Maxillary sinus and bone grafting surgery (Implant Dentistry Today) - 01-09-2011

Chetan Sharma reports back from the ‘Advanced cadaver maxillary sinus and bone graft’ course held at the Royal College of Surgeons of England earlier this year

Dental practitioners from around the United Kingdom attended a hands-on three-day practical course at the Royal College of Surgeons of England in London. The ‘Advanced cadaver maxillary sinus and bone graft’ course is designed for dentists who already have experience with dental implants and wish to further their skills in bone generation and maxillary sinus grafting. The course conforms to the guidelines set out by the General Dental Council and is one of only a few courses in the UK demonstrating innovative techniques with a hands-on approach.

The state-of-the-art Wolfson Surgical Skills Unit of the Royal College of Surgeons, headed by Professor Vishy Mahadevan, is a purpose-built, fully-equipped, air-conditioned modern facility specifically designed for education and hands-on training for dentists and surgeons from all disciplines. It simulates an operating environment with around 20 surgical slabs, each equipped with boom arms, compressed air outlets, vacuum suction, piezosurgical units and high intensity illumination with overhead cameras for projection to multiple monitors. Instruments are sourced from Science Care in the United States of America.

For this meeting two delegates were allocated one unembalmed frozen cadaver head, allowing each to practise demonstrated techniques.
Prof. Mahadevan started the meeting with a detailed and interesting lecture on oral anatomy. This lecture consisted of a detailed description of the surgically-relevant anatomy of the innervation and blood supply of the upper and lower dentition (maxillary antrum and mandibular regions).

For the upper dentition, the infratemporal fossa, an irregularly shaped cavity, situated below and medial to the zygomatic arch, was described with information given on borders, communicating sinuses, masticatory muscles, blood vessels and neural innervation. The pterygopalatine fossa, a smaller cavity within the infratemporal fossa, was also detailed with fully illustrated slides. Additionally, the following structures were also highlighted as important to the surgeon: middle cranial fossa, trigeminal ganglia and associated branches (maxillary and mandibular nerves), lingual nerve, maxillary artery, inferior dental artery, middle meningeal artery, pterygoid plates and parotid glands. An understanding of these fossae and structures is crucial to clinicians performing maxillary surgery and for comprehending the spread of infectious or inflammatory complications. Finally, the anatomy of the maxillary sinus (antrum) and ethmoid sinus, two of four pairs of paranasal sinuses, all of which communicate with the nasal cavity, were described with cross referencing to surgical techniques of this area.

For the lower dentition, Prof. Mahadevan described the most relevant and important anatomical structures with relevance to mandibular surgery. The mylohyoid muscle is an important palpable topographical landmark that forms the floor of the oral region. Peri-apical infection can spread to the sub-mandibular and sub-lingual spaces, so these cavities were extensively described. The relationship of the lingual and inferior dental nerves to the mandible was also highlighted.

Using a cadaver head, Dr Feran demonstrated the surgical techniques required for maxillary antral access via a sinus lift.

Delegates gathered round the surgical slab to obtain close views of the procedure, while others viewed the multiple monitors and discussed the procedure under the auspices of Prof. Mahadevan, Prof. Ucer and Mr Toma.

Dr Koray performed a surgical lift over the course of one hour, with continuous commentary and highlighted common pitfalls and complications such as a membrane perforation. Delegate questions were also continually answered.

Following a coffee break, delegates were allowed to practise this procedure on their allocated cadaver heads for the next two hours, while the experts remained in attendance to help and to answer any technical questions.

Following a lunch interval where delegates intermingled with experts, continuing educational conversations, Dr Feran, in a similar manner to the morning session, demonstrated mandibular bone harvesting techniques used for subsequent grafting. Again, useful tips and techniques were demonstrated and potential complications discussed.
Mr Toma demonstrated nasal dissection on a sagittal section of a cadaveric head, during which delegates gained a clear understanding of the nasal cavity, bordering structures, important vessels and nerves, and their relationship to the maxillary sinus.

As an encore, Mr Toma also demonstrated intracranial anatomy and Dr Feran delicately dissected the muscles associated with mastication.
Delegates were then allowed ample time to practise these surgical techniques. Help from the experts was on hand to guide delegates with any difficulties.

Throughout the day, representatives from Geistlich Biomaterials were available to discuss the company’s bone generative products and answer any general questions.

In summary, delegates were able to attain a clear understanding of the anatomy and surgery related to maxillary sinus and mandibular regions, which allowed them to practise their skills on cadavers under the guidance of experienced and eminent clinicians. This course will permit clinicians to take the next step in their careers, from dental implantation to maxillary and mandibular surgery. The programme received widespread praise from attendees who were rewarded with a certificate of training after the event.

For further information, contact Cemal Ucer at and Koray Feran at Geistlich Biomaterials can be contacted by email at

Implant Dentistry Today - September 2011

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