continue evolving and creating better treatments for our patients.

Paul, I disagree with your impression of Dentistry especially, "here it is a craft starting with dental schools and continuing throughout the years". I DO believe Dentistry is a specialty in Medicine, specifically oral medicine whether it's classified here as such or not. I think Dentistry as a technician is more of a layman's impression of what dentistry actually is in this country. And I believe you do the profession a disservice if you don't clear that up with your patients, as I do on a daily basis. Would you consider surgeons/doctors in any other medical field, technicians? No? Do they have to account for patient's well being? Yes? Similarly, Do you not take a patient's medical status (meds, complications, possible med interactions before prescribing) into consideration before proposing surgical vs. non-surgical options? Because if you do not, and if you don't use medical science about healing, and don't provide pharmaceuticals for infection and analgesia basically manage the patient throughout, I guess you are a technician. In that case, anyone can take the tooth out. Since, I believe most of us do all that and then some more to help our patients' overall health, I Do Not consider Dentists to be technicians, only That's a very narrow worldview of the people who are not dentists. This comment is not written with an admonishing tone but just highlighting that We gotta stop looking at ourselves just as tooth docs, otherwise Yes, like other commentators have said in other blog post, we are just tooth jewelers. But we in practice actually know, it's a lot more than just white teeth.

While I agree that the rigor of engineering is in many ways greater than medical fields, their expertise is limited to a narrow focus. I would have to disagree with the suggestion that undergraduate coursework in engineering is equivalent to a PhD, from my experience with my in house laboratory technician, who holds a mechanical engineering degree, with honors. The short response to your observation that many dentists are underqualified, is that the US system allows for a range of quality, so long as it is clinically acceptable. Thus, C- work is legally acceptable, and should be associated with a lower fee, while A level work should command higher remuneration. Treatment that falls short of the standard of care can be dealt with through civil litigation. In my opinion, it takes approximately 5 years for most dentists to gain enough experience to provide high level dentistry. Prior to this time, I advise young doctors to find a mentor and be very critical of their own work. Having said all that, let's try to stay on this thread's topic of sinus grafting advice.