Sinus and bone grafting course

Professor Cemal Ucer talks to The Revu about how the Intensive 3-Day Sinus and Bone Grafting Course with hands-on cadaver surgery, which he co-developed with Dr Koray Feran, has evolved strongly over the past nine years to become the benchmark course for experienced implant surgeons aspiring to carry out complex oral reconstructive surgery such as maxillary sinus grafting and innovative procedures such as the bone ring and other advanced techniques.

What first gave you the idea for this course?

Maxillary sinus surgery and bone grafting surgery have traditionally been offered by oral or maxillofacial surgeons. However, as implantology evolved and more clinicians have become involved with dental implants in practice, moving from Straightforward cases to Advanced then on to Complex surgery, there has been an increasing demand for clinicians to learn more about reconstructive hard and soft tissue techniques and grafting procedures. Dr Koray Feran and I started the course in 2008 in response to this need and we were very fortunate to team up with Mr Abbad Toma, who is an ENT consultant in London. Abbad has a special interest in rhinology and endoscopic sinus surgery and this really complemented Koray’s and my skills in this area. More recently we have been privileged to be joined by Miss Sarah Little, who is also a consultant ENT surgeon specialising in rhinology and treating sinus disease.

How has the course developed over the last nine years?

The course has become established as a benchmark in Europe for sinus and bone grafting, thanks mainly to the multi-disciplinary teaching we offer using fresh frozen cadavers, one of the first of such courses in the country. It’s a requirement of the GDC that if you want to progress into advanced surgical procedures such as sinus surgery or bone grafting, you must complete a structured advanced level course and develop skills through mentoring. We believe that being able to operate on cadavers in order to develop final pre-clinical skills before moving on to patients is a great privilege, as the surgery is almost identical to working on live patients, and we are very fortunate to be able to do this. The trainees learn all the theory from dental, oral surgery and ENT perspectives and develop competence by carrying out cadaveric surgery under supervision before actually moving on to treat patients. This ensures that the learners develop the necessary skills and surgical precision and accuracy safely and effectively.

Our courses have been attended by a great mix of dentists, ranging from oral and maxillofacial surgeons to periodontists, oral surgeons and general practitioners who bring a wealth of knowledge and experience, which adds a strong multi-disciplinary emphasis to teaching and learning on the course.

Do delegates have to place a certain number of implants before they come on the course?

You’re not going to be able to do advanced sinus, bone or soft tissue grafting until you have achieved basic clinical competence in implantology, and that requires placing at least 50 to 100 implants. You need to be comfortable with Straightforward and Advanced cases before moving on to Complex reconstructive surgery. Therefore, it’s not really a suitable course for beginners.

Working together with ENT surgeons is an unusual aspect of the course. Can you tell us more about how this works?

It shouldn’t really be a surprise that ENT surgeons are involved in the course as maxillary and paranasal sinuses are their day-to-day working environment. If you are grafting the maxillary sinuses or placing implants within them, you will need to develop a close professional relationship with an ENT surgeon as you will need to routinely collaborate with them and seek their expertise in managing the sinus patients.

Both Sarah and Abbad specialise in endoscopic sinus surgery that they also teach on the course; I believe we are the first course in Europe to offer such a distinguished ENT input. Learning how to assess sinus diseases and treat these conditions before implant procedures is a very important part of the learning process. It’s also about developing a greater understanding of how to work together with other professional colleagues and when it’s the right time to refer to an ENT surgeon. Maxillary sinus grafting is a highly predictable and safe surgical treatment, provided that it is carried out in patients with no pre-existing sinus disease or anatomical problems. As up to 30–40% of the public suffers from some form of sinus disease, ENT input is required regularly before sinus grafting. In my private practice, I routinely work with an ENT consultant who is asked to perform functional endoscopic sinus surgery (FESS) to open up the osteomeatal process to clear the sinuses and restore normal drainage when there is significant chronic sinus disease. 

After completing the course, is there still a need for delegates to have additional mentoring?

Mentoring is not just a requirement imposed by the GDC, it’s vitally important for everyone, from beginners to those involved in complex surgery. We are very happy to provide mentorship to those who’ve been on our courses, no matter where they are on their career journey.

Finally, what makes this course so unique?

As I’ve already said, this is truly a benchmark course. It’s unique in structure and taught by eminent dental and ENT surgeons with many years of experience to give the most comprehensive theoretical and practical introduction to advanced sinus grafting and bone & soft tissue regenerative surgery.

Working with such a highly experienced, multi-disciplinary team on cadavers is a totally unique experience. As today’s clinicians come under increasing pressure to perform more advanced implant cases, this is the ideal opportunity to develop clinical skills in one of the most advanced postgraduate implant training hospitals in Europe. Delegates spend the whole day at the Manchester Surgical Skills and Simulation Centre at Manchester Medical School under supervision of the full course faculty, carrying out surgical dissections, sinus grafting, bone grafting, bone harvesting from the ramus, the chin and other intra-oral sites, as well as using the bone ring technique. The learner can practice placing implants in the pterygoid or paranasal region in severely atrophic cases and learn to handle the entire range of botiss® hard and soft tissue products when placing implants.

Throughout this intensive course, digital dentistry and the full digital workflow is given a great emphasis from CBCT-based 3D assessment of the sinus anatomy and pathology, treatment planning using coDiagnostiX™ and 3D guided surgical access to the maxillary sinuses. This year we will also be teaching a revolutionary new technique using the 3D guided piezo and the closed osteotome technique guided by real-time navigational surgery. These are very exciting, recently introduced advanced techniques at the forefront of digital dentistry, which enhance the precision and safety of surgery in oral reconstructive procedures. We want to ensure that surgeons practising advanced hard and soft tissue reconstructive surgery are fully aware of the techniques.

The next Intensive 3-Day Sinus and Bone Grafting Course with hands-on cadaver surgery is being held in Manchester on 9th–11th November 2017 is now fully subscribed.
The next Intensive 3-Day Sinus and Bone Grafting course with hands-on cadaver surgery will be held in London in the spring of 2018 and repeated at ICE Hospital & Manchester Medical School in November 2018. For more information or to book your placevisit
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