Sinus-lift procedure

A sinus-lift procedure is a surgical procedure, performed by a specialised dentist, to augment bone mass in the top jaw (maxilla), which increases the likelihood of successful placement of dental implants. Bone from another part of the body, such as the iliac crest, is grafted in the bone (endosseous) below the floor of the maxillary sinus. In the upper jaw the amount of bone is reduced by the presence of the sinus. A number of techniques are used to increase the bone height:

1. Onlay grafts
2. Interpositional (Lefort I) grafts
3. Inlay grafts for nasal floor
4. Sinus-lift and grafting

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History

Sinus-lift procedure was first performed by Dr. O.H. Tatum Jr. Boyne and James were the first to report their 4-year experiences with autogenous graft placed into the sinus and allowed to heal for 6 months, which was followed by the placement of blade implants. In 1986, Tatum described his techniques for raising the sinus membrane, from a lateral and from an inferior approach.

Surgical technique

Lateral approach is used commonly in the severely resorbed and thin ridge cases. A crestal incision is made with vertical extensions and the lateral aspect of the maxilla is exposed. Then the osteotomy is completed. The lateral wall with the sinus membrane is rotated medially into the sinus. The sinus membrane can fold on itself when reflected medially. Implant sites can be prepared and implants placed at this stage. The medial part of the sinus is grafted first. After the implants have been placed, the remaining lateral part of the sinus defect is grafted. The flaps are relieved and closed primarily. The graft is left for 6-9 months. Implant placements should be delayed if they cannot be properly stabilised, to prevent complications.

Complications

• Graft failure
• Infection
• Oral antral fistula
• Sinusitis
• Tilting or loosening of implants

References

• Raghoebar GM, Timmenga NM, Reintsema H, Stegenga B, Vissink A. Maxillary bone grafting for insertion of endosseous implants: results after 12-124 months. Clin Oral Implants Res 2001; 12(3): 279-86. PMID 11359486