The upper back jaw has traditionally been one of the most difficult areas to successfully place dental implants due to insufficient bone quantity and quality and the close proximity to the sinus or air space in your skull. If you’ve lost bone in that area due to reasons such as periodontal disease or tooth loss, you may be left without enough bone to place implants.
Sinus augmentation can help correct this problem by raising the sinus floor and developing bone for the placement of dental implants. Several techniques can be used to raise the sinus and allow for new bone to form. In one common technique, called a lateral window, an incision is made to expose the bone. Then a small circle is cut into the bone. This bony piece is lifted into the sinus cavity, much like a trap door, and the space underneath is filled with bone graft material. We can explain your options for graft materials, which can regenerate lost bone and tissue.
Why do I need a sinus lift?
The maxillary sinuses are air spaces in our skulls that are important anatomically because if we didn’t have them our heads would be too heavy for our necks to support. These air spaces are like balloons in our skull and are usually found at the end of the roots of the back upper teeth. If you’ve been told you need a dental implant to replace a missing upper back tooth this can potentially be a problem. The upper back jaw has traditionally been one of the most difficult areas to successfully place dental implants because of the possibility of insufficient bone quantity and quality and the close proximity to the sinus or air space. If a tooth has been removed insufficient bone may exist because the roots of your teeth act like tent poles that hold the sinus in position. Once the teeth (or tent poles) are removed the sinus can begin to droop and you no longer have sufficient bone where the teeth used to be and where the implant needs to be placed. If an implant were attempted, it would be like poking a pen into the balloon and popping it. A sinus lift (augmentation) can help correct this problem by raising the sinus floor to its original position and developing bone for the placement of dental implants.
How are sinus lifts done?
Several techniques can be used to raise the sinus and allow for new bone to form. The first technique is called a “lateral window” where an incision is made to expose the bone. A small circle or square outline is cut into the bone and this bony piece swings into the sinus cavity, much like a trap door and becomes the new roof of bone. The space underneath is then filled with some type of bone graft material (see bone grafting on this web site). Finally, the incision is closed and healing is allowed to take place. Depending on your individual needs, the bone usually will be allowed to develop for about three to six months before implants can be placed. On occasion the implant(s) can be placed at the same time as the sinus lift depending on the amount of existing natural bone to hold the implant firmly in place. If there is not enough natural bone, a second surgery will be required to place the dental implants once healing has occurred from the sinus lift.
The second technique used to lift the sinus is called an “osteotome” sinus lift. This type of sinus lift is performed when there is enough bone to place a stable implant but 1-3mm of lifting is needed in order to prevent puncturing the sinus membrane. A hole is drilled and implant site prepared in the area where the implant is to be placed without going into the sinus membrane. Before inserting the implant, bone is placed into the hole and an instrument used to place gentle pressure on the bone which acts like a hydraulic jack to lift the bone, which in turn lifts the membrane. This is repeated several times with the implant itself used as the final instrument to lift the bone and membrane when placed. Sinus lifts (augmentation) have been shown to greatly increase your chances for successful implants that can last for years to come.
What are the risks associated with sinus lifts?
The biggest risk associated with sinus lifts is perforation or puncture of the membrane. If this occurs it can increase the risk of an infection and you will need to be put on an antibiotic for 10 days along with a decongestant and an antihistamine for 3-7 days. This can occur because the sinus lining is very thin and friable and the hole or tear in the membrane can allow bacteria or other foreign matter into the sinus cavity. If you are having an implant placed at the same time you will already have an antibiotic prescribed and will just need the other medications. You may find that you have some bleeding from the nose which can be a common occurrence whether or not the membrane has been punctured. You will be informed following the procedure if a sinus perforation has occurred along with any other necessary instructions and/or precautions. Many patients experience minimal discomfort during this procedure and find that it is a worthwhile way of making dental implants and tooth replacement a reality.