Sinus floor elevation – also known as sinus lift – is the raising or thickening of the floor of the maxillary sinus. The sinus lift is a special form of bone augmentation in the upper jaw and becomes necessary when the bone mass in the upper jaw is not sufficient for an upcoming treatment with a dental implant. If the bone mass is too thin, even small and short implants cannot hold it sufficiently and permanently.
With the sinus lift, a stable foundation can be created again for the subsequent implantation. For this surgical procedure, we use our own bone after a detailed clarification using the latest equipment.
What exactly is a sinus lift?
Existing gaps between teeth can be closed again optimally with implants and are convincing due to their stability and durability, which is why they have been very popular for many years. However, a stable bone foundation is an absolute prerequisite for a sustainable and functional implantation. Due to tooth loss, it can lead to a reduction in the jawbone due to the lack of chewing force on the bone. This bone loss can also be caused by periodontitis, osteoporosis, mechanical processes, long-term tobacco or heavy alcohol consumption, diabetes, chronic inflammation or cancer.
The sinus lift is a special oral surgery procedure and a method of bone augmentation by which the floor of the maxillary sinus (also known as the sinus floor) is thickened so that there is again sufficient bone mass.
The maxillary sinus is a paranasal sinus whose maxillary sinus floor or sinus floor forms the bony boundary to the upper jaw. The sinus floor carries the roots of the lateral teeth of the upper jaw. When the bone is lost, the bone mass of the jaw decreases, as does the thickness of the sinus floor.
In the sinus lift procedure, the sinus floor is carefully loosened at the affected area via a small opening, lifted and the resulting cavity filled with the body’s own bone material. At this point, the bone material used is finally deposited and grows together with the surrounding bone tissue, so that the bone increases in volume here and the sinus floor thickens. The height of the bone thickening is determined by the later implant height and then forms a resilient and permanent foundation for the subsequent tooth implantation.
In many cases, after a sinus lift, there is no need to wait until the inserted bone material grows together with the surrounding bone. In many cases, the dental implantation can be carried out in the same operation directly after the sinus lift.
How exactly does the sinus lift procedure work?
Sinus floor elevation or sinus lift is an outpatient oral surgery procedure performed by Dr. med. Thomas Franke in our practice in Berlin Charlottenburg.
Naturally, the procedure is meticulously and conscientiously prepared in advance with a detailed diagnosis.
Blood analysis and DVT
First of all, after a personal consultation with the patient, we have his blood values determined. This enables us to identify existing deficiencies or concomitant diseases before an operation and to adjust our patient in advance so that he or she receives the best possible care at the time of the operation – and also afterwards. We have been using this method in our practice for many years – and have consistently had very good experience with regard to the healing and treatment success after an operation.
In a further step, the bone structure of the jawbone or sinus floor is precisely examined in terms of its exact thickness and position using digital volume tomography (DVT).
DVT is a state-of-the-art, 3D-based, imaging X-ray procedure that provides us with very precise, high-resolution, three-dimensional images of the head and face, including the jaws and sinuses. This diagnostic procedure enables us to accurately assess bone structures and the surrounding soft structures, such as the exact course of nerves, with only low radiation exposure. DVT is an absolute prerequisite for the exact planning of dental implants as well as for many oral surgery procedures, so that these can be carried out as safely and minimally invasively as possible.
After the exact and holistic clarification, Dr. med. Thomas Franke will go through the procedure in detail in a personal conversation with the patient. Existing fears and wishes of the patient are also discussed and taken into account.
The elimination of pain
The procedure should be as painless as possible. Usually we achieve this by eliminating the pain in the form of a local anaesthetic. In some cases, twilight sleep or general anaesthesia can also be used to eliminate the pain.
The oral surgery procedure via sinus lift
The procedure is performed as minimally invasive and safe as possible. The later implant height determines the height of the thickening of the sinus floor.
In general, a sinus lift involves placing a small opening (window) in the bony boundary of the front wall of the maxillary sinus and then carefully lifting the floor of the maxillary sinus. The mucosa of the maxillary sinus is now also lifted. Bone material previously removed from the patient’s own bones is then inserted into the opened maxillary sinus below the mucous membrane.
We also use the biological method for bone augmentation and generally only use our own bone, since autologous bone material is optimally tolerated by the body and no rejection reactions of the body are to be expected. We have also made the experience that the healing results are excellent when using autologous bone. The own bone is usually taken from the mouth area, preferably from the area of the wisdom teeth. But other donor regions can also be considered.
In addition to the body’s own bone material, platelet-rich plasma (also known as PRP for short) is now also introduced into the affected area.
PRP is a concentrate obtained from the patient’s own blood by centrifugation and is a state-of-the-art method for promoting wound healing.
The concentrate is applied to the affected tissue and supports the bone healing process there.
There are two different methods of sinus lift, which can be selected depending on the individual condition of the jaw bone floor.
Procedure 1: The internal sinus lift
The internal sinus lift – also known as a small sinus lift – can be considered if only a small bone height of 2-3 mm needs to be added. This procedure is minimally invasive and therefore best protects the patient. In this case, the floor of the maxillary sinus is slightly raised above the implant hole with an osteotome (a medical instrument for cutting through bone in a conical or cylindrical shape) and filled with the body’s own bone material. Only slight swelling in the patient’s mouth area is to be expected with this procedure.
Procedure 2: The external sinus lift
The external sinus lift is an extensive bone augmentation procedure. It is carried out when a bone height of more than 3 mm needs to be added.
In this case, access is via a bone window: the gums are opened in the affected area and the wall of the maxillary sinus is made accessible. Using special ultrasound instruments, the sinus floor is now reached and carefully lifted. Finally, the artificially created cavity is filled with the body’s own bone replacement material through the resulting bone window.
Biological implant treatment
In most cases, we can perform the dental implantation directly after the sinus lift and thus spare our patients, as they only have to undergo one operation. Thanks to the shape of the special ceramic implants that we use, we can keep the mucosa of the maxillary sinus away from the bone during the implantation in such a way that the bone can regenerate on its own. The wounds are then closed again with the finest suture material and the outpatient procedure is finished.
Finally, we fit the implant with a temporary denture so that our patients are ready for use again as soon as possible. The fixed, final prosthesis is fixed after the bone has healed and the implant has grown together with the bone.
After the operation
As a rule, the bone including the dental implant heals for 3 to 6 months after a sinus lift. After this time, both the healing of the bone with the inserted bone material and the fusion of the implant with the bone is completed and a stable foundation is created, which is modelled on the natural tooth adhesion and is in no way inferior to natural teeth in terms of function and aesthetics.
Immediately after the procedure, pain and swelling of the affected area must be expected, but these should subside after 7 days at the latest. Of course we provide our patients with appropriate medication to relieve pain. We also recommend adequate cooling of the affected area and physical rest for a few days after the procedure. In addition, only soft food should be taken and the consumption of nicotine and alcohol should be avoided completely, as these massively disturb the wound healing processes.
We also offer our patients an individually tailored medication regimen to strengthen the immune system, stimulate regeneration and support the healing process. Bone healing and the ingrowth of the implant are checked at regular intervals. In this way we can ensure optimal healing and the best possible ingrowth of the implant.
How strong is the pain during a sinus lift?
During the operation we ensure that the pain is completely eliminated so that you will not feel any pain during the operation. In general, we always make the operation as painless and pleasant as possible. Pain is usually eliminated by local anaesthesia, but twilight sleep or general anaesthesia can also be used, especially if the sinus lift is performed on both sides.
You can expect swelling and pain after the procedure, but we will provide you with appropriate painkillers to help control the pain. We also recommend additional, adequate cooling of the affected area.