I observed a sinus lift at Dr. Whitneys office in Coeur DAlene, Idaho; Dr.

Whitney is
an endodontic and a periodontist, which is not very common. It was great to be able
to watch him. The procedure lasted 2 hours. There are many guidelines that can be
followed for when to refer to a periodontist, but in the end the big deciding factor is
what the referring dentist feels. Any patient that is periodontal involved or needs
surgery that involves the periodontist expertise can be referred. Here are all the
reasons why a patient could be referred: Severe chronic periodontitis, Furcation
involvement, Vertical/angular bony defect(s), Aggressive periodontitis (formerly
known as juvenile, early-onset, or rapidly progressive periodontitis), Periodontal
abscess and other acute periodontal conditions, Significant root surface exposure
and/or progressive gingival recession, Peri-implant disease, Any patient with
periodontal diseases, regardless of severity, who the referring dentist prefers not to
treat. With Dr. Whitney he says that there are some general dentist that use him
more than others and a big part depends on how much the referring dentist does in
their own office.
The procedure started by the assistant bringing back the patient. After seating the
patient the assistant had the patient read over the consent for work paper and sign.
The assistant then put a patient bib with a towel under the bib onto the patient.
Right after this Dr. Whitney came into the room and begun discussing the procedure
with the patient. The patient voiced her understanding on the treatment and
explained that she understood what was going to happen. Dr. Whitney explained to
patient that I was a student in hygiene school and was wondering if I could observe
the procedure. The patient stated that she was happy to help me learn and that
everyone has to learn somehow.
The assistant then gave the patient safety glasses, and then pulled the Pano
radiograph up on the computer screen behind the patient. Dr. Whitney was washing
up at the sink, and already had on a mask and safety glasses (I later asked if he
wears loupes, and he said that he does, but not for all procedures). The assistant
then placed topical for a PSA in the upper left, then Dr. Whitney gave a PSA injection
with 4% septocaine 1:100K w/epinephrine very slowly (his advice for me was to
always go slow with anesthetic). He then proceeded to give a GP with 2% Lidocaine
1:100k w/epinephrine; Dr. Whitney then explained to patient that he would let the
anesthetic do its job and he would be back.
Upon returning Dr. Whitney washed hands again, and re-gloved, he then asked the
patient if she was numb and the patient stated that she was. He then stated that he
would start, but if at anytime there was sharp pain to let him know and he would
administer more anesthetic. He then placed an incision on the maxillary ridge where
tooth #13-#16 would be (the patient was missing all of these teeth), he then placed
an incision vertical on the buccal plate from the gingival margin of #12 about 5mm
superior, and the same incision where #15-#16 would have been located. He then
took a molt periosteal elevator and laid the flap open by separating the soft tissue

from the bone. At this point there was a flap and all the bone could be seen. The
assistant used her surgical suctioned to suction any bleeding that was happening.
Dr. Whitney then held the flap with the molt and then used a machine called
piezotome that flushed with sodium chloride 0.9% as it removed the layer of bone
sitting over the sinus. He switched the tip of the piezotome twice, at the beginning
he used a round diamond tip and then he switched to an elephant foot tip. The hole
that he drilled in the buccal plate was about 8 mm X 4 mm. It did not take much to
remove the bone over the sinus cavity. Once the bone was removed the membrane
of the sinus looked like the lining in an egg. Just a thin layer, which he used a 4R/4L
to perform swiping motions along the inside of the bone to separate the membrane
from the bone. I said that it looked like gingival curettage, but on the bone and he
agreed it was similar.
The assistant was mixing up the bone graft at this time, she mixed Grafton (cadaver
bone) and Bio-Oss (bovine) in a 70/30 percent ratio and used anesthetic to moisten
the bone graft. The doctor than takes sinus lift curettes and unhooks the membrane
from the bone, until there is a pocket of area under the membrane that the he can
slip the bone grafting material under. Right before the end of un-attaching the
membrane the membrane tore and a small hole was in the membrane. He then
packed helitape into the membrane area, and then the assistant carried the bone
grafting material over to the site and scooped it close to the opening and the doctor
would pack the material into the sinus. After packing in 2 packs of Grafton and biooss mixture he then asked for another piece of helitape. Helitape- is used as a
membrane product. He placed the Helitape over the 8 mm X 4 mm opening and laid
the flap back over the bone. He then took sterile saline and rinsed the edge of the
flap.
After laying the tissue back the assistant handed the dentist 5-0 monofilament
sutures. The dentist placed 6 sutures and the assistant would cut the suture string
after he tied the end off. Gauze was then placed over the site and then Dr. Whitney
de-gloved and explained to the patient that he would be back in just a little bit. The
assistant then went over the post-op instructions with the patient. Dr. Whitney then
returned and asked the patient how she was doing, which she stated that she was
fine. They then proceeded to discuss antibiotics, pain medication and ice pack. The
patient was told that she would possibly feel congested and she voiced her
understanding. The dentist then continued discussing how the procedure went and
that in 2 weeks the patient would be back to check the site, and to remove the
sutures. The patient seemed really happy and excited to heal up so she could get an
implant on that side.