How to use Summers technique exactly? What sequence?

As Periopath suggests, always best to have a Hands-On Mentor to help guide you...Most if not all of us 'seasoned implant docs' have had one. Try to find one locally to help.

+1 Best answer yet!

Robert: in truth, over 50% of subantral augmentions involve some degree of perforation, pinholes to outright blowouts. I got my training from Carl Misch and Mike Pikos, and learned how to recognize when tears are likely to occur, how to minimize and mange them. If Mike Pikos is still teaching, take his courses. Poor technique leads to poor outcomes as you describe. Training and experience teach is how to know exatly where to open the antrum & how high to pack the graft. Infections and graft migration are part of this surgery’s risks and need to be in tje consent. The surgeon needs to be confident in managing infections, early and late. I’ve experienced both and successfully treated all of them. Again, this is my personal opinion. You will experience graft failure if you do enough of these procedures, so the risks/benefits of controlling placement and size of implant needs to be weighed. As far as piezo, it is very precise, but for me slower than a bur, and there are issues of access to consider. I started with a #2 round bur and stuck with it - I remove the bone over the window anyway. It is as easy for a surgeon to perforate a sinus with a piezo as it is with a bur, it depends on the surgeon, the patient, and the moon phase. Preoperative chlorhexidine rinsing AND scrubbing along with intraoperative chlorhexidine irrigation, pre/post surgical antibiotics and antibiotics in the graft along with rigid aseptic technique, careful planning including preop/postop CBCT are de rigeur. Learning this surgery dispelled the notion that the sinus is the “black hole of death” and opened up other methods and techniques for me, and I count it as one of the most valuable tools in my skill set. I have retrieved lost roots, improved my extraction technique, and learned how to manage OA fistulas from extractions. I very humbly ask one question: if you perform a closed elevation, introducing a graft through a contaminated access, and there is a tear and an infection, do you manage your patient, or do you ask an oral surgeon to clean up after you? Again, I feel if we are to treat the sinus, we must be ready to treat it with reopening, irrigation, drains, and IV antibiotics as quickly as we are ready to treat them with implants. If not, perhaps we should not be treating the sinus ourselves at all. How well trained would you want your surgeon to be?Apologies for misspelling and verbosity, but I feel this is one of the greatest privileges a dentist can have, but it has to be earned, not taken. Respect to all here and your efforts, this is my opinion such as you find it, and I stick by it.

I couldn't agree more. Unfortunately the world of specialty dentistry has rapidly disappeared. Dentist are trying more advanced procedures and taking greater risks every day. It usually takes just one major screw up to question their motives, but the lesson is a terrible price to pay for the victim.

Just ignore the people who simply criticize. Fact is, there are various techniques, instruments etc. for sinus lift, and it can get confusing, especially as different courses may recommend different things. There are new studies all the time comparing different techniques. Your question was a fair one. Ultimately, it's better to raise questions about the procedure than pretend to be a "know it all". I think the best teacher is experience (not just courses), and you never get anywhere without trying and asking questions. As an aside, I do agree with one of other posters here to shelve the osteotomes in favor of new instrumentation and/or a new technique. You may want to take a look at the SCA Kit for example, if you plan on doing more of the crestal approach.

Thank you for your comment. Your comment reminded me of another important issue. I'm from a poor country. I don't have access to all the technology available. I have to work with I have. Many recommend densah burs and etc and i just took a look at this SCA kit and it's very expensive to me.

Where are you practicing? Have you spoken with your local distributors about which items/brands they carry?

I sincerely hope that none of my comments came across as critical. That is certainly not my intention. Merely recommendations based on my 25 years of experience in the field as someone such as yourself, a doctor with good intentions, desiring to improve himself for the sake of all he is responsible to: Patients, Practice, Family, Self. The electronic age has given us great access to information. It is up to us how we use it. Weigh criticisms for what they are worth; don't dismiss them outright because of the seemingly harsh tone. In my career, I was chastised by specialist and GP alike for only trying to learn new skills. I'll leave the reasons for those motivations to reader's own speculations. Doubts, absolutely! First surgery, every surgery. Mostly over small things. With time and experience, they become less and less. Even Hilt Tatum had his first surgery, and all the giants in the field were subjected to intense criticism and scrutiny. Imagine having the stones to criticize Carl Misch and Mike Pikos. Think of that when it happens to you, but don't dismiss criticism out of hand. It can be a guide. Your skills will develop over time. In the beginning, live surgical course, preferably ones you can participate in, are the best start. I don't know the particulars of the case you are performing; I only offer an insight into a possible path of future study based on my own experience as a general dentist who made some lucky choices along the way that enabled me to develop and advanced skill set. You can never know enough, and you likely already have found that advanced knowledge and skills in one spill over into other areas as well. The skills in flap management for implants and sinus elevations potentially translate into surgical extractions, periodontal care, crown lengthening, and other areas. A comment was made that there is a trend for GPs to rush into advanced areas without adequate training. That may be so in some cases, but it should not discourage you from broadening and deepening your skill set. I wish you and your patient all the best in their upcoming treatment, and a long and prosperous future in dentistry.

Thanks for your comment. I tried to download but I wasn't succesfull. I have no access to this article.

send me your email and i will forward it to you as an attachment. you need to be registered with iJOMI to get it online, or you need to go to a Uni. Library to make copies for the future.