Sinus lift for dental implants

Above the roots of the upper back teeth sits the maxillary sinus, an air-filled space. When those teeth are lost, the bone below the sinus thins and sometimes isn't enough for an implant. A sinus lift raises the membrane on the sinus floor and makes room for new bone. Before I suggest one, I measure on the CT scan how much bone there is and whether it's truly needed: sometimes a short implant solves it without a graft.

Imaging

3D CT scan (CBCT)

Anesthesia

Local, with sedation if needed

Technique

Crestal or lateral window, depending on bone

Implant

Same surgery or a second stage

When it's indicated

• You want an implant in an upper molar or premolar and the CT scan shows there isn't enough bone height for a standard-length implant.
• You lost those teeth years ago and the bone below the sinus has been thinning.
• A short implant isn't a good fit for your case, because of how little bone is left or where the tooth sits.
• Your sinus is healthy; if there is active sinusitis, it's treated first.

Before surgery

• If you already have a recent CT scan, bring it or send it ahead: it saves time and sometimes a repeat scan.
• Tell me about your medications and conditions, especially diabetes, blood thinners or osteoporosis treatments.
• If you smoke, stop: smoking is linked to more membrane perforations and lower implant survival after a sinus lift.
• If you have sinusitis, congestion or a cold close to the date, let me know so we can treat it or reschedule.
• If you're having sedation, come with someone and fast per the written instructions.

How I plan it

How I do it

1. 01AnesthesiaLocal and, if you prefer or the case calls for it, sedation. The anesthesia prevents pain during the surgery.
2. 02Crestal approachWith enough bone, I work through the implant site itself, gently push the sinus floor upward, with or without graft, and place the implant.
3. 03Lateral windowWith less bone, I open a small window in the wall of the upper jaw, lift the membrane and fill the space with graft. With less than 4 mm of bone, or if you smoke, covering it with a membrane is advised.
4. 04Implant: now or laterIf the remaining bone holds it steady, it goes in during the same surgery; if not, after the graft matures. Long term, the two approaches showed no difference in implant loss.
5. 05Closure and follow-upStitches, written instructions and a follow-up to check the wound.

Recovery

• First few days: swelling, sometimes a bruise on the cheek, a little bleeding from the nose or a blocked nose. Cold packs and taking it easy help.
• First few weeks: don't blow your nose hard, sneeze with your mouth open and avoid blowing forcefully. This protects the membrane and the graft.
• No flying or diving until I clear you at the follow-up: pressure changes push on the sinus.
• The usual is a preventive antibiotic and antiseptic rinses, plus pain medication. No smoking or straws, and chew on the other side.
• Months: the graft has to mature before the implant takes a load. How long depends on the case; I confirm it with an image, not the calendar.
• First year: of the implants lost after a lateral sinus lift, 59% are lost that year; those check-ups aren't skipped.

Risks and how I prevent them

Membrane perforation

On average it happens in about one in five sinus lifts; depending on technique and instrument, reported rates range from 3.8% (crestal approach) to 24% (lateral window with rotary burs). I prevent it by locating septa on the CT scan; if it happens, it's repaired in the same surgery with a collagen membrane or the graft is postponed.

Sinusitis

It was reported in 1.11% of patients. I only operate on a healthy sinus; if it appears, it's treated with medication and, if it persists, by an ENT specialist.

Infection

With the crestal approach it was reported in 0.8% of patients. The antibiotic and rinses help prevent it; if it affects the graft, the material is removed.

Bleeding, blocked nose or vertigo

Nosebleeds, a blocked nose, bruising and dizziness when changing position are also described. If they don't settle, message me.

Implant loss

With the crestal approach, 3-year survival was 92.8%. With a lateral window, 95.8% were still in place at 5–13 years (low certainty), and having less than 4 mm of bone or smoking reduced survival. If an implant is lost, it's removed and we reassess.

Other options

Short implant

With 4 to 9 mm of bone, at one year it's unclear whether a sinus lift works better or worse than a short implant (5 to 8.5 mm), and sinus lifts had more complications. With implants of 6 mm or less, results were comparable for the first 5 years; at 5 years the trend favored a regular implant with a graft, without being significant.

Pterygoid or zygomatic implants

With very little bone, there are implants anchored behind the last molar (pterygoid) or in the cheekbone (zygomatic) that avoid large grafts, with their own indications and risks.

Bridge or removable denture

They replace the tooth without sinus surgery, with other drawbacks for the neighboring teeth or for comfort.

Not replacing the tooth

If the missing tooth doesn't affect your bite or bother you, that's also a valid choice. If surgery isn't needed, I'll tell you.

Frequently asked questions