Sinus Lift (Sinus Augmentation)

What types of sinus lift procedures are available?

There are two main groups of procedures based on the amount of existing bone at the planned implant site:

1a) External approach without existing bone

Grafting material will be added from the cheek side of your sinus to raise the membrane. The dental implant will not normally be placed until the bone has healed, and you will need another surgical procedure for this.

1b) External approach with some existing bone

Grafting material will be added from the cheek side of your sinus to raise the membrane. Your dental implant can be placed at the same time.

2) Internal approach with some existing bone

Your sinus will be raised by gently tapping through the implant preparation site in your mouth. Grafting material might be pushed through the implant preparation site and your dental implant will be placed at the same time.

What grafting materials are used in sinus lift procedures?

Bone grafting materials from yourself, other human, animal, and synthetic sources are available. The graft material creates a scaffold for your own bone to grow into. This process may take four to 12 months.

The most commonly used material used in sinus lifts is called Bio-Oss. This artificial sterilised bone comes from cattle and is treated to make it safe for use in humans. Additionally, a membrane patch may be placed over the bone graft to protect it.

The most commonly used membrane for sinus lift is Bio-Gide, which is dissolvable. This artificial membrane comes from porcine (pig) origin. Your surgeon will explain which products they intend to use for your sinus lift.

If you have any concerns about use of animal-based products, please discuss them with your surgeon.

What are the risks of sinus lift procedures?

In normal healing, you should expect:

• pain to be controlled with simple painkillers such as ibuprofen and paracetamol
• swelling to be at its worst after two days
• bruising over the cheek and spreading over lower jaw
• to feel better after stitches are removed in 10 days’ time
• to feel back to normal after two to three weeks

Problems that may happen straight away

• The main risk is that the membrane could puncture or tear (19% chance in external approach and 3.8% chance in internal approach). The surgeon will either stitch the sinus tear or place a patch over it. If the repair is not successful, your surgeon may stop the procedure and give the puncture or tear time to heal.
• Your dentist can redo the sinus lift when the membrane has healed. Healing usually takes a few months. A healed membrane tends to be thicker and stronger, which means a second attempt at a sinus lift is likely to be successful.
• Swelling.
• Numbness from local anaesthetic.
• Pain.
• Bleeding. This could include a nose bleed.
• Your sinuses may feel ‘full’ or ‘blocked’ for some weeks after the surgery.
• Vertigo (this is rare, and temporary).

Problems that may happen later

• infection (2.9% chance in external approach and 0.8% chance in internal approach)
• graft exposure (3%)
• facial pain and swelling after two to seven days
• severe facial bruising appearing after one to three days
• no graft present after maturation phase. The risk of failure is higher in some people, especially in smokers. Your surgeon will tell you if they think your risk of failure is higher than normal (1.9% chance in external approach)
• insufficient bone generated for implant placement (1%)

Problems that are rare, but serious

• Numbness over the cheek and upper gums and teeth on the side the procedure was performed immediately after surgery. This is usually temporary but, very rarely, can be permanent.
• A communication between the sinus and mouth.
• Longer term infection necessitating graft removal.

Minimising the risks

• Use painkillers to ease discomfort.
• Don’t blow your nose for two weeks after the procedure.
• Take menthol inhalations with hot water three times a day for ten days.
• Use any specified prescribed medications, such as antibiotics and decongestants, after the procedure.

What will happen if I choose not to have a sinus lift procedure?

Conventional dental implants may not be possible towards the back of the upper jaw. Sinus lift surgery is completely elective and, after considering the possible alternatives (see below) the decision to proceed is entirely yours. Your dentist will discuss all the options to replace your missing teeth again including a denture or a bridge, and the option of no tooth replacement, so that you can decide how to proceed.

What alternatives are available?

The most common alternatives to sinus lifts include the following.

A shorter implant

• This requires enough bone to be available without needing a sinus lift.
• The risk of implant failure increases as the implant length decreases.
• Multiple short implants might be an alternative.
• Although the success rates are good, the risk of complications is potentially higher with shorter implants compared to those with longer implants placed in sinus augmented sites.

Fewer implants which are placed further forward

• This either replaces fewer teeth on a bridge fixed onto the implants, or replaces teeth on a removable denture that clips onto the implants.
• The sinus lift is avoided but you may need grafting around the other implant sites.
• Fewer implants usually mean more biting and chewing forces happen through the implants, which can potentially lead to more frequent complications of both the bridges/dentures and implants. This can be particularly difficult if you have a heavy bite or clench or grind your teeth.
• Angled implants might be placed next to your sinus to avoid a sinus lift and can be restored with removable dentures or fixed bridges in your mouth.
• These implants have similar survival and success results compared with conventional implants after five years.

Bridges fixed on adjacent teeth

This approach includes either gluing directly onto the adjacent tooth or teeth (resin bridges), or filing down the adjacent tooth/teeth for crowns (conventional bridges). The decision is based on the length of the span, the quality of available tooth structure on the adjacent teeth, the bite, and the root canal/pulp status. Usually only one or two teeth can be replaced on a bridge.

Dentures

If implants and bridges won’t work for you, your missing teeth can be replaced on a removable denture. Dentures should be removed after eating for cleaning, and should not be worn overnight.

Zygomatic and pterygoid implants

These are placed into facial bones that lie behind the upper jaw. They are long and angled so that they enter the mouth for restoration on either removable dentures or fixed bridges. The surgery is more complicated compared with conventional dental implant placement and not all surgeons can provide it.

No tooth replacement

If there are sufficient functional teeth in the mouth it might be better to accept the gap.

How should I prepare for sinus lift procedures?

Please:

• Eat and drink as normal before procedures with local anaesthetic and sedation.
• Take your usual medications.
• Take the same painkillers you would take for headaches, e.g. Ibuprofen, before the sinus lift.
• Bring any retainers your dentist gave you to wear during your scan before the sinus lift.
• Arrive by your allotted appointment time.

Most sinus lift procedures are performed with you awake using local anaesthesia to numb the area. Sedation with local anaesthetic, or use of general anaesthetic, are used only when surgery will be difficult or when multiple procedures are required.

The procedure may take 45 minutes to two hours to perform depending on the complexity. We might give you antibiotics just before the sinus lift. You will not need to arrange an escort to take you home unless sedation or general anaesthetic is used.

Asking for your consent

We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with treatment, by law we must ask for your consent and will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves.

Staff will explain the risks, benefits and alternatives before they ask you to sign a consent form. If you are unsure about any aspect of your proposed treatment, please do not hesitate to speak with a senior member of staff.

What happens during a sinus lift procedure?

The surgery is normally done under local anaesthetic as an outpatient and is not normally painful.

Your surgeon will make a cut in the gum where your back teeth used to be.

In an external sinus lift, a small window is then opened in the bone. The lining of your sinus is gently pushed up and away from your jaw. Bone is packed in below the sinus. A membrane patch might be placed over the bone graft in the external approach. When the bone is in place the gum is closed with dissolvable stitches. The sinus lift is then allowed to mesh with your own bone, which can take 4-9 months, before placing dental implants. The amount of time depends on the amount of bone needed, and the graft material used.

In the internal approach your dentist will prepare the bone for implant placement and will gently tap up the bone under your sinus. Bone graft material will be packed into the space between the sinus lining and the jaw bone. This is done at the same time as implant placement where only around 3mm of extra bone height is required.