Sinus lifting

SINUS GRAFTING (AUGMENTATION)

Grefarea

Posterior (back) areas of the superior maxillary are located in the vicinity of maxillary sinuses. Teeth from the sinus vicinity are usually maxillary molars and sometimes one or both premolars. Maxillary sinuses are large and empty (air filled) cavities located in the maxillary bone’s thickness. Doctors can locate these structures with panoramic x-ray (2D) and can inspect/diagnose with dental tomography (3D).

When between the outer edge of the bone crest and sinus inferior limit there is sufficient bone (minimum 10mm width), a standard implant can be inserted without any problems.

Implant standard

Sinus expansion after extraction

If teeth behind the superior maxillary have been extracted a long time ago and haven’t been replaced with dental implants, the maxillary sinus will expand (enlarge its volume), destroying (replacing) the maxillary bone underneath.

sinus lifting

Therefore, remaining bone will present a decrease in height, making implant insertion impossible (implant would penetrate the sinus) without additional procedures – sinus lifting and sinus augmentation. Maxillary bone, in its posterior area, presents a naturally low density (being porous). Once a tooth is extracted from this region, bone will start to atrophy (resorb) in a more accelerated rate than other areas of the mouth.

To conclude, sinus expansion can be prevented/limited by the presence of root underneath: either natural (teeth), or artificial (implants).

expandarea sinusului

When we replace a maxillary tooth (superior) with a dental bridge, there are several disadvantages:

  • We will sacrifice neighboring teeth to support the bridge;
  • Bone underneath the deck body (fake tooth from the bridge) will continue to resorb in the absence of stimuli to maintain its volume (stimuli produced by the root or implant);
  • Sinus will expand in the missing tooth area, destroying increasingly more bone;

When we replace a missing maxillary tooth with a dental implant, advantages are multiple:

  • Neighboring teeth won’t be sacrificed;
  • Bone will not resorb, being stimulated by mastication forces through the implant;
  • Maxillary sinus will remain in position (will not expand) and no additional procedures will be necessary such as sinus lifting (costs are considerably reduced).

SINUS LIFTING AND SINUS AUGMENTATION procedure

There are several methods of restoring bone volume occupied by maxillary sinus and implanting area preparation:

a. External sinus lifting (with lateral window) – the most frequently used technique when sinus augmentation is needed in case of large (severe) resorptions.

Sinus lifting extern

Sinus lifting technique with lateral window involves:

  • Lateral bone incision and gum removal from bone covering the maxillary sinus;
  • Creating a window inside the bone until sinus membrane is reached (an extremely thin membrane, which “coats” the sinus in its inner part, white color in the drawing);
  • Careful membrane detachment from bone and raising (lift – ing) up to the level where bone augmentation will be performed;
  • Filling the space underneath the lifted sinus membrane with bone augmentation (addition),(mixture of various bone addition materials) up to the desired level;
  • Covering the bone window through which sinus was accessed with special barrier role membranes (prevents gum growing inside the sinus) resorbed on their own after a few months;
  • Covering with gum and suture;
  • After approximately 7-9 months, when necessary bone was formed inside the sinus, the dental implant can be inserted without any issues, sustaining the dental work.

sinus lifting
b. Internal sinus lifting (with crestal orifice) – represents the technique of choice when sinus resorption and expansion is small, limited and only a 2-3mm bone height lifting inside the sinus is needed.

Sinus lifting intern

Internal sinus lifting technique involves:

  • Middle bone area incision and gum removal from bone underneath the sinus;
  • Creating an orifice inside the bone and drilling until sinus level (being a “blind” technique, this procedure is performed only with dental tomography navigation, which offers extremely accurate measurements; if measurements are performed with errors, the risk of accidental sinus opening and infecting is extremely high);
  • Opening the sinus cavity with special, non-traumatic instruments, without sinus membrane alteration;
  • Sinus membrane detachment and lift up to the desired level – with a special balloon progressively filled with liquid or with other specific instruments;
  • Filling the space underneath the sinus membrane up to the desired level with bone augmentation (addition) material (biomaterial mixture);
  • Covering the orifice through which sinus was accessed with special barrier role membranes (prevents gum growing inside the sinus) resorbed on their own after a few months;
  • Covering with gum and suture;
  • After approximately 7-9 months, when necessary bone was formed inside the sinus, the dental implant can be inserted without any issues, sustaining the dental work.

Sinus lifting procedure can be performed individually or concurrently with dental implant insertion. For the second option, when dental implant is needed to be performed in the same time, it is mandatory, that after insertion, an exceptional mechanical stability to be present (to be immobile in the addition material introduced within sinus). This stability can be achieved with special, modern implants and only if under the sinus a bone “headboard” of 3-4 mm thickness (height) exists. Otherwise, implanting will be postponed for 7-9 months until mature bone is formed within the maxillary sinus.

sinus lifting2

In Implantodent clinics, sinus lifting and sinus augmentation represent “routine” procedures, given the field experience (over 15 years), specialist surgeons and unique equipment for this kind of treatment:

  • Dental CT scanner with variable volume – Orthophos XG3D/Galileos (Sirona-Germany);
  • Surgical dental laser – Sirolaser (Sirona-Germany) and Waterlase (Biolase-SUA);
  • Piezo-surgical devices – EMS (Switzerland) and Mectron (Italy);
  • Microscope and surgical magnifiers – Zeiss (Germany);
  • External/Internal sinus lifting kits – Meisinger (Germany), Hu-Friedy (USA);
  • Bone augmentation materials – Botiss (Germany);
  • Bioresorbable membranes – Botiss (Germany);
  • Modern dental implants – Nobel Biocare (Switzerland), Euroteknika (France), Bredent (Germany);
  • Operating blocks equipped with electric generator and with permanent vital function monitoring and general anesthesia – General Electric (USA);
  • Postoperative resting wards;
  • Sterilization units equipped with class B autoclaves – Sirona (Germany), Melag (Germany), Technogaz (Italy);

To check Implantodent clinics equipment technology, click here!

DIGITAL PLANNING – precise, fast and non-traumatic

Thanks to investigation imaging technology and three dimensional planning, we can thoroughly investigate the sinus to be operated even since the preoperative stage, so the intervention becomes precise with minimum risks. At the same time, the smaller the surgical trauma, the faster and qualitative the healing will be. These types of procedures performed with two dimensional investigations (panoramic x-ray), inaccurate and with several image errors are risky and not recommended. “Golden standard” for investigation, diagnosis and treatment planning is represented by cone beam dental tomography (minimum radiation), and Implantodent clinics own 5 such devices, sparing you from taking exhausting trips to radiology centers and naturally, from additional expenses. Nothing random, without “blind” maneuvers, everything analyzed in detail…

Tomografie dentara

Three dimensional image represented by the section on dental tomography

 

Tomografie dentara cu fascicul conic (CBCT)

Sagittal (lateral) section through maxillary sinus

 

Tomografie dentara cu fascicul conic (CBCT)

Yellow outline represents bone and red outline represents sinus mucosa which “coats” the maxillary sinus

 

Tomografie dentara cu fascicul conic (CBCT)

In order not to penetrate the sinus mucosa and cause sinusitis, it must be surgically raised (lifting)

 

Tomografie dentara cu fascicul conic (CBCT)

The space underneath the sinus membrane will be filled with biomaterial to support bone regeneration. After approximately 6 months, biomaterial will be replaced by your own bone and implants will benefit from a solid anchoring.

 

Tomografie dentara cu fascicul conic (CBCT)

Three dimensional planning of implants on cone beam computed tomography (CBCT)

 

Tomografie dentara cu fascicul conic (CBCT)

Three dimensional planning of implants on cone beam computed tomography (CBCT)