Sinus lift - Raising the bottom of the sinus
Sinus lift is an oral-surgical procedure for raising the bottom of the sinus for the purpose of upgrading the bone required for the implantation of dental implants. If the patient opts for an implant-prosthetic solution to treat edentulousness in the upper jaw, one of the common obstacles is bone deficiency in the lateral region. This is where the maxillary sinuses are located, and if a long period of time has passed since tooth extraction, the sinus can cause bone resorption by pneumatization.
The aim of the procedure is to fill a part of the sinus cavity with biomaterial that will over time ossify and form a solid foundation for future implants. Such a partially filled sinus will have no adverse effect on the physiological functions of the sinus and the health of the patient.
The implant must be embedded in the bone the entire length of it. Therefore, depending on the amount of bone available, the operation of raising the bottom of the sinus can be divided into osteotomy and standard sinus lift. Also, implants can be placed on the eve of the sinus lift itself and we also have delayed implantation, after 6-9 months depending on the situation.
Osteotomic sinus lift
This technique is performed at the same time as implant placement. The osteotomic technique is named after the instrument used to raise the sinus. The procedure is performed when we have sufficient bone volume to fit the implant, but it still lacks about 2 mm to the full length of the implant. With the osteotome, which is the same diameter as the implant, gently lift the sinus membrane and fill the space before implant placement with artificial bone that will bone together with the implant during the required osseointegration period before placement of crowns or bridges.
Standard sinus lift
When a larger bone volume is missing, a lateral approach is called the lateral window technique. The procedure is still performed in the oral cavity so nothing is visible on the patient's face. If the available amount of bone allows for a stable implant placement, the implantation of the bottom of the sinus involves simultaneous implant placement. If the bone is missing to such an extent that the implant cannot be stabilized, there is a delayed implant sinus lift, otherwise there is a high risk of implant loss and a failed sinus lift with numerous complications such as sinus inflammation, fertilization and the like. Therefore, it is best for the oral surgeon to know individually what type of surgery you need with his knowledge, experience and detailed analysis of each case.
Biomaterials used in sinus lift surgery
Only materials that are biocompatible are used to fill the desired volume of sinus that will ossify. In short, sinus augmentation may be using patient bone or artificial bone (synthetic bone substitutes) and PRP / PRF growth factor method to aid healing or biomembranes to stabilize the clot and bone substitute. All of these materials will resorb over time, so with bone remodeling, we get a new solid bone mass that will withstand all the chewing forces that are transmitted through the implant to the surrounding bone.
The complications of sinus lift surgery are really very rare. The procedure is routinely performed as part of implant therapy or as pre-implant preparation for implant placement. Also, the procedure itself is completely painless and is performed under local anesthesia. The most common complication that can occur during surgery is a rupture of the membrane that surrounds the inner layer of the sinus. If the perforation of the membrane is not immediately repaired, there is a high risk of "leakage" of the artificial bone into the sinus cavity, leading to sinus inflammation and a failed sinus lift procedure. This complication is quite common because sometimes a healthy sinus membrane can be about 0.16mm to 2-3mm thick on average. There is great individual variability in membrane thickness. If there is also a crack, the patient will have no problems quickly repairing various techniques.
Post-operative sinusitis is a complication that can occur after surgery, most commonly involving the implantation of an implant or bone biomaterial into the sinus cavity by careless handling, penetration of an infection from the oral cavity, or surgery performed on a diseased sinus. One of the prerequisites for sinus lift surgery is that the patient has physiologically healthy, "ventilated" sinuses. If there is a history of sinus disease, the patient should consult an otolaryngologist before surgery. Failure to follow this protocol can lead to even more sinus inflammation.
The sinus lift is a procedure that has been routinely performed in dentistry for many years. It is painless and is used to obtain favorable biomechanical conditions for normal chewing function of food. If the surgery is performed by an experienced surgeon, the success of the surgery is extremely high, and complications are very rare as a rule.