When is it necessary to refer patients to an Ear, Nose and Throat Specialist prior to sinus grafting?


63 ENT specialists responded to mailed questionnaire that include various sinus pathology scenarios.  Their responses were statistically evaluated and analyzed.


58% recommend routine CT Scan prior to sinus-lift surgery.  

Patient symptoms that indicate referral to ENT prior to sinus grafting include nose problems and sinus issues.  

CT- scan findings that suggested a referral in the opinion of a majority of ENT specialists :  

1) Occluded sinus with septum.  

2) Inflammation at the base of the sinus only

3) Generalized thickened sinus membrane

4) Oro-antral fistula

5) Thickened sinus membrane in association with perio or endo involved teeth.

6 ) Near completely occluded sinus 

Other concerns included past history of sinus surgery, chronic sinusitis, ostium stenosis, nasal obstruction and oro-antral fistula 


A CT Scan prior to sinus-lift surgery was recommended by 58.7% of ENT specialists.  Their greatest concerns were prior sinus surgery, severe sinus inflammation, nasal/sinus obstruction and oro-antral fistula.


for more information please refer to:

New York State Ear, Nose and Throat Specialists view on pre-sinus lift referral.

Cote MT, Segelnick SL, Rastogi A, Schoor R

Journal of Periodontology Feb 2011, Vol. 82, No.2, Pages 227- 233. E-publication: 2010, September 1


Do multiple adjacent extractions affect implant bone levels?


Beagle dogs were assigned to three groups with 16 sites each:

Group 1: Single tooth extraction and one immediate implant

Group 2: Two adjacent teeth extractions and one immediate implant

Group 3: Three adjacent teeth extractions and one immediate implant 

Jaw segments were analyzed for bone thickness, marginal bone loss and bone to implant contact.


Group 3 (Three adjacent teeth extractions with one immediate implant in the middle socket) had the most severe buccal marginal bone loss (3.20mm compared to 0.375mm for Group 1 (single extraction and immediate implant). 


Multiple adjacent teeth extraction causes more extensive buccal bone remodelling and greater amount of buccal marginal bone loss around immediately placed implants.  This may be due to the severing of the interdental bone blood supply.


for more information refer to:

Alveolar Bone Remodeling Around Immediate Implants Placed in Accordance With the Extraction Socket Classification: A Three-Dimensional Microcomputed Tomography Analysis.

Munirah Saleh Al-Shabeeb, Mansour Al-Askar, Abdulaziz Al-Rasheed, Nadir Babay, Fawad Javed, Hom-Lay Wang and Khalid Al-Hezaimi

Journal of Periodontology August 2012, Vol. 83, No. 8.


Does Puros Dermis have comparable results to Alloderm?


Split mouth design with 26 sites treated with Puros Dermis and 26 sites treated with Alloderm. A coronally advanced flap was used.


At 6 months both groups had similar improvements in recession coverage with an average of 2.83 mm for Puros Dermis and 3.13 mm for Alloderm. 81.4% root coverage for Puros and 83.4% for Alloderm. Difference between the two materials was not statistically significant.  


No statistical or clinical difference in root coverage, probing depth or keratinized tissue in coronally advanced flaps using etither of the two acellular dermal matrix materials. Both were successful in achieving root coverage.


for more information please refer to:

A Comparative Study of Root Coverage Using Two Different Acellular Dermal Matrix Products

Thomas S. Barker, Marco A. Cueva, Francisco Rivera-Hidalgo, M. Miles Beach, Jeffrey A. Rossmann, David G. Kerns, T. Bradley Crump and Jay D. Shulman

Journal of Periodontology November 2010, Vol. 81


What is average distance from the crest to the mandibular canal on a CT?


195 CT scans from a private practice were examined.  Measurements were made with computer software (Simplant) at 5mm intervals.  Patients were categorized as to age, sex, and missing posterior teeth.


The following data emerged at the 95% confidence level  (Excerpted from Table 1):

Distance from the crest to the inferior alveolar nerve at the first molar:

In males with no missing teeth : 13.85mm

In females with no missing teeth : 12.50mm

In males with missing posterior teeth: 10.20mm

In females with missing posterior teeth: 8.96mm

Other measured variables were available bone volume from the alveolar nerve to the inferior border of the mandible, the buccal cortex and the lingual cortex. 


A high degree of variability in mandibular bone volume surrounding the inferior alveolar nerve.  Greater risk of injury for females. CT scan should be considered when limited bone above the nerve is observed in conventional radiographs.

Dr GebrAel’s comments: 

A must read (and re-read) article giving helpful average measurements as they relate to implant placement in the posterior mandible.


For more information PLEASE Refer To:

Radiographic Considerations for the Regional Anatomy in the Posterior Mandible

Natasha Yashar, Christopher G. Engeland, Alan L. Rosenfeld, Timothy P. Walsh, Joseph P. Califano

Journal Of Periodontology Jan 2012, Vol. 83, No.1, Pages 36-42