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01-BE-SINUS-LIFT 29 November 2023

Sinus Lift: An Essential Step in Dental Implantology

Lecture : 6 min. par Harmonie Bodyexpert.online

Many patients who’ve lost their molars in the upper jaw lack the bone density needed for dental implants. A Sinus Lift serves as a bone grafting procedure, enabling the placement of implants. Discover how it operates.

What is a Sinus Lift?

A Sinus Lift is a common procedure in dental surgery. It involves grafting bone into the maxillary sinus—a cavity at the upper jaw’s back. This thickens the bone over the molars and premolars, providing a stable base for dentures via dental implants.

During the procedure, the surgeon lifts the delicate membrane that lines the sinus bone to create room for the graft. Conducted under general anaesthesia, the surgery’s duration varies from 30 minutes to 1.5 hours, based on the graft’s complexity. A Sinus Lift is typically scheduled three to six months before implant placement.

Why Undergo a Sinus Lift?

Many patients experience bone loss in the jaw due to tooth loss. When teeth are missing, the bone naturally resorbs and becomes thin. The air pressure within this bony corridor also leads to the thinning and descending of the sinuses. A Sinus Lift fortifies the jawbone, aids in dental implant placement, and elevates the sinus floor. Installing dental implants subsequently restores the jaw’s strength and function, enabling patients to chew effectively once again.

Primary Causes of Bone Loss

Many patients face decreased jawbone density when missing teeth are left unreplaced. The absence of teeth triggers irreversible bone resorption in the jaw, primarily due to a lack of pressure stimulation that eventually results in the bone dissolving into the body.

Bone density loss can also be attributed to periodontal disease. This includes gingivitis (gum inflammation caused by dental plaque), gum recession leading to tooth loosening, and simple or chronic periodontitis (inflammation of tooth-supporting tissues).

Other factors contributing to bone loss encompass accidents, genetic issues (like fluctuating estrogen levels in women during pregnancy or menopause), poor dental hygiene, smoking, and unhealthy eating habits.

Sinus Lift as a Remedy for Bone Loss

The jawbones are crucial in supporting teeth and are closely connected to the facial skeleton, especially the sinuses. Dental implants require adequate bone for effective placement for patients missing some or all of their teeth. A bone graft in the maxillary sinus is necessary when the jawbone lacks sufficient volume. This procedure ensures a secure foundation for the dental implants, which may be placed either during the same session or after a period of 3 to 6 months.

Once secured within the jawbone, the dental implant undergoes osseointegration. This forms a robust and enduring mechanical connection between the implant and jawbone. Following a period of 6 to 9 months to allow for proper implant anchoring, the final stage involves fitting the appropriate dental prosthesis. Choices include dental crowns or All-On 6 dental arches, allowing patients to enjoy life fully.

How Is a Sinus Lift Performed?

Preoperative Assessment: Identifying the Need for a Sinus Lift

During an initial consultation with the implantologist, the necessity for a bone graft is determined based on the jawbone’s thickness and the number and depth of the implants needed. Depending on the evaluation, the surgeon will opt for either an internal or external sinus lift. Generally, the bone graft material is a synthetic biomaterial, serving the same purpose as allogenic (human-sourced) or xenogenic (animal-sourced) bone grafts, but is faster and easier to produce and place.

Internal or External Sinus Lift?

  • External Sinus Lift without a bone base: The bone graft is positioned under the zygomatic bone, and implants are placed after 3 to 6 months.
  • External Sinus Lift with a bone base: A smaller graft is added under the zygomatic bone, and dental implants may be placed during the same procedure.
  • Internal Sinus Lift with a bone base: A bone graft is used to reinforce the maxillary sinus where the dental implants will go. Dental implants can be placed during the same operation.

Key Steps of a Sinus Lift

  • Estimation of the amount of missing bone
  • Incision of the gum and lifting of the membrane
  • Injection of synthetic bone material
  • Placement of the graft and suturing
  • Bone remodeling and calcification
  • Installation of the dental implant

Risks, Potential Complications, and Post-Operative Instructions

Sinus lift surgery is pain-free, as it’s carried out under general anaesthesia. Post-operation, it’s essential to adhere to the instructions provided by the surgical team. Any discomfort can be managed with over-the-counter anti-inflammatory drugs like Ibuprofen or Paracetamol. Swallowing might be challenging for a few days post-surgery, and you may notice swelling and discolouration around the cheekbone area. Oral discomfort usually subsides within about ten days, following stitches’ reabsorption and sutures’ removal. If dental implants were inserted simultaneously with the sinus lift, expect a longer recovery period (2-3 weeks), particularly for resuming normal eating and chewing. Blowing your nose should also be avoided for two to three weeks.

Complications or infections are uncommon but still possible, like any surgical intervention. The primary risk with a sinus lift is puncturing the membrane surrounding the sinus, with a 19% risk in external sinus lifts and a 3.8% risk in internal sinus lifts. If this occurs, the dentist can promptly stitch the opening or apply a dressing. If you experience inflammation, nose or gum bleeding, or persistent pain, consult a dentist immediately. Although rare, it’s also possible for the body to reject the bone graft. While not medically severe, it means working with your dentist to find an alternative to the sinus lift.

Alternatives to Sinus Lift

Dentists can propose several alternatives to traditional dental implants if a sinus lift is not feasible due to medical or financial constraints—especially since the NHS does not cover them.

  • Subperiosteal Implants: Typically screwed into the bone, implants can also be “subperiosteal,” i.e., positioned under the gum tissue. This option is suitable when the jawbone is too thin or if the bone graft is rejected. However, these implants are less stable and less long-lasting.
  • Short Implants: These are smaller than regular implants, measuring 6 to 8 mm compared to the standard 10 to 15 mm. Short implants may reduce both healing time and treatment costs, but they often have a lower success rate for bone integration and may require additional implants.
  • Anteriorly Placed Implants: This approach involves replacing fewer teeth with prostheses affixed to a bridge or denture, which is anchored by implants placed further forward in the jawbone or attached to existing teeth. While this avoids the maxillary sinus, a bone graft may still be needed for the anterior implants. However, this alternative has less chewing strength and durability than maxillary sinus implants.
  • Zygomatic Implants: These long implants, ranging from 30 to 50 mm, are inserted into the zygomatic bone, providing stable and durable anchorage. The main advantage is speed, as both implants and dentures can be installed in a single session. These implants offer similar success rates and stability to regular implants but are more complex to install.
  • Bridges Attached to Adjacent Teeth: To replace missing molars without implants, it is possible to adhere one or two artificial teeth directly to the existing front teeth (resin bridge), or place a bridge made of ceramic dental crowns that are fixed to existing teeth. This solution is less comfortable, durable, and stable than implants and doesn’t halt bone resorption.
  • Removable Dentures: The last resort for those who can’t or don’t want implants or bridges. These dentures allow for the replacement of missing teeth and are partially covered by the NHS. However, they are much less comfortable and durable than implant-supported dentures and require removal and cleaning after each meal and also while sleeping.

Sinus Lift: price comparison

  • Price of a Sinus Lift in the UK : £600 to £3000
  • Price of a Sinus Lift in the US: $1000 to $2500
  • Price of a Sinus Lift in Spain : €500 to €800
  • Price of a Sinus Lift in Turkey: between €350 and €500

Sinus Lift Refund

In the UK, the NHS does not cover Sinus Lifts unless in severe cases such as reconstructive surgery, after major face trauma or head/neck cancer. Some mutual insurance companies may offer partial reimbursement, provided you have taken out a specific policy covering major dental services. In the US, Medicare can cover a Sinus Lift operation only if it is considered medically necessary.

Why Choose Turkey for Sinus Lift

Turkey has become a hub for dental tourism, largely because of its high-quality medical infrastructure, cutting-edge technology, skilled implant surgeons, quick treatment times, and cost-effective pricing. It’s essential to pick a reputable dental clinic, preferably through a specialised and accredited agency like Body Expert. They ensure the quality and safety of dental services. Popular destinations for dental treatments in Turkey include Istanbul, the country’s cultural and economic capital, and the Mediterranean city of Antalya. Both have an international reputation and quality tourism and medical infrastructure that draw patients from around the globe.

Patient testimonials – Before and after photos

SOURCES

Bathla, S. C., Fry, R. R., & Majumdar, K. (2018). Maxillary sinus augmentation. Journal of Indian Society of Periodontology, 22(6), 468–473. https://doi.org/10.4103/jisp.jisp_236_18

Pal, U. S., Sharma, N. K., Singh, R. K., Mahammad, S., Mehrotra, D., Singh, N., & Mandhyan, D. (2012). Direct vs. indirect sinus lift procedure: A comparison. National journal of maxillofacial surgery, 3(1), 31–37. https://doi.org/10.4103/0975-5950.102148

Schiavon, L., Perini, A., Brunello, G. et al. The bone lid technique in lateral sinus lift: a systematic review and meta-analysis. Int J Implant Dent 8, 33 (2022). https://doi.org/10.1186/s40729-022-00433-3

Roberto Pistilli, Luigi Canullo, Paolo Pesce, Valeria Pistilli, Vito Carlo Alberto Caponio, Luca Sbricoli, Guided implant surgery and sinus lift in severely resorbed maxillae: A retrospective clinical study with up to 10 years of follow-up, Journal of Dentistry, Volume 121, 2022,104137, ISSN 0300-5712, https://doi.org/10.1016/j.jdent.2022.104137

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