A sinus lift is a special operation performed to build up bone in the upper jaw.
Years of toothlessness, periodontitis, and/or other diseases may cause the bone which supports the tooth to recede.
Moreover, if teeth are missing (blinking in the picture) the maxillary sinus in the upper maxilla may expand, so that there is not enough bone to hold implants.
Both the quality and the quantity of the maxillary bone are crucial to the success of implantation. Fortunately, there are now numerous surgical techniques for building up jaw bones gently and painlessly.
The sinus lift operation is a special technique for the upper jaw – the maxillary sinus membrane is lifted through a small opening and bone replacement material is inserted between the membrane and the bone.
Depending on the material used, in 4-8 months it turns into bone, which enables implantation. Depending on the consistency and amount of available maxillary bone matter, implantation can take place immediately after the sinus lift operation, or sometime later.
There are two kinds of sinus lift – external and internal. In the internal sinus lift, the maxillary sinus membrane is treated through the implant hole. Bone material is put into this empty space. The intact membrane prevents bone material from entering the sinus. The internal sinus lift especially works well if few teeth have to be replaced.
An external sinus lift is especially useful when several teeth need to be replaced or there is very little bone left. A small opening is made from the side into the maxillary sinus, and the bone replacement material is inserted.
The film shows a patient who, aside from two roots, has no more teeth in the upper jaw. Golden caps have been attached to the teeth, which aid in stabilizing the total prosthesis during bone build-up treatment. You will now see an external sinus lift.
The mucous membrane of the mouth has been lifted aside and a small opening made through the thin remaining bone to the maxillary sinus. The maxillary sinus membrane rises and sinks with breathing, as can be seen through the opening – a sign that the membrane is intact.
Here you can see a white collagen membrane is inserted to protect the maxillary sinus membrane from the sharp bone replacement material.
The bone material is now inserted into the opening using gentle pressure. It is not necessary to inject this material with cells or growth accelerators. Human bone heals very fast.
Finally, the tissue is stitched up, the patient receives his or her prosthesis and thus has a well-fitting tooth replacement until implantation is performed. In this case implants are inserted, later on, cause the remaining bone is not adequate for immediate implantation.
Alternatives to planned surgery would be either another surgery technique or a removable denture. If a fixed denture is requested you could also screw a bone block on the jaw ridge-thus the jaw ridge is not build up inwards, like it is done with sinus lift, but outwards-you call this an onlay plastic. This technique produces better aesthetic results, but it is also riskier and only used in the aesthetical section.
If there is a little bone left for implantation you can use a partial or full denture instead of a fixed denture.
The risks of surgery are little if you are operated by an experienced surgeon. Nevertheless, there can be complications in a given case, which cause further measures. Complications can occur with every measure, which can be become life-threatening. Some complications are:
- No ingrowth of denture material, implantation is not possible anymore
- fibrous ingrowth of denture material, implantation is not possible as well
- break down of maxillary sinus, which leads to loss of denture material, implantation is not possible
- inflammation of augmentation. This inflammation can expand on enclosed structures (maxillary sinus, eye..)-a removal of the augmentation is soften necessary within a second surgery
- injury of enclosed structures like nerves, cheek, blood vessels with its consequences
- inflammation of the maxillary sinus
- sense disorders in lips, upper jaw
Fortunately, those complications are less often nowadays due to positive progress in medicine!