February 1, 2019

View from the dentists chair – does “anything work in the sinus”?

“Anything will work in the sinus”

One of the most common phrases I hear when I’m lecturing is that “anything will work in the sinus.”  I’m sure you’ve heard it before, maybe even said it yourself – “I can put any biomaterial in the sinus and it will work fine, it doesn’t matter what material it is.”

Is this true?  Will “anything” work in the sinus?  I guess it all depends how you define “work”.  For me, “work” means the regeneration of true host bone, with no foreign particles left in the site long term.  This lets us achieve true osseointegration of the implant, giving us the best chance of success.

Do all biomaterials achieve this outcome?  No.  We know that when you use a xenograft, or HA, that this material can take a very long time to resorb.  You can see it in scans taken years later – there is a nice white area but this doesn’t look particularly similar to the surrounding host bone.  This is particularly true in the sinus. 

I’ve even seen a few cases over the years where implants have failed because of this, losing stability long-term.

I’ve been working exclusively with alloplastic / synthetic materials for almost 20 years, specifically with B-TCP, and have performed thousands of sinus augmentations with the material.  The results I get in the sinus are fantastic – the material definitely “works” in this setting! In particular I see several significant benefits over using traditional xenografts / HA in sinus procedures:

  • True host bone regeneration – numerous clinical studies have shown B-TCP to be completely replaced by host bone, meaning the implant will benefit from true osseointegration with healthy, regenerated host bone that will naturally remodel over time.

  • Reduced patient pain – as a biocompatible material, patients appear to experience significantly reduced post-operative pain. Most of my patients only require pain-killers for 3 days post-surgery.

  • Fantastic soft tissue healing and aesthetic results.

  • Quick loading times – I often place implants and graft simultaneously, after which we routinely load at 12 weeks (subject to ISQ readings). We have done numerous histological studies showing 50% new bone in the graft site within 12 weeks.

I have been using EthOss® in my practice for several years.  A mixture of 65% B-TCP and 35% Calcium Sulphate, I believe the material showcases all of the benefits of the latest generation of synthetic materials.  It handles and performs completely differently to the B-TCP products I have used in the past, making my job much easier and giving fantastic results.

I would encourage all implantologists to carefully consider the material they use in sinus augmentations.  We shouldn’t just “throw anything in there” – think about biology.  Modern synthetic materials give us the ability to upregulate the host healing environment leading to true bone regeneration in the graft site which should be the optimal outcome for any procedure.

I will be covering all of the above, as well as discussing many clinical cases, in an upcoming webinar for the EthOss Academy.  If you are interested in learning more then please register now – it will be great to see you there!