Sinus Lift as a Separate Procedure
As discussed in the previous section, if less than 5 millimeters of bone is available under the sinus, a sinus lift as a separate procedure is often necessary. After local anesthesia is administered, the gum tissue is pushed back and a “window” is made in the front side of the jawbone adjacent to the maxillary sinus that needs modifying. Next, the sinus membrane is gently raised using special instruments, and a bone graft material is placed. Usually a resorbable membrane is placed over the opening, and the gum tissue is sutured closed. It usually requires six to nine months of healing before implants can be placed.
Antibiotics and antihistamines are often prescribed before surgery to allow them to begin circulating in the bloodstream to decrease the chances of sinusitis and infection.
The most common complication that can occur with sinus elevating augmentation is perforation of the sinus membrane. Research shows this complication can occur from 10 percent to 60 percent of the time. The membrane varies in thickness, but is generally only 0.3 to 0.8 millimeters.
A variety of techniques can be used to manage these perforations, all of which can typically be performed and the sinus lift successfully completed. These include using sutures, collagen membranes, fibrin sealants, or freeze-dried human bone sheets.
All these techniques involve repair of sinus membrane perforations that range in size from 2 millimeters to 1.5 centimeters. Typically a collagen membrane is placed over the perforation to prevent any grafting material from entering the sinus cavity. If the perforation is larger than 1.5 centimeters, the surgical site is closed and the body is allowed to heal (usually for two to three months) before entering the site again.
Researchers have noted a potentially helpful side effect of a sinus lift procedure. The ostium is a 7 to 10 millimeter long passage located at the top of the sinus that allows for drainage of fluids. Because the level of the sinus is raised, the distance the fluid
in the sinus has to travel to reach the ostium is decreased, thus making drainage easier. We have actually had patients with persistent sinus trouble tell us the sinus lift procedure has eradicated their sinus issues!
Maxillary sinus anatomy
If you are considering a sinus lift procedure and have sinus trouble such as a chronic irritation, cysts, or polyps, it is imperative that you inform your periodontist. Usually, a referral to a local ear, nose, and throat doctor is recommended to ensure the sinus is in good enough condition to be raised.
Questions to ask if you are considering a sinus lift:
- What are some of the complications of the surgery?
- What happens if there is a tear in the sinus?
- How long will the implants take to heal after they are placed in the grafted bone?