What is sinus lifting?
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What a sinus elevator is for
Dental restoration with implant crowns involves implanting metal posts into the jaw. These act as artificial tooth roots.
However, the available bone volume may not be sufficient for reliable fixation of the implants. This situation occurs for a variety of reasons:
- age-related changes in the body;
- Bone atrophy caused by the long-term absence of one or more teeth.
In this case, osteoplasty, a surgery to build up additional bone volume, is used.
A peculiarity of the upper jaw is that its height is often insufficient for implants. It requires 8-10 mm, and its height can be 4-5 mm. It is not possible to simply increase its height, because it is connected to the maxillary sinuses, air-bearing cavities that communicate with the sinuses of the nose. Therefore, in order to avoid damaging them and to provide space for bone augmentation, the surgeon must raise the bottom of the sinus.
Indications for surgery
A sinus elevator is usually performed if the height of the upper jaw is less than 4-6 mm. This is required for osteoplastic purposes, due to a lack of bone tissue.
In most cases, the problem that leads to the need for surgery is bone atrophy. It occurs:
- due to age-related changes - this is a natural process, after about 35 years of age the bone density in the body gradually decreases;
- As a result of trauma, such as a hard blow to the jaw area;
- due to insufficient load - this is caused not only by long-term absence of teeth, but also by wearing removable dentures, which do not provide the necessary load on the jaw.
The decision on the need for a sinus elevator is made by the doctor. It is based on the results of preliminary diagnostics.
Types of sinus elevator
There are two main techniques - open and closed. The choice between the two depends on the condition of the maxillary bone. The surgeon chooses the best option to ensure that the bone is expanded to the amount needed to hold the implants securely.
Open sinus elevator
The surgery is usually performed when there is a significant deficit of bone tissue. This option is also chosen when the patient's maxillary sinuses have a complex anatomy. Its peculiarity is that the floor of the maxillary sinus is raised using lateral access.
The surgeon makes an incision in the side of the maxillary sinus and injects the bone material through it. It is possible to implant the implant at the same time as the procedure or after some time, when it is clear that the osteoplastic material has taken root and the bone volume has increased. Simultaneous implant placement is possible if the maxillary bone height is at least 4 mm.
The main disadvantage of open sinus elevator is a more difficult and prolonged rehabilitation process. This is due to the fact that the area of surgery is relatively large.
Closed sinus elevator (cruciate)
This option is considered to be more gentle and recovery after surgery takes less time. In this case, bone material is inserted through the implant hole. One-stage placement of a metal post is possible if the surgeon believes that the available bone height is sufficient for normal engraftment. This procedure is usually performed when one or two implants are implanted, and single-stage placement is difficult for larger implants.
Closed sinus elevator is performed when the sinus anatomy is relatively simple and there is a relatively small lack of bone tissue.
Stages of Sinus lift procedure
Regardless of the chosen option, the procedure is performed in several stages. It is carried out after consultation with a dentist and preparatory measures - it is necessary to pre-treat caries, perform oral cavity sanitation. The operation is planned taking into account the individual characteristics of the patient, the structure of his upper jaw, so you need preliminary diagnostics: radiography, computer tomography.
Anesthesia is necessarily used, thanks to which the patient does not feel pain during the operation. Usually one of two options is used:
- local anesthesia;
- Sedation is a gentle and safe medically induced sleep.
The choice between these options is determined by the patient's individual characteristics and wishes. Anesthesia is performed under the supervision of an experienced anesthesiologist.
A small incision
The details of the next step depend on whether the sinus elevator is open or closed. In any case, the doctor tries to minimize the impact.
The surgeon either provides himself with lateral access or creates an opening for future implant placement. He uses these to gain access to the bone of the upper jaw. The doctor also makes an incision in the gum and exposes the bone.
In the next step, the doctor removes a small section of bone. The amount depends on the specific situation.
Adding bone material
The surgeon carefully lifts the mucosa, which serves as the floor of the maxillary sinus, and fixes it in its new position using a self-absorbing membrane. In the vacated space, he adds the necessary amount of bone material. Used in this capacity are:
- own bone material taken in small quantities from another site;
- synthetic material.
If a one-stage placement protocol is chosen, the doctor will implant the implant immediately. In a two-stage implantation, the patient will have to visit the doctor again 4-6 months after the elevator to have the implant placed.
After the bone material has been placed, the surgeon sutures the bone. This completes the operation.
Complications are possible with any surgical procedure, and sinus elevator is no exception. The surgeon's manipulations always affect your health in some way. The doctor's task is to minimize complications and prevent serious problems from occurring.
Swelling is considered normal. It occurs on the first day after the procedure and goes away on its own after a while. If the swelling does not disappear on the 3rd or 4th day after the operation, inform your doctor. The same applies to swelling.
Pain in the gum may also be felt for a few days. It will gradually subside until it is completely gone. If the pain persists for a week or more or suddenly increases a few days after surgery, you should see a doctor.
Serious complications after a sinus elevator procedure can include:
- maxillary sinusitis is an inflammation of the maxillary sinus;
- Rhinitis is an inflammation of the nasal mucosa.
These diseases are caused by trauma or infection. In our clinic, during surgery, measures are taken to prevent possible infection. The surgeon strictly follows the protocol, carefully performs manipulations to avoid trauma to the mucosa.
Bleeding after surgery is also a reason to see a doctor. It should stop soon after stitching. A small amount of blood may still be present for a few days. This can manifest itself, for example, in the fact that saliva is colored pinkish. But if it flows and cannot be stopped, medical attention is needed.
To accelerate rehabilitation and reduce the risk of postoperative complications, it is necessary to strictly follow the doctor's recommendations. He gives them based on the individual characteristics of the patient. But it is usually required:
- no physical activity for about seven days;
- for two weeks without air travel;
- take antibiotics, pain relievers, and antihistamines prescribed by your doctor;
- do not sneeze or cough with open mouth, do not drink through a tube, do not blow your nose loudly - all this causes pressure fluctuations in the area of elevation of the floor of the maxillary sinus and can lead to displacement of the implanted bone material;
- do not go to the bath, do not overheat the surgical area;
- no mouthwash;
- make mouth baths with preparations that the doctor specifies: you should keep the solution in your mouth for 20-30 seconds and then spit it out.
Contact AESTHET Dental Center! Our doctors perform osteoplasty and implants using advanced techniques and modern equipment. We perform open and closed sinus elevator, which allows us to build up bone tissue on the upper jaw and ensure successful implant engraftment. Great experience and high qualification of our specialists is a guarantee that you will get an excellent result.
Questions and answers
Can a sinus elevator be performed in children?
Theoretically, yes, but in practice such operations are not performed. The fact is that in children the bone tissue is still developing and forming. Osteoplastic surgery and the pressure exerted by implants can lead to disturbances in the natural processes of jawbone formation.
How long does a sinus elevator procedure take?
It depends on the complexity of the surgery. Usually, the surgeon performs the work within 30 minutes to several hours.
Krivospitskaya Yu. S., Tiunova A. V. Reconstructive and restorative surgeries in the maxillofacial region. Vestnik operative surgery and topographic anatomy. 201. Т. 1. № 2. С. 40-44. Reference: https://cyberleninka.ru/article/n/rekonstruktivnye-i-vosstanovitelnye-operatsii-v-chelyustno-litsevoy-oblasti
Magamadov M. S., Zernyaev D. V., Didenko A. Y., Safarova E. R., Rogava T. A. Direct prosthetics on implants as a method of physical and social rehabilitation. Fundamental aspects of mental health. 2019. № 2. С. 21-23. Link: https://cyberleninka.ru/article/n/neposredstvennoe-protezirovanie-na-implantatah-kak-metod-fizicheskoy-i-sotsialnoy-reabilitatsii
Rokityanskaya A. I., Ratushnaya O. V., Pavlova A. O. Complications arising during sinus-lifting surgery. Bulletin of Medical Internet Conferences. 2019. Volume 9. Issue 7. P. 292. Link: https://cyberleninka.ru/article/n/oslozhneniya-voznikayuschie-v-hode-operatsii-sinus-lifting