Sinus Lifting

What Is Sinus Lifting?

Sinus lifting (sinus floor elevation) aims to create space for an implant between the floor of the maxillary sinus and the jawbone in the back of the upper jaw. The membrane lining the sinus is carefully raised and, depending on the technique planned, graft material that supports bone formation may be placed in that space.

Bone height can reduce after tooth loss, and the position of the sinus can limit where an implant will go. Not every patient having an implant in the upper jaw needs a sinus lift.

Who Is Assessed as a Candidate?

The decision does not rest on a single bone height measurement. The width and quality of the bone, the anatomy of the sinus, the planned prosthesis and the likely initial stability of the implant are all assessed together. Three-dimensional imaging is used where indicated.

Active sinus symptoms, previous sinus surgery, medication, general illnesses and smoking should all be reported to the surgeon. If there is an existing sinus problem, assessment or treatment may be needed first.

Open and Crestal Approaches

Open Approach: The Lateral Window

The membrane is reached through an opening made in the side wall of the sinus. This may be considered where a larger increase in height is needed. The implant may be placed in the same session, or in a separate session after the grafted site has healed.

Crestal Approach: Through the Implant Site

The sinus floor is reached through the bone where the implant is to be placed. In suitable anatomy it can be considered for a more limited elevation. A smaller opening does not make the procedure risk-free.

Neither approach is superior in every patient. Pjetursson and Lang report the main complications of the transalveolar approach as perforation of the Schneiderian membrane in 3.8% of patients and postoperative infection in 0.8%, and note that the technique was most predictable where residual bone height was at least 5 mm and the sinus floor relatively flat.

Is There an Alternative to Sinus Lifting?

In suitable cases short implants or a different prosthetic plan can be considered. Where bone deficiency is advanced the options require a more extensive surgical assessment. It cannot be said that one method is better than another in every patient.

The Cochrane review by Esposito and colleagues compared short implants (5 to 8.5 mm) with sinus lifting in bone with residual height between 4 and 9 mm. One year after loading there was insufficient evidence to claim a difference in prosthesis failure or implant failure — but there were more complications at the sites treated with a sinus lift (odds ratio 4.77, 95% CI 1.79 to 12.71). Among the many trials comparing one sinus lift technique with another, none showed that a particular procedure reduced prosthetic or implant failure. The choice is made by weighing anatomy, the possibility of additional procedures and your own expectations, rather than a single success percentage.

Graft Materials

Materials that support bone formation may be used. Each has trade-offs, and the choice is made for the case rather than by default:

The source of the material, and the alternatives to it, should be discussed with you before the procedure rather than afterwards.

• The patient's own bone, which requires a second surgical site.
• Human-derived (allograft) material from a tissue bank, processed to remove antigenic properties.
• Animal-derived (xenograft) mineral matrix, which resorbs slowly and helps maintain volume.
• Synthetic (alloplastic) materials produced to a standard specification in the laboratory.

Risks

Tearing of the sinus membrane, infection or sinusitis, bleeding, loss of the graft and failure of the implant to integrate are possible complications. A communication between the mouth and the sinus can develop rarely. If the membrane tears, it may have to be repaired, the procedure changed, or the appointment postponed.

Reported outcomes vary with patient groups and techniques. These rates should not be read as a promise of success or of uneventful healing for you.

After the Procedure

Swelling, bruising and discomfort can occur in the first days. Do not blow your nose for the first two weeks; if your surgeon has advised a longer period, follow that. Keep your mouth open if you have to sneeze. Follow the instructions you are given on medication, cleaning, diet and activity. Agree with your surgeon when you may fly, dive or return to heavy exercise.

If pain or swelling is steadily increasing, or if there is fever, bleeding that does not stop, or fluid passing from the mouth to the nose, contact the team treating you without delay. Keep your review appointments even if you have no complaints.

What the Published Evidence Reports

These are figures for studied groups, not forecasts for one person.

Two things stand out below. Perforation is common rather than exceptional, and how it is managed matters more than whether it is mentioned. Failures cluster in the first year, which is why the first year of review is the part not to skip.

• Pjetursson and colleagues (2008) pooled 48 studies covering 12,020 implants and estimated a 3-year implant survival of 90.1% after sinus floor elevation. Analysed at the level of the person rather than the implant, the same data indicate that 16.6% of subjects experienced implant loss over three years. The best results in that review, 98.3% at three years, were obtained with rough surface implants and membrane coverage of the lateral window.
• Del Fabbro and colleagues (2013), requiring at least three years of loading, reported implant survival of 93.7% for the lateral window approach (6,500 implants) and 97.2% for the transalveolar approach (1,257 implants), and noted that 80% of failures occurred within the first year.
• Díaz-Olivares and colleagues (2021) found a Schneiderian membrane perforation rate of 30.6% across the lateral-window studies they reviewed, and reported implant survival of 97.68% below repaired membranes against 98.88% below intact ones — concluding that a repaired perforation was not itself a risk factor for implant survival (p=0.229).

Frequently Asked Questions

Is sinus lifting painful?

Anaesthesia is used to control pain during the procedure. There can be pain and swelling afterwards, to a degree that depends on the extent of what was done. Pain that is worse than expected, or increasing, needs to be checked.

Where does the bone graft come from?

It may be the patient's own bone, human- or animal-derived material, or a synthetic option. The choice is made according to what the case requires, and the source and the alternatives are discussed before the procedure.

What determines the fee?

Whether one or both sides are treated, the technique, the need for a graft and whether the implant is placed in the same session or a separate one all affect it. The scope and the stages of treatment are explained after examination. Ask what happens, and what it costs, if the procedure has to be staged differently than planned. The cost drivers are set out in our guide to sinus lift prices.

Scientific References

• Pjetursson BE, Tan WC, Zwahlen M, Lang NP. A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation. *Journal of Clinical Periodontology*. 2008;35(8 Suppl):216-240. PMID 18724852. DOI
• Pjetursson BE, Lang NP. Sinus floor elevation utilizing the transalveolar approach. *Periodontology 2000*. 2014;66(1):59-71. PMID 25123761. DOI
• Esposito M, Felice P, Worthington HV. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. *Cochrane Database of Systematic Reviews*. 2014;(5):CD008397. PMID 24825543. DOI
• Del Fabbro M, Wallace SS, Testori T. Long-term implant survival in the grafted maxillary sinus: a systematic review. *International Journal of Periodontics & Restorative Dentistry*. 2013;33(6):773-783. PMID 24116362. DOI
• Díaz-Olivares LA, Cortés-Bretón Brinkmann J, Martínez-Rodríguez N, et al. Management of Schneiderian membrane perforations during maxillary sinus floor augmentation with lateral approach in relation to subsequent implant survival rates: a systematic review and meta-analysis. *International Journal of Implant Dentistry*. 2021;7(1):91. PMID 34250560. DOI