Sinus Lift

WHY THE UPPER BACK JAW IS DIFFERENT

Directly above the roots of your upper back teeth sit the maxillary sinuses — two air-filled spaces within the bones of the face, one on each side, lined with a thin membrane.

In most people these sinuses sit close to the tooth roots, and the layer of bone separating them is naturally thin. When an upper back tooth is lost, two things happen at once. The ridge below shrinks, as it does anywhere a tooth has been removed. And the sinus above tends to expand downwards into the space the root used to occupy.

The result is that the upper back jaw is the single most common place in the mouth where there is not enough bone height for an implant — and the longer a tooth has been missing, the more likely that is.

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WHAT THE PROCEDURE DOES

The sinus itself is not removed or altered. What happens is that the membrane lining the floor of the sinus is gently lifted upwards, and graft material is placed into the space created underneath it.

Over the following months that material becomes living bone, and the floor of the sinus has effectively been raised. The implant is then placed into the new bone height.

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THE TWO TECHNIQUES

The crestal, or internal, sinus lift is used where only a small amount of extra height is needed — generally a few millimetres. The approach is made through the same channel prepared for the implant itself, the sinus floor is raised from below, graft material is introduced, and in many cases the implant is placed at the same appointment. It is the less invasive of the two.

The lateral window sinus lift is used where more height is required. A small opening is made in the bone at the side of the jaw, above the gum line, giving direct access to the sinus membrane. The membrane is lifted and the space filled with graft material. The implant may be placed at the same time or after a healing period, depending on how much bone was there to begin with.

Which technique is appropriate is decided from a three-dimensional scan, which shows the height of the available bone, the shape of the sinus and the position of the blood vessels in the area.

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WHAT TO EXPECT AFTERWARDS

A sinus lift is usually carried out under local anaesthetic. Sedation or general anaesthesia may be used where the case is larger or the patient prefers it.

Swelling is normal and tends to peak two or three days afterwards. Bruising on the cheek is common after a lateral window lift. Some people notice a small amount of blood when they blow their nose in the first days, which is expected.

The instructions given afterwards are specific to this procedure and matter more than usual, because the aim is to avoid pressure changes in the sinus while the graft settles. They typically include not blowing your nose, sneezing with your mouth open, avoiding straws, not flying for a short period, and avoiding heavy lifting and strenuous exercise. Your surgeon will tell you how long each applies for.

Antibiotics and sometimes a decongestant are often prescribed.

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HEALING TIME

The graft material placed under the sinus membrane needs time to become living bone before it can support an implant under chewing load.

Where the implant has been placed at the same time, it heals alongside the graft. Where it has not, several months of healing are generally needed before the implant can be placed — the exact time depends on how much bone was there at the start and how much was added.

Your surgeon will confirm the healing is complete with a scan before proceeding.

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WHEN A SINUS LIFT IS NOT SUITABLE

A sinus lift is a well-established procedure, but it is not for every patient or every sinus.

Active sinus infection or inflammation needs to be resolved first. Some anatomical findings on the scan — a very thin or scarred membrane, a bony partition inside the sinus, or the position of certain blood vessels — change the plan or the technique. A history of sinus surgery, chronic sinusitis, or nasal conditions that affect drainage may require an ear, nose and throat opinion before proceeding.

Smoking significantly increases the risk of complications, as it does for all bone grafting.

There are also alternatives. Shorter implants, implants placed at an angle to avoid the sinus, or zygomatic implants anchored in the cheekbone can in some cases make treatment possible without lifting the sinus at all.

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POSSIBLE COMPLICATIONS

The most common one is a small tear in the sinus membrane during the procedure. This is well recognised, usually repaired at the time, and in most cases does not prevent the graft from being completed — although occasionally the procedure is stopped and rescheduled to allow the membrane to heal.

Less commonly, infection of the graft or a sinus infection can occur afterwards, which is why the post-operative instructions and any prescribed medication matter.

As with any bone graft, the graft can fail to integrate, in which case the procedure can generally be repeated.

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QUESTIONS PATIENTS ASK

Will it change my breathing or my voice? No. The sinus is not entered in the sense of being opened into the airway, and the space is not reduced in a way that affects how you breathe or sound.

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Will I feel it in my sinus afterwards? Most people describe pressure and congestion on that side for a few days, similar to a cold, rather than pain in the sinus itself.

 

Can I fly afterwards? Not immediately. Pressure changes are exactly what the aftercare is designed to avoid in the early days. Your surgeon will tell you how long to wait, and if you have travelled for treatment this needs to be planned before you book.

 

Is it done on both sides at once? It can be, where both sides need it.

 

How long before I have my implant? Where the implant is placed at the same appointment, there is no additional wait beyond the usual healing. Where it is not, several months are generally needed.

 

Is it painful? The procedure is carried out under anaesthetic. Afterwards, most people describe swelling and pressure rather than significant pain, and ordinary painkillers are usually sufficient.

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