Testori Masterclass: Maxillary Sinus Surgery

Category: Surgery

Instructor(s): Tiziano Testori

Course structure: Lessons: 14 lessons | Duration: 13 hours 6 min

Course overview

Diagnostic tips, clinical indications, and surgical techniques: the lateral approach and alternative treatments.

This Masterclass is recommended to all young professionals who are eager to gain a deeper understanding of maxillary sinus surgery, as well as to all experienced periodontologists and implantologists who want to keep up-to-date with the latest clinical protocols and techniques.

Thanks to its practical how-to-do approach, this Masterclass shows you how to perform sinus lift step by step, from diagnosis and case selection to the management of intra- and postoperative complications.

By joining this evidence-based educational path, you’ll gain a deeper understanding of the evolution of sinus lift protocols and techniques over the last decades, as well as of the key role played by sinus grafting surgery and its impact on implant survival rate.

In particular, you’ll learn how a new flap design and a new antrostomy technique can help you make sinus surgery with lateral approach less invasive and minimize the risk of postoperative complications.

Are you eager to know more?

Then join Prof.

Testori in this incredible journey into maxillary sinus surgery!

Topics covered in the course:
– Sinus physiology: when to refer to an ENT specialist?
– Case selection: diagnosis, indications and contraindications
– Maxillary sinus lift: clinical indications, treatment planning, surgical procedures
– Lateral vs crestal approach: the rationale behind this choice
– How to prevent, detect, and manage intra- and post-op complications
– A new flap design technique to avoid biological and vascular complications The Simplified Antrostomy Design (S.A.D.) Technique
At the end of the course, you will be able to:
– Perform sinus lift with lateral access using piezoelectric devices or traditional rotary tools;
– Manage common complications such as membrane perforations, cysts removal, and septum bones;
– Understand and perform the S.A.D.

Technique to facilitate maxillary sinus membrane elevation;
– Properly use the correct instruments for membrane detachment and elevation;
– Performs different functional antrostomy designs;
– Understand when and how to prepare the site for implant placement;
– Identify and propose alternatives to sinus lift: the M.I.F.A. protocol.

Curriculum

Lecture 1 - Different treatment plans

• In this first lecture of this Masterclass, Prof. Testori discusses the many different treatment options available for maxillary sinus elevation, as well as the main factors that influence the choice of treatment, such as the patient's financial implications and chief complaint, the clinician’s expertise, and many others.
• According to Prof. Testori, the clinician’s goal should be to improve the efficiency of the treatments by using digital devices and evidence-based techniques. In the second part of this lesson, Prof. Testori discusses more technical topics, such as when to refer to an ENT specialist, how to avoid intra- and post-operative complications, the features of the maxillary membrane, and the clinical symptoms of an unhealthy maxillary sinus.
• In particular, this lesson covers the following topics:
• – Surgical membrane classification: thick, medium, and thin (color and transparency)
• – The patient’s medical history and radiologic evaluation
• – The role of ENT specialists in the preoperative phase
• – Clinical symptoms and signs of maxillary sinus infection

Lecture 2 - Sinus elevation difficulty score and diagnostic tips

• This lesson centers on the factors determining the difficulty score of maxillary sinus elevation. Professor Testori illustrates his Sinus Elevation Difficulty Score system and explains how it helps clinicians easily understand the complexity of each clinical case. Case selection is indeed one of the most relevant factors to consider when dealing with maxillary sinus lift. For this reason, Prof. Testori explains which cases are ideal for younger or less experienced clinicians.
• In particular, this lesson covers the following topics:
• – Which cases are better for beginners?
• – Diagnostic tips: from simple cases to more difficult ones
• – The importance of case selection
• – Preoperative CBCT evaluation and the face screening phase

Lecture 3 - Clinical evaluations

• In this lesson, Prof. Testori introduces some relevant considerations about the clinical approach to manage maxillary sinus elevation. The lecturer illustrates how to spot clinical symptoms and signs of sinus infection, such as graft material in the ostium and sinusitis.
• A strong working relationship with ENT specialists is crucial during this preliminary phase, as it can help implantologists to better define thick and pathological membranes due to subclinical sinusitis.
• In particular, this lesson covers the following topics:
• – The histological structure of the sinus membrane
• – Biologically challenging patients: minimal quantity of crestal bone, heavy smokers, bone dehiscences
• – Clinical approach: patient’s monitoring on a monthly basis

Lecture 4 - Histological and biological sinus structure

• In this video lecture, Prof. Testori will discuss, thanks to several clinical examples, how to utilize different biomaterials such as Novomatrix in combination with fibrin sealant and Baxter Deerfield and then there will be time to deepen the functions and the advantages of the application of collagenated porcine dermal matrices.

Lecture 5 - Anesthesia, flap design and antrostomy indications

• After discussing the theoretical basis behind clinical protocols and necessary diagnostic considerations, Prof. Testori puts his surgical protocol into practice, commenting on it step by step. The surgery starts with the anesthetic protocol, after which Prof. Testori illustrates a cutting-edge flap design: a crucial step that he considers as the key point of any sinus lift procedure. Finally, the lecturer discusses the best ways to perform an antrostomy, whether with piezoelectric devices or traditional rotary instruments.
• In particular, this lesson covers the following topics:
• – Step-by-step anesthetic protocol: buccal-distal, buccal-mesial, palatal-distal, palatal-mesial, corner of the mouth
• – Incorrect procedures for local anesthesia: the most common errors
• – A modern surgical trend: periodontal flap design to cover recessions
• – The most efficient way to open the antrostomy: piezosurgery vs traditional rotary instruments

Lecture 6 - Osteotomy, bone repositioning and DASK technique

• After introducing the key concept of antrostomy, Prof. Testori gets deeper into osteotomy, bone repositioning, and the DASK technique. The lecturer then focuses on how to properly use DASK, an all-in-one kit for different sinus lifting techniques.
• In particular, this lesson covers the following topics:
• – The erosion technique with a large diamond bur
• – Bone repositioning sealing with tisseel
• – Antrostomy by erosion or by deflection

Lecture 7 - SAD technique: Simplified Antrostomy Design

• Prof. Testori illustrates a new approach to antrostomy design that simplifies membrane detachment and lifting in sinus floor augmentation.

Lecture 8 - Low window technique

• This lesson focuses on the Low Window Technique developed in recent years. Professor Testori shows the impact of this new technique on the incision protocol: incisions are limited to a linear incision and no-release incisions are made. This allows for better postoperative outcome and less pain, hematomas and swelling.

Lecture 9 - Intraoperative complications: anastomosis and perforations

• In this lesson, filled with excerpts from surgical videos, Prof. Testori shows the most common complications that can occur during a sinus lift procedure, as well as how to intercept and manage them intra-operatively and post-operatively.

Lecture 10 - Implant site preparation, flap incision and suture protocol

• According to Professor Testori, the key factor that determines the success or failure of sinus lift procedures is the design of the flap: a crucial step to which this lesson is dedicated. The lecturer also illustrates when (in which cases) and how implant site preparation is necessary, and the proper suturing protocol to be used.

Lecture 11 - Crestal approach with piezosurgery

• Historically, the crestal approach has been considered as unpredictable and too risky. Instead, Prof. Testori considers it a safe treatment choice in clinical cases characterized by no vertical discrepancies, small horizontal discrepancies, and a large sinus.

Lecture 12 - Sinus lift alternative treatments

• In this last theoretical lesson of this Masterclass, Prof. Testori shows the possible alternatives to sinus lift, including All-on-4, transinusal and zygomatic implants, and the M.I.F.A (Minimally Invasive Full Arch) protocol.

ReLIVE Surgery: Bilateral Sinus Lift

• In this first ReLIVE Surgery, Prof. Testori will show a bilateral sinus lift procedure and he will comment on every surgical stage in a step-by-step way. Patient’s chief complaint is a full-denture, a total upper prosthesis that’s not stable. The patient didn’t accept surgery to place zygomatic implants so the accepted treatment plan of care is to do an overdenture supported by six implants.

ReLIVE Surgery: maxillary sinus lift on difficult patient (2 parts)

• This last ReLIVE Surgery, which concludes the video course, aims to summarize in a single surgical operation all the theoretical notions and protocols shown and commented on during this learning experience.