Synthesising Sinus and Bone Grafting

Dr Koray Feran talks to The Revu about the Intensive 3-Day Sinus and Bone Grafting course with hands-on cadaver surgery to be held in Manchester on 9th – 11th November 2017.

How long have you been presenting the course?

Professor Cemal Ucer and I started the course in 2008. We started it tentatively with a few people and realised that it was going to be in demand and over the last nine years it’s gradually grown into a course we run twice a year. The first day of the three-day course is theoretical lecturing, the second gives delegate the opportunity to practice their skills on fresh frozen cadavers and day three allows them to observe live surgery. So, we cover everything from techniques and materials to radiograph assessment and complications, including the ENT side of things. It’s a very comprehensive course and we cover as much as we can in the time available.

Is grafting fundamental to successful implant treatment?

In my opinion, it is almost impossible to place dental implants without some degree of bone and/or soft tissue grafting as most cases have some level hard or soft tissue deficiency, so a comprehensive understanding of the techniques and materials available is vital for all dentists placing implants. I want all my cases to be successful both in terms of stability and aesthetics, and to achieve this my material of choice is the botiss product portfolio as it covers most of my needs for both bone and soft tissue augmentation. During the course, delegates are given a fantastic opportunity to work with the botiss range of products, including bovine xenograft grafts, which are best documented, synthetic bone graft materials and differing types of collagen membrane.

To attend the course, do delegates need extensive implant experience?

We like delegates to have completed an introductory year course as the FGDP would recommend and they will probably have worked with a mentor to place 20–30 implants in that time. Most delegates with this level of experience will have had a few cases requiring some bone grafting and they are ready to build their knowledge and experience. Although it’s a sinus augmentation course primarily, we do cover everything else – soft tissue, particulate grafting, block grafting, etc. Working unrestricted on fresh frozen cadavers provides delegates with an excellent opportunity to explore a ‘fresh’ patient to trying all kinds of techniques – ridge splitting, block grafting, Khoury plates, bone screws, membrane tacks, whatever they like.

The course has many benefits; can you outline these?

The course is very didactic in its presentation and we take delegates step by step through as many scenarios as possible, allowing them to become immersed in the subject. Cemal and I are joined on the course by two consultant ENT surgeons, Mr Abbad Toma and Miss Sarah Little, who offer critical insight into the pathology of the sinuses before we do any kind of sinus augmentation, how to treat sinus disease, when to treat it, how to refer it. Without our ENT colleagues, it wouldn’t be a complete course and it’s vital that they’re involved. This team approach provides delegates with a wealth of knowledge including anatomy and the physiology of sites, limitations of procedures and possible complications. Working with a highly experienced, multi-disciplinary team on cadavers is indispensable and this, coupled with didactic teaching and live surgery, is very beneficial to delegates. It’s an intensive three days, but great fun.

Mr Toma comments: “From and ENT perspective, delegates need to have a detailed understanding of the sinuses and what can go wrong. If there is a complication, they also need to be able to explain to the patient why they’re involving an ENT surgeon in the overall treatment plan. The worlds of ENT and dentistry are separate, but when it comes to implant surgery and bone grafting they are only a membrane apart, and I think this collaboration is an excellent way to gain successful patient outcomes.”

During the course, do delegates gain a better understanding of CT scanning?

We cover CT scanning in some detail because the whole teaching team are of the opinion that if you’re dealing with the sinuses, CT scanning is a pre-requisite for planning from both a medical and legal viewpoint. It’s quite indefensible to be going into a sinus if you don’t know what it looks like in 3D and whether we have patent drainage or any pathology. We also cover interpretation of sinuses on CT and how various appearances should lead to the opinion to refer the case to either a more experienced dental colleague or an ENT specialist. My ENT colleagues and I have seen many disasters in our working lives – most of which could have been avoided if a CT scan had been used to assess the case before surgery had taken place.

Mr Toma comments: “From my experience, when I joined the course, very few people were using CT scans, but in my world, we wouldn’t consider sinus surgery without one. More dentists are starting to use CT scans, but often the bit I want to see is missing! Ideally, when the scan is taken it should include all the sinus and then problems can be more easily identified. On the course, we show a vast array of CT scans to help delegates interpret the information they are looking at and then how to use this to plan the case. There’s a crossover between ENT and dentistry and it’s very important to understand the whole anatomy rather than individualising the parts as just a sinus, just a mouth or just a tooth. It’s invaluable for successful treatment of the patient.”

After the course, will delegates have gained enough skills and knowledge to work unaided?

Delegates will certainly gain enough knowledge to know which cases they can tackle and which they should refer, which is invaluable. Planning a case and making sure you have all the information you need is an integral part of the course – especially when deciding who is suitable and who isn’t – both from an anatomical viewpoint and from a medical viewpoint. Mr Toma and Miss Little spend time showing delegates how to assess a case before they go in and what happens if there’s a problem and, most importantly, how to deal with issues. The course covers the pros and cons of differing techniques and delegates who have placed 20 or 30 implants prior to the course should leave with a clear understanding of the procedures they can undertake.

The course is presented at ICE and MSSSC. What are the benefits of these facilities?

We host days one and three at the ICE private teaching hospital in Manchester. ICE is the brainchild of Professor Ucer and is specifically designed for postgraduate dental teaching. The environment is perfect as the venue provides excellent lecture facilities linked by CCTV to the surgical suite. For day two we move to MSSSC, who are able to provide fresh frozen cadavers for delegates to gain extensive practical experience. This combination of venues provides the very best environment for learning.

Can you tell us about your day-to-day work and the work of the LCIAD Academy?

At the moment, I work in a 4 surgery practice in the West End of London, We are effectively a general practice but we carry out pretty much everything. We like being in control of the cases in full, so we do our own bone augmentation, implants, periodontal and restorative work… It’s a busy practice with 7 clinicians, 5 of whom place implants! We tend to get patients who may have had failed dental work or specific problems that are beyond the remit of most general practitioners, so we see quite advanced cases, which is very rewarding.

The LCIAD Academy works in conjunction with ICE, providing a wide range of courses from implants and bone grafting, occlusion and photography to business and finance, and it is very rewarding to work in a collaborative way.

For more information or to book your place on the next Intensive 3-Day Sinus and Bone Grafting course with hands-on cadaver surgery, visit www.bonegraftingcourse.co.uk.
For more information about the botiss® product portfolio, visit www.botiss.com.

 

Dr Koray Feran BDS MSc FDSRCS

Dr Feran qualified in 1989 from Guy’s Dental Hospital, winning the Final Year Prize for overall excellence and the S. J. Kaye Prize in Oral Medicine and Pathology. Between 1991 and 1993 he completed a Master of Science degree in Periodontology.

He has since been in practice dedicated to quality dental care, having a special interest in multi-disciplinary cases that require detailed planning and co-ordination of several specialist branches of dentistry. In 2005 he founded The London Centre for Implant and Aesthetic Dentistry (LCIAD Ltd) in Wimpole Street, at the heart of London’s dental and medical community.

Dr Feran lectures nationally and internationally on surgical and restorative implant dentistry and the training of dental surgeons and nurses for implant practices. In addition, he has held numerous professional positions, including President of the British Academy of Aesthetic Dentistry 2012–14, Treasurer and Executive Committee member 2006–2015 and has been an active member of the European Academy of Aesthetic Dentistry since 2015.

Mr Abbad Toma FRCS (ORL) Consultant Ear, Nose & Throat (ENT) and Facial Plastic Surgeon

Mr Toma is appointed to St George’s Hospital and Kingston Hospital NHS Trusts. From 2001 to 2004 he was Lead Clinician of the Ear, Nose and Throat department at St George’s Hospital. Mr Toma is Honorary consultant to Moorfields Eye Hospital in London, where he advises on joint nasal sinus and eye conditions such as tear duct surgery and thyroid eye disease. As Fellow of the Royal College of Surgeons and Member of the European Academy of Facial Plastic Surgeons, British Rhinological Society and the British Association of Otorhinolaryngology – Head and Neck Surgery, Mr Toma is heavily involved in education at all levels.

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