IMPLANT AND SURGERY
Sinus Lifting
Gaining bone height for an implant in the upper jaw back region
Provided at our clinic in Altunizade, Üsküdar (Istanbul).
IN SHORT
In the back region of the upper jaw, just above the roots of the teeth, there is an air cavity called the sinus. When the teeth in this area are lost, the bone both resorbs from below and the sinus cavity expands downwards; there is not enough bone height left for an implant. Sinus lifting is the procedure of lifting the membrane covering the sinus upwards and placing a graft beneath it. It has two techniques; which one is applied is determined according to the existing bone height.
What is the sinus and why does it cause a problem?
The maxillary sinus is an air-filled cavity located within the upper jawbone. There is one on each side of the face. Its base is adjacent to the roots of the upper back teeth. When the teeth in this area are lost, two processes take place at the same time:
The bone resorbs from below. The stimulus that the tooth root sends to the bone disappears.
The sinus cavity expands downwards. This is the natural tendency of the sinus.
The result: the bone height into which an implant can be placed decreases rapidly. The upper jaw back region is the area in the mouth where bone insufficiency is seen most often. In addition, the bone in this region is softer than in the lower jaw; this also makes the initial anchorage of the implant more difficult.
How is sinus lifting done?
The inner surface of the sinus is lined with a thin membrane (the Schneiderian membrane). This membrane separates the sinus cavity from the bone.
In the sinus lifting procedure, this membrane is carefully separated from the bone and lifted upwards. Graft material is placed in the space formed beneath the membrane. Over time, new bone forms in this area and provides sufficient height for the implant.
Not tearing the membrane is the most critical point of the procedure.
Imaging
A panoramic X-ray gives an initial assessment of the existing bone height. However, the true shape of the sinus, whether it contains a septum, and the thickness of the membrane cannot be fully assessed on a two-dimensional image.
For this reason, three-dimensional imaging is requested in cases where sinus lifting is planned. Septa within the sinus are the most important anatomical variable that increases the risk of membrane tearing, and they are only seen on a three-dimensional image.
Who is it not suitable for? In which cases does the risk increase?
Active sinusitis or a sinus infection. It must be treated first; if necessary, an ear, nose and throat assessment is requested.
The presence of a cyst, polyp or other pathology within the sinus.
Heavy smoking. It impairs the function of the sinus mucosa and increases the risk of graft failure.
Uncontrolled diabetes.
Use of bisphosphonate-type medication or a history of radiotherapy to the area.
Chronic allergic rhinitis. It requires assessment.
In some cases, instead of sinus lifting, the placement of angled implants into areas where the bone is sufficient (methods such as All-on-4) can be considered. This is an option that reduces the surgical scope and should be discussed together during the examination.
Post-procedure rules — pay attention here
After sinus lifting, every movement that creates pressure within the sinus is prohibited. Pressure can cause the graft to shift and the membrane to tear. During the first 2–3 weeks:
Do not blow your nose. This is the most important rule. If there is nasal congestion, consult your dentist; it can be wiped gently but not blown.
Keep your mouth open when sneezing. Sneezing with a closed mouth creates pressure in the sinus.
Do not drink through a straw.
Do not smoke.
Do not play a wind instrument or blow up a balloon.
Do not lift heavy objects or do exercises where the face is downwards.
Consult your dentist about air travel and diving.
Although these rules may seem ordinary, the most common cause of graft loss after sinus lifting is failure to follow them.
Healing
In the first days, swelling, bruising and tenderness are expected findings. A nosebleed or a small amount of blood-tinged discharge from the nose may be seen; this is usually normal.
Bone formation usually takes 4–9 months. At the end of this period a radiographic assessment is made and, if sufficient bone has formed, the implant is placed. If the implant was placed in the same session with the closed technique, a further 3–6 months is awaited for osseointegration.
Risks and possible complications
Tearing of the sinus membrane. This is the most common complication. Small tears can be repaired during the procedure and the procedure can continue. With large tears the procedure is ended and repeated after healing.
Sinusitis. It can develop after the procedure; it requires treatment.
Infection and graft loss.
Nosebleed.
Escape of graft material into the sinus cavity.
Swelling and bruising. These are expected findings; they may last a few days on that side of the face.
A tear of the sinus membrane does not mean the procedure has failed; in most cases it is a manageable situation. However, the presence of a septum within the sinus increases this risk — for this reason it is important to assess it beforehand with three-dimensional imaging.
The two techniques: open and closed
Sinus lifting is done with two techniques. The only decisive factor is the existing bone height. If there is sufficient bone, the closed technique can be applied and the implant can be placed in the same session; if the bone is scarce, the open technique is needed and the implant is most often placed in a separate session. The types of graft material used are described on the Bone Powder (Graft) page.
Compare the options
| Closed technique (crestal) | Open technique (lateral window) | |
|---|---|---|
| How it is done | The sinus floor is pushed up through the implant socket. | A window is opened in the side wall of the jaw to reach the sinus. |
| Existing bone | Usually 5–6 mm or more is required. | Can also be applied where there is less bone. |
| Height gained | Limited (usually a few mm). | Greater. |
| Implant | Most often placed in the same session. | Most often in a separate session, after healing. |
| Surgical scope | More limited. | Wider. |
| Swelling after healing | Less. | More pronounced. |
| Total time | Shorter. | Longer (graft healing 4–9 months + implant fusion). |
Which option is suitable is decided together after an intraoral examination.
Frequently Asked Questions
The procedure is carried out under local anaesthesia and no pain is felt during it. Afterwards, swelling, bruising and tenderness lasting a few days are expected findings. With the open technique the swelling may be more pronounced.
No. The nose should not be blown for the first 2–3 weeks. Blowing the nose creates pressure within the sinus and can cause the graft to shift or the membrane to tear. When sneezing, the mouth should be kept open, a straw should not be used, and smoking should be avoided. The most common cause of graft loss after sinus lifting is failure to follow these rules.
Bone formation usually takes 4–9 months. At the end of this period a radiographic assessment is made and, if sufficient bone has formed, the implant is placed. If the implant was placed in the same session with the closed technique, a further 3–6 months is awaited for fusion.
Tearing of the membrane is the most common complication of the sinus lifting procedure. Small tears can be repaired during the procedure and the procedure is continued. With large tears the procedure is ended and repeated after healing. This does not mean the procedure has failed.
In some cases it is possible. Placing angled implants into areas where the bone is sufficient (methods such as All-on-4) can make it possible to avoid the sinus region. Whether this option is suitable is assessed according to the bone volume and the number of missing teeth.
The procedure is not carried out while active sinusitis or a sinus infection is present. It must be treated first; in cases deemed necessary, an ear, nose and throat assessment is requested. Chronic allergic rhinitis should also be assessed separately.
The pressure change during a flight affects the sinus. You need to consult your dentist about air travel and diving after the procedure.
A small amount of blood-tinged discharge from the nose in the first days is usually normal. However, if the bleeding is heavy, does not stop or is increasing, you should contact the clinic.
Related treatments
The content on this site is for information only and does not replace a clinical examination. The suitability, duration and scope of treatment are determined after a clinical assessment.
This content was prepared by Dt. Mevlüt Yazıcı.
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Altes Diş Kliniği
Altunizade, Üsküdar, İstanbul
- PHONE+90 533 474 43 94
- EMAIL[email protected]
- ADDRESSAlperen İş Merkezi, Valide-i Atik Mahallesi, Altunizade, Nuhkuyusu Cd D:191/B, 34664 Üsküdar/İstanbul
- WORKING HOURSWeekdays 10:00–19:00 · Saturday 10:00–16:00 · Sunday closed