Dentaltown March 2018 - 30

show your work
case study

A Simple Approach

to Crestal Sinus Augmentation
by Dr. Matthew F. Bickel
Matthew F. Bickel, DMD,
and his wife, Kathleen
J. Bickel, DMD, own and
practice at Dayspring
Dental in Sewell, New
Jersey. The Bickels focus
on providing advanced
dental technology,
including laser dentistry
and CBCT. He focuses on
restorative, endodontics and implants, while she
focuses on restorative, orthodontics, and infant
tongue and lip tie revisions.
Email: info@dayspringdentaltwp.com

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30

MARCH 2018 // dentaltown.com

The world of the general dentist has
changed a lot over the years. When I graduated from the University of Medicine and
Dentistry of New Jersey-New Jersey Dental
School (now Rutgers School of Dental
Medicine) in 1992, implant surgery was not
common among GPs. We got zero exposure
to implants as undergrads; I merely knew
that they existed, and thanks to a sales rep
at a school presentation I knew you had
to use a special plastic scaler to clean one.
But that was the extent of my dental school
implant education.
During my Advanced Education in General Dentistry residency, also with UMDNJ, I
had the privilege of being taught by Dr. Stanley
Praiss, a pioneering implantologist/surgeon GP
who taught the residents much more about
surgery than we learned in dental school.
Praiss tried very hard to get the residents
to learn implant placement, but the school
administration would not sanction it; it
believed that GPs had no business placing
their own implants. My, how times have
changed! Most, if not all, GP residency
programs now teach implant placement,
and many older docs, myself included, have
taken continuing education to learn implant
placement.
My implant surgery journey began in
2013, when I took a Hiossen surgical course.
Through the teaching
Fig. 1
of some great specialists
and GPs (including my
implant mentor, Dr. Paul
Goodman), I was able
to start placing implants
in my off ice. A s my
experience progressed, I
began taking courses in

guided bone regeneration (GBR) and sinus
augmentation. One of the things I enjoy
most about implant surgery is that I have
total control over the restorative position of
my implants.

Case study
A 59-year-old patient presented with a
failing implant at #4-which happened to
be one of the first implants I had ever placed!
The patient had disappeared from the practice
for a couple of years before I could restore it,
he had been a smoker, and his periodontal
disease was now uncontrolled. In addition,
the implant was placed without a CBCT,
and it's possible there was an osseous defect
that I was not aware of.
Fig. 1 shows the CBCT images of the
failing implant and the resulting osseous
defect. You can also see sinus thickening
because of the infection penetrating the sinus
floor. The patient was now a nonsmoker, and
was fully committed to treating his periodontal
disease and restoring his missing teeth.
Step 1 was to remove the failing implant,
completely debride the area and graft the
defect. A flap was laid with a WaterLase iPlus
dental laser, and the defect was thoroughly
curetted as well as cleaned with the laser
until we were down to clean, healthy bone.
The area was grafted with Steiner Socket
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Table of Contents for the Digital Edition of Dentaltown March 2018
