Preparing for implantation: sinus elevator

Sinus elevator surgery is necessary for most patients before placing a dental implant in the upper jaw. The implant can only be securely fixed and take root in a sufficient amount of bone tissue — 10 mm or more. But in the case of a long absence of a tooth, the bone material decreases, because the lack of chewing load reduces the intensity of blood flow and the bone cells are deprived of nutrition. The anatomy of the face is such that immediately above the tissues of the upper jaw are the maxillary sinuses, which descend as the bone density decreases at the site of the missing tooth. The bottom of the sinus is traumatized when an implant is placed into a small volume of bone. The width of the bone and the location of the sinuses are evaluated by the dental surgeon on x-rays and a decision is made to perform a sinus elevator.

A sinus elevator — is the raising of the sinus (sinus – cavity, lift — to lift) and building up the amount of bone material in the lateral regions of the upper jaw. Sinus elevator surgeries are open and closed.

Open sinus elevator

An open sinus elevator is performed when there is very little bone — less than 5 mm. To access the bone, the gum tissue is first incised and pulled away. A hole is created in the freed bone, through which the lower membrane of the sinus is accessed. This membrane is lifted, and the space between the bottom of the sinus and the bone is filled with bone material. After the surgery, the bone tissue must thicken and take root in order to hold the implant securely in place. Immediate implant placement in open sinus elevators is very rare and requires extra care and more complex rehabilitation.

Closed sinus elevator

Closed sinus elevator is considered less traumatic: the bone material is inserted directly through the implant site. An incision is made in the gum, a hole is drilled in the bone, through which the sinus membrane is first raised and then the bone material is inserted into the cavity. The implant is implanted into the formed bed immediately, and the mucosa is sutured. The closed method is used only if the bone volume is sufficient — not less than 6 mm, so that the implant placed immediately can be fixed.

Despite the low invasiveness of a closed sinus elevator, the risk of damage to the sinus membrane is slightly higher because manipulation through the implant hole is more difficult.

Peculiarities of rehabilitation

Sinus elevator — it is a full-fledged surgical operation, which requires from the body large resources for recovery, and from the patient's attention and compliance with the rules. Of course, in the first few days, discomfort, pain and other manifestations of the body's reaction to the trauma cannot be avoided:

1. Bleeding. In the first 1-3 days, the surgery site will hurt and possibly bleed, which is not a complication. To relieve pain, you can drink painkillers and treat the oral cavity with antiseptics.
2. Bruising and swelling after sinus lifting subside in about 7-10 days, depending on the complexity of the operation. If the swelling gradually decreases, does not spread to a large area and is not accompanied by suppuration at the site of surgery, then it is not a complication.
3. A rise in temperature of 1-2 degrees for the first few days.

Complications after sinus elevator surgery

1. Perforation of the sinus membrane. Microdamage to the sinus can occur during surgery, especially with the closed technique, and the consequences depend on the size of the rupture. If the rupture is up to 2 mm, a membrane is placed between the sinus floor and the bone material, and the lesions will heal on their own. If the lesions are up to 5 mm, they should be sutured immediately and the surgery should be continued. If the diameter of the rupture is more than 5 mm, the operation should be stopped and postponed until the membrane heals.
2. Inflammation. It is caused by poor care, penetration of bone grafting material into the sinus, poor hygiene or poor immunity of the patient. It is characterized by increased pain and swelling, severe fever, purulent discharge at the surgical site or from the nose if the sinus is traumatized. If these symptoms appear, as well as an unpleasant odor or severe redness at the site of the gum, you should immediately consult a doctor.
3. Gaymoritis. Can occur due to damage to the sinus or an infection. If you have symptoms of maxillary sinusitis, you should see a doctor. Usually in such cases, a course of antibiotics, anti-inflammatory and vasoconstrictive drugs is prescribed.

Sinus elevator, performed by an experienced doctor, rarely provokes complications. This surgery is now very common and familiar to any specialist surgeon. Most of the complications after sinus elevator are due to poor care or poor preparation for the surgery. The patient should take all recommended tests, honestly tell the doctor about diseases and body condition and carefully follow the recommendations during the rehabilitation period.

Contraindications to sinus lifting

There are a number of general contraindications for sinus lifting, as for any surgical operation:

• Heart and vascular disease;
• Malignant tumors;
• Decreased immunity;
• Diabetes;
• Poor blood clotting;
• Impaired tissue regeneration;

Since a sinus elevator is performed in a specific area, attention must be paid to the condition of the ENT and oral cavity. The surgery will be postponed or canceled if the patient is diagnosed:

• Gaymoritis or sinusitis, polyps in the maxillary sinus;
• Chronic rhinitis;
• Poor oral hygiene, multiple cavities.

The surgery may be denied to active smokers, people with psychological disorders, alcohol and drug addiction.

Is it possible to do without sinus lifting?

If the patient's upper jaw bone width is greater than 10 mm, the implant can be fixed without additional bone augmentation.

In cases where there is not enough bone material, a full implantation without a sinus elevator is not possible. Removable prostheses can be an alternative, but their durability and convenience are inferior to implant-supported crowns.

There is no need to be afraid to perform a sinus elevator. Modern dentistry creates all conditions for an absolutely safe operation: high-quality materials, instruments, proven technologies and high professionalism of doctors.

Sinus elevator gives an excellent result — provides 90% success rate of implant placement and implant engraftment.

Cost of sinus elevator