Sinus Lift Surgery: What It Is and Why You May Need It

Sinus Lift Surgery, Sinus Augmentation, or sinus graft is an invasive procedure to add bone in the maxilla by lifting the overlying sinus. Dentists advise a sinus lift surgery to secure dental implants in the maxilla where there is insufficient bone available. According to a study, the prevalence of sinus lift surgery performed in implant placements was found to be around 38%.¹Tomruk, C. O., Sençift, M. K., & Capar, G. D. (2016). Prevalence of sinus floor elevation procedures and survival rates of implants placed in the posterior maxilla. Biotechnology & Biotechnological Equipment, 30(1), 134-139. A sinus lift operation is done by an oral surgeon or a periodontist. Let’s find out about the procedure, techniques, and recovery of a sinus lift surgery.

Who needs a Sinus Lift Surgery?

Patients who need a dental implant in the posterior (back) maxillary (upper jaw) region often need a sinus augmentation surgery. Sinuses are hollow, air-filled cavities located between the skull bones. The maxillary sinuses (pair) are the largest sinuses of the cranium and rest right above the upper jaw.

Over time, some people experience enlargement of the sinuses, i.e., sinus pneumatization. Research shows that the maxillary sinus pneumatization leads to significant decreases in the average maxillary bone height and density at the edentulous sites.²Elsayed, S. A., Alassaf, M. S., Elboraey, M. O., Mohamado, L. L., Huwaykim, D. A., Albouq, A. K., … & Huwaykim, D. (2023). The impact of maxillary sinus pneumatization on the quality of the alveolar bone in dentated and edentulous patients: a cone-beam computed tomography radiographic analysis. Cureus, 15(9). Thus, to improve bone quality and secure the sinus from rupturing during implant placement, doctors opt for sinus lift surgeries.

At times, there is a combination of problems in the posterior maxillary region that warrants a sinus lift procedure. While sinus pneumatization takes more space than usual, severe periodontal disease, cancer, and birth defects contribute to excessive bone loss. Both of the medical issues lead to poor bone quality and close proximity of the maxillary sinus.³Misch CE. Contemporary Implant Dentistry. 3rd ed. Mosby Elsevier; 2008.

Contraindications For Sinus Lift

There are no definitive contraindications for sinus lift. However, certain conditions and habits negatively impact the treatment outcomes. So, doctors do not prefer patients with the following conditions:

• Uncontrolled diabetes mellitus
• Poor oral hygiene
• Severe periodontal disease (gingivitis or periodontitis)
• Lifestyle habits like drug addiction, smoking, and alcohol

Sinus Lift Surgery Procedure

After careful analysis/examination of your ridge and workups based on radiographs (orthopantomogram or OPG X-rays, CT scans), your doctor will perform the sinus lift procedure. The procedure comprises two steps, i.e., sinus lifting and bone grafting. Some doctors prefer placing an implant simultaneously because, in several cases, most of the bone graft material resorbs if implant placement is delayed. Only if the bone height is less than 2mm that the doctors decide to delay implant placement to a later time.

Anesthesia:

The doctor gives you local anesthesia or puts you under conscious sedation to make the procedure pain-free.

Doctors can adopt different approaches for this purpose:

External Approach:

As the name indicates, the lateral approach targets the lateral wall of the sinus. The doctor creates a window from the lateral side (above the posterior teeth). At first, the doctor creates an incision in the gum and then carefully removes a small portion of the bone without harming the sinus membrane (called the Schneiderian membrane). After gaining access to the sinus, the surgeon softly and carefully lifts the sinus with special sinus lift surgical instruments. He then adds bone graft (allograft, xenograft, or autograft) to the site and seals the location by stitching together the incised gingiva. You can learn more about bone grafts by clicking here! As it involves opening up the bone from a lateral position, the process is also called open sinus lift.

Internal Approach:

In this procedure, doctors access the sinus through the tooth-bearing area, i.e, the alveolar crest. Also known as the crestal approach, in this technique, the surgeon creates a deep hole in the alveolus and exposes the sinus membrane.⁴Soltan M, Smiler DG. The use of the hydraulic sinus condensing technique as an alternative to the lateral sinus lift technique. J Oral Implantol. 2005;31(2):73–81. In the internal or closed sinus lift, surgeons can use multiple methods, including:

• Sinus floor elevation with an inflatable balloon: A balloon is added to lift the delicate sinus membrane into the cavity, which is followed by the addition of bone.
• Bone added osteotome sinus floor elevation (BAOSFE): A special set of instruments called osteotomes is used to lift the sinus floor, followed by the addition of bone graft material.⁵Summers RB. A new concept in maxillary implant surgery: The osteotome technique. Compendium. 1994;15(2):152–162.
• Crestal approach sinus (CAS) kit: It is an advanced and minimally invasive way of lifting the sinus. Doctors across the globe use specially designed crestal approach sinus kits, which have precise drills and osteotomes for controlled sinus elevations.

Studies show that the CAS kit and balloon elevation offer greater safety in sinus lifting than BAOSFE.⁶Yassin Alsabbagh, A., Alsabbagh, M. M., Darjazini Nahas, B., & Rajih, S. (2017). Comparison of three different methods of internal sinus lifting for elevation heights of 7 mm: an ex vivo study. International journal of implant dentistry, 3, 1-7. The doctor closes the incision with sutures after lifting the sinus and placing the bone grafts. In the majority of cases, oral surgeons/periodontists place dental implants simultaneously with sinus lift procedures.

Sinus Lift Surgery Recovery

Typically, it takes several weeks for substantial healing to take place. However, full recovery generally takes six months or even longer. During the recovery period, you can notice the following:

First Week:

During the first few days, you might notice some swelling and associated post-op pain. The symptoms can be easily managed with medications (over-the-counter pain killers) and ice packs.

First Month:

In the first month, the swelling and bruising subsides. Patients can resume normal activities, but underlying bone healing continues during this period.

Sinus Lift Surgery Aftercare

To ensure quick and uneventful healing, you should follow these steps:⁷AAOMS. Sinus lift patient care instructions. [Available on AAOMS.org under patient resources.]

• Strictly follow your doctor’s instructions and take your medicines regularly.
• Use ice packs during the first couple of days to alleviate swelling.
• Avoid strenuous activities during the first week.
• To ensure good healing, shift to a softer diet (cheese, pasta, yogurt, etc.) for a couple of weeks.
• Avoid vigorous nose blowing as it may dislodge the bone graft.
• Avoid hard brushing to prevent bleeding.

Sinus Lift Surgery Complications

The most common complication associated with sinus augmentation is perforation of the Schneiderian membrane. The membrane lining the maxillary sinus is very delicate and prone to rupturing during surgery. A study found that the prevalence of sinus membrane perforation in sinus lift elevation procedures was 27.6%. If this happens, you may experience excessive nasal discharge or bleeding. The unnatural communication between the oral and the nasal cavities leads to air escaping from the mouth. Perforations increase the risk of sinusitis/sinus infections and delayed healing. Small perforations do not need any intervention and heal on their own. However, doctors seal large perforations surgically.⁸Esposito M, et al. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. Cochrane Database Syst Rev. 2014;(5):CD008397.

Sinus Lift Surgery Alternatives

If unfeasible, your doctor will try to find alternatives for the sinus lift surgery. To avoid a sinus lift surgery, your doctor may offer you short implants (less than 8mm in size) to adjust to the available space. You can also get a wide-body implant that provides greater surface area. This allows better adherence of the implant to the bone.
If the bone quality is very poor and sinus lift surgery can’t be performed, your dentist may go for some other type of prosthesis (like dentures or bridges).

Wrapping Up

A sinus lift surgery is an invasive procedure to increase the thickness of the bone when placing an implant in the posterior maxilla (upper jaw). Pneumatization (enlargement) of the sinus and loss of tooth (especially due to periodontitis) reduce the space between the alveolar bone and the sinus. This makes implant placement without sinus rupture almost impossible. Thus, doctors lift the sinus and push it away from the alveolar bone.

There are different approaches for sinus augmentation. In the lateral (open) approach, the surgeon makes a window in the maxillary bone and lifts the sinus while adding bone graft material in the area created by sinus lifting. In the closed (crestal) approach, doctors augment the sinus from the alveolar bone using an inflatable balloon or specialized instruments called osteotomes. Crestal approach sinus (CAS) kit has been shown to do the job well. Basic healing of the wound takes a few weeks, but complete recovery may take several months. Sinus membrane perforation is the most common complication, which is managed surgically if large in size.

Refrences

• 1
  Tomruk, C. O., Sençift, M. K., & Capar, G. D. (2016). Prevalence of sinus floor elevation procedures and survival rates of implants placed in the posterior maxilla. Biotechnology & Biotechnological Equipment, 30(1), 134-139.
• 2
  Elsayed, S. A., Alassaf, M. S., Elboraey, M. O., Mohamado, L. L., Huwaykim, D. A., Albouq, A. K., … & Huwaykim, D. (2023). The impact of maxillary sinus pneumatization on the quality of the alveolar bone in dentated and edentulous patients: a cone-beam computed tomography radiographic analysis. Cureus, 15(9).
• 3
  Misch CE. Contemporary Implant Dentistry. 3rd ed. Mosby Elsevier; 2008.
• 4
  Soltan M, Smiler DG. The use of the hydraulic sinus condensing technique as an alternative to the lateral sinus lift technique. J Oral Implantol. 2005;31(2):73–81.
• 5
  Summers RB. A new concept in maxillary implant surgery: The osteotome technique. Compendium. 1994;15(2):152–162.
• 6
  Yassin Alsabbagh, A., Alsabbagh, M. M., Darjazini Nahas, B., & Rajih, S. (2017). Comparison of three different methods of internal sinus lifting for elevation heights of 7 mm: an ex vivo study. International journal of implant dentistry, 3, 1-7.
• 7
  AAOMS. Sinus lift patient care instructions. [Available on AAOMS.org under patient resources.]
• 8
  Esposito M, et al. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. Cochrane Database Syst Rev. 2014;(5):CD008397.