Sinus Lift
For dental implants to be successfully placed in the posterior maxilla, there needs to be good volume of the jaw.
There is a sinus above the back teeth. When teeth are lost in this area, the sinus expands and the jaw ridge loses height. This can result in a ridge that is too short to place an implant.
A sinus lift is a well-established procedure to increase height of the posterior upper jaw ridge. It is a type of bone graft whereby the sinus floor is raised, bone is grafted underneath, and it’s allowed to heal. This increases ridge height, allowing for placement of an implant of adequate size. Evidence-based literature shows that dental implant survival rates in grafted sinuses is very high.
Many times, the implant can be placed at the same time as the sinus lift to decrease numbers of surgeries as well as reducing overall healing time. After an appropriate healing time, a crown (tooth) is able to be placed on the implant.
There are different clinical scenarios when a sinus lift could be performed. Probably the most common example is when an implant is to be placed in the posterior upper jaw ridge that already has deficient vertical height of bone (see case immediately below).
Another time to consider a sinus lift is at the time of extraction of a posterior upper (maxillary) tooth (usually a molar) when it has been predetermined that there is already inadequate height for an implant (see case further below).
Case #1: Implant placed with simultaneous sinus lift
A preoperative CT scan is used with software to plan a virtual implant in ideal position. Different views of the area show the bone height is about 5 to 6mm tall. An implant of adequate height and width was able to be placed. A sinus lift was performed at the time of implant placement to sufficiently support the implant. After a healing period, the patient is ready to have a tooth placed.
Case #2: Use of CT to plan for a future implant
In this case an upper right molar with a root canal has failed and needs extraction. The patient desires an implant to replace it. A CT scan helps evaluate the local anatomy.
The image on left is the 3D picture. The right image is a cross section of the failing tooth. The ridge height is approximately 5mm tall. It’s debatable, but many people would say an ideal implant is at least 10mm tall in this area. This helps plan for increasing the vertical height of bone at time of extraction.
Planning software can place an implant and crown in ideal position
A virtual implant that is 10mm tall is planned in this site. It shows the need for increased ridge height to better stabilize a future implant. This image helps visualize how much bone is needed to build an ideal ridge for an implant (see below).
Image immediately after extraction with simultaneous sinus lift
The three top pictures are cross sections of the ridge. They relate to the green vertical line on the bottom image. The post-operative scan shows the ridge height was raised from 5mm to 10mm. After a healing period, this will allow for placement of an ideally sized implant.
Case #3:
Missing upper molar with i
nadequate bone height
Sinus lift bone graft is planned. Virtual planning software helps improve planning accuracy.
Guided implant surgery helps place implant in as close to planned position as possible (see slide below).
Implant placed with simultaneous sinus lift
This is the same case as the slide from above.
Able to place implant in the planned position.
Able to increase the vertical height of bone with a sinus lift at the same time as implant placement (white dome of bone graft at the top of the implant).
After a healing period the patient is ready to have a tooth (crown) placed.