Maxillary Sinus Lift Procedure
Maxillary sinus spaces are cavities in the upper jaw (Maxilla) on each side of the nose and above your upper back teeth.
The lateral and apical aspects of the supporting bone walls may be destructed as a result of peri-apical infections, and the sinus floor may directly or indirectly become infected and lose its integrity.
Once the apical and lateral aspects of the alveolar bone ridge become deficient, adequate support for the future dental implant’s primary stability and functional capacity can be compromised. Allografts, Xenografts, synthetic bone substitutes, or bone from other areas of the mouth or body is placed into the floor of the sinuses.
Over a period of time, the augmented bone grafts are gradually replaced by new native bone, thus providing a bed into which implants can be placed.
Whatever type of bone grafts is added into the sinuses, it must be left intact for six to nine months to mature before implants are brought into function. Implants can also be placed into the integrated grafts according to a second-stage protocol after the augmented sinus is fully healed after four to nine months.
In most cases the implants are left in the upper arch under the sinus to integrate into the native residual bone bed as well as the grafting materials. The more graft is used to compensate the height shortage, the longer the healing period should be before the implants can be loaded or restored with a crown, bridgework or prosthesis. However, all bone replacement materials are unique based on their sources, structure and resorption profile.
When the residual bone under the sinuses isn’t sufficient to support dental implants, sinus floor elevation (SFE) could be performed to create more bone height. There main approaches have been reported:
1. Indirect (Crestal / Internal/trans-alveolar) SUMMER TECHNIQUE Sinus floor elevation
Indications
- Mild bone loss (only 2–4 mm of extra height is needed).
- Immediate implant placement is required
- Single missing tooth
Benefits
- Minimally invasive, does not require flap surgery
- Shorter healing time required
- Simultaneous implant placement
- Reduced down time in form of discomfort and swelling compared to lateral sinus elevation
Disadvantages
- Localised and limited bone augmentation; not suitable for extensive bone loss
- Increased risk for perforation of thin sinus lining
- Limited indication in multiple implant or complex cases
2. Indirect (Crestal / Internal/trans-alveolar) OSSEODENSIFICATION Sinus Lift (Densah® Burs)
Indications
- Moderate bone height of 4-6 mm is required
- Moderate bone quality and strength is required
- Simultaneous implant placement
- Reduced down time in form of discomfort and swelling compared to lateral sinus elevation
Benefits
- Least invasive SFE technique with modern technology
- Least traumatic to compact and strengthen the residual existing bone; require no bone removal.
- Facilitate simultaneous sinus elevation and implant placement in one procedure
- Accelerated biological healing with less discomfort.
Disadvantages
- Localised and limited bone augmentation; not suitable for extensive bone loss
- Advanced instruments and specialist training is required
- Limited indication in multiple implant or complex cases
3. Direct (Lateral Window) Sinus Lift
Indications
- Advanced bone height loss to create 4–8 mm additional heigh
- Multiple missing sites to be augmented
- Large bone augmentation is required for staged implant placement
Benefits
- Facilitated significant bone height augmentation
- More reliable and versatile technique implemented in complex cases.
- Achieve predictable outcome, well evidenced with long track record with
Disadvantages
- The lateral approach requires flap surgery, hence more invasive surgery
- Longer healing period required before implants are placed
- Prolonged biological healing with more discomfort and down-time.
FAQ: What are the risks and complications involved in sinus lift?
At the time of the procedure: If an infection is found or a large tear in the sinus’ lining occurs, it may be necessary to discontinue the procedure.
Immediately after surgery: Severe complications are infrequent, but most patients will have some swelling and a minority of bruising. Occasionally partial closure of the eye and mild nose bleeds occur. It is not possible to predict who has what after-effects. It is advised to have a home rest for a few days.
Late complications: The possibility of infections of the sinus post-operatively is low. If this does occur and the infection continues after antibiotic treatment, it may be necessary to clean the sinus graft out. A rare complication is the development of a small hole from the sinus into the mouth. This can be treated.
What are the post-operative instructions?
- Avoid blowing your nose for two weeks
- Sneeze through your mouth
- Avoid swimming or flying
- Report nose bleeds or sinus pain or swelling immediately
- Swelling is often worse by the 2nd or 3rd day and may persist for a few days. However, If the swelling persists for more than a week, please contact the clinic immediately.
Antral Complications
Postoperative infection may occur after:
- The insertion of an implant by entering the sinus
- Sinus floor elevation or use of the summers technique, particularly if the Schneiderian membrane’s integrity had been breached (prevalence: 35%), albeit sinusitis prevalence: 5%
Large perforation 🡪 resorbable membrane/fibrin sealant
Very large 🡪 abandon the procedure - Infected graft material; Loss of graft into the sinus; Implant lost (peri-implantitis, late failure)
Symptoms: Facial pain, purulent nasal drainage, foul smell or taste, fever and Sensitivity to palpation of the overlying oral and facial tissues, exacerbated when lowering the head
Diagnosis: Waters’ view radiograph; Fiberoptic nasal antrostomy
The antral area appears cloudy or opaque 🡪active institute therapy: Surgical drainage (antral lavage)
- Purosanguinous material 🡪 antibiotic sensitivity test: Penicillin 500mg qds/ Augmentin 500mg tds., for 7days.
- Decongestant: Ornade spansules, bid. or pseudoefedrine 60mg, qds. /10 d.
- Post. Op. Information.
Dr. Nico Kamosi
Dr. Nico Kamosi
Specialist Periodontist, Implantologist, Prosthodontist, Holistic and Biological Dentist
TDL. DDS. (Swe.), MSc.Perio.(Eng.),
MClinDent.Perio.(Eng.), MSc.Imp.Dent.(Eng.),
Dip.Aesth.Med. (Eng.), MClinDent.Prosth.(Eng.),
Cert., Dip.DHSLM.(RCS.Eng.), Cert.Orth.(Eng.), Cert.Law (Eng.), AIAOMT
Accredited member of IAOMT, SMART Certified
Member of AACD, EFP, AAP, ESCI, IAOMT
