Added by Yuliana Sandoval on 08.07.2021

What is a sinus lift?

What is a sinus lift or maxillary sinus lift? This procedure, also known as sinus augmentation, is a dental treatment that is usually required before getting dental implants, especially if the patient needs full mouth dental implants in the upper jaw.

In addition to sinus lift, the placement of a bone graft is also required for the treatment to be effective. But what is a sinus lift procedure and how is it done? Sinus lift and bone graft procedure consist of exposing the jaw bone and drilling a small “window” in it to gain access to the membrane that covers the maxillary sinus.

Work of dentist with patient. Survey of the teeth

A sinus lift is a procedure that includes placing the material in a jaw bone to increase its density

Once the membrane is accessed, special instruments are used to push it up gently, avoiding any damage or rupture. Then the bone graft material is placed in the space obtained by moving the membrane upwards. The gum is then sutured, and the area should be allowed to heal for approximately six months for the graft material to fuse properly with the jawbone and increase its thickness and density, achieving a successful maxillary sinus augmentation. Sinus lift surgery takes between 60 minutes and 2 hours, can be done under local or general anaesthesia, and the patient can usually go home once the anaesthesia wears off.

Sinus lift and bone graft increase the bone density of the upper jaw bone so that it can support a dental implant (screw), in addition to moving the membrane of the maxillary sinus upwards so that the length of the implant does not cause any injury as it is located completely within the bone. A dental sinus lift can make the difference between the success or failure of dental implant treatment, since sinus lift bone augmentation provides greater stability to the implant. Getting a sinus lift augmentation may sound annoying, but it has been shown that lift sinus dental implants can last a lifetime.

Sinus lift for dental implants

happy woman holding teeth model and showing thumb up in dental clinic

A sinus lift surgery may be necessary before placing the implants to the upper jaw

Sinus augmentation for dental implants is usually necessary when the jawbone is not of the appropriate thickness and density to receive and provide stability to a dental implant (screw). Sometimes sinus lift for dental implants is done when the maxillary sinus cavity is very close to the roots of the teeth and the length of the implant could injure the sinus membrane. An implant sinus lift is only necessary for dental implants in the upper jaw and allows patients to rehabilitate their teeth even if they have bone loss Sinus lift dental implants are ideal for patients who need a total rehabilitation of the upper jaw, as in the case of requiring All on 4 dental implants. The only “downside” for some patients is the waiting time after sinus lift for implants while the bone graft heals and the bone becomes strong enough to receive the screw.

Sinus lift technique

Sinus lift procedures can be performed following two different sinus lift techniques, even so, these may vary slightly in terms of the type of materials and instruments used during the procedure, and because of this they are usually mistakenly considered as a different technique.

Dentist talking to male patient and presenting results on Dental x-ray film About the problem of the patient in dental office

There are two different techniques for this procedure; open sinus lift and closed sinus lift

The two types of maxillary sinus lift techniques are:

  1. Open sinus lift, external sinus lift technique or lateral sinus lift.
  2. Closed sinus lift, internal sinus lift procedure or crestal sinus lift.

The internal sinus lift technique is also known as crestal sinus lift, hydraulic sinus lift, or osteotome sinus lift. All of these different names basically consist of the same sinus lift technique but with some slight variations in the procedure.

Lateral sinus lift

A lateral sinus lift is also called “lateral window sinus lift” because the procedure consists of drilling a “window” in the lateral surface of the maxilla, that way the surgeon has access to the sinus cavity without damaging its membrane. The lateral or external sinus lift technique is the traditional procedure, and even though there are less invasive techniques, this one stills the preferred one by many surgeons since it provides many advantages compared to other more modern techniques. The most relevant advantage of an open sinus lift is that the surgeon can visualize the sinus membrane and all the structures involved in the procedure, that way, they can make sure the sinus membrane is intact by the end of the procedure. Unfortunately, an open surgical technique also results in increased postoperative discomfort for patients and this is the main reason why the closed sinus lift technique was created.

Crestal sinus lift

Dental assistant adjusting light

A closed or crestal sinus lift technique is minimally invasive, this means that discomfort and possible postoperative complications are greatly reduced

A closed or crestal sinus lift also known as a crestal approach sinus lift technique consists of accessing the maxillary sinus cavity through the alveolar ridge, this is achieved by drilling the area as if the implant screw were to be installed. The sinus membrane is then separated from the floor of the sinus cavity and moved upwards to later fill the newly formed space with bone graft material. This technique offers the possibility of installing the implant simultaneously with the sinus lift and the bone graft, but this is only possible when the thickness of the patient’s natural bone (without the graft) is equal to or greater than 5 mm, otherwise, the bone will not support the implant. When there is not enough pre-existing bone, it is usual to wait between 3 and 6 months until the graft heals properly to install the dental implant. This sinus lift technique is minimally invasive, which means that discomfort and possible postoperative complications are greatly reduced. However, as it is a closed technique, there is no direct visual monitoring, so it will be very difficult for the surgeon to make sure that the sinus membrane has not been injured and that the bone graft material is evenly distributed in the space under the membrane. Even so, the crestal sinus lift technique has gained a lot of popularity due to the comfort it offers to patients and this is why it is becoming more and more used every day, due to this, many companies have designed crestal sinus lift kits that simplify the procedure for both patients and surgeons.

There are many variations of the crestal approach sinus lift technique but the most used are two:

  • Osteotome sinus lift technique.
  • Hydraulic sinus lift technique.

Both are performed through a crestal approach (both are closed techniques) but the method used to detach the sinus membrane from the floor of the cavity and move it upwards varies.

Osteotome sinus lift technique

dental surgery

Osteotome sinus lift technique and hydraulic sinus lift technique are the variations of crestal approach sinus lift

Sinus lift osteotome technique consists of the implementation of osteotomes, osteotomes for sinus lift are manual surgical instruments that allow to fracture the alveolar cortical bone  (the outer layer of compact tissue that is part of the bones) and detach the sinus membrane from the sinus floor, reducing the chances of tearing it since osteotomes have a blunt tip. Different types of osteotomes can be used to detach the sinus membrane and move it upward. Once the space between the sinus membrane and the sinus floor has become large enough, the bone graft material is gradually introduced. Osteotomes are also used to push the graft material into the space below the membrane, although the instrument designed for this purpose is the bone condenser. It is also recommended to use a bone spreader to ensure that the bone graft material is distributed evenly throughout the space, as being a closed surgical technique there is no direct visual monitorization of the area. Once the bone graft material has been correctly introduced and distributed, the implant (screw) is installed, as long as the amount of pre-existing bone allows it, otherwise, the area is simply sutured until the bone graft has healed and the implant can be installed.

Hydraulic sinus lift

A hydraulic sinus lift procedure is performed in much the same way as the osteotome technique.  A hole is drilled through the alveolar ridge (crestal approach), the place where the implant will be installed later, osteotomes are used to carefully fracture the cortical bone and gain access to the sinus cavity and membrane. Once the cortical bone has been fractured, the surgeon must ensure that the membrane is intact before continuing with the procedure. After this, instead of using osteotomes or any other surgical instrument to detach and move the sinus membrane away from the maxillary sinus floor, hydraulic pressure is used to detach the membrane more gently. This is done through a hydraulic sinus lift system consisting of a disposable syringe connected to a hydraulic lifter that covers the drilled hole completely to have the required pressure to lift the membrane.  Once the lifter is properly fitted, the syringe is used to push the saline solution through the perforation and push the sinus membrane until it is detached from the floor of the cavity and moved upward. The saline solution can be pushed and pulled several times until the membrane has been sufficiently lifted. The hydraulic lifting system and saline solution are then removed to proceed with the placement of the bone graft material and, if possible, with the installation of the dental implant. This technique is a bit longer than the previous ones as it requires careful execution, however, it offers the best results for both surgeons and patients. Numerous clinical studies have shown the high effectiveness rate of this procedure as well as the considerable reduction in postoperative discomfort and possible complications of a maxillary sinus lift.

Sinus lift procedure

We previously explained the most common variations in sinus lift procedures as an overview of current techniques. Basically, all maxillary sinus augmentation procedures consist of drilling a window or hole in the maxillary bone to gain access to the sinus cavity allowing the sinus membrane to be detached and displaced until the necessary space is obtained to place a bone graft and install an implant screw. Despite sounding complex, newer techniques for doing a sinus lift operation have simplified the procedure and today sinus lift procedure is a fairly common ambulatory surgery. The best way to visualize what the procedure consists of, we encourage patients to look for sinus lift procedure videos. Here is an animated short video of a hydraulic sinus lift: 

Sinus lift recovery

Sinus lift recovery is different for each patient and will also vary depending on the technique used and the experience of the surgeon who performed it. But usually, immediately after surgery, it is normal for the patient to experience swelling, bruising on the face, and possibly some nosebleeds during the first and second days. A bone graft and sinus lift recovery will take some time, but the most annoying symptoms will disappear in the next 7/10 days, also during these first days, the surgeon must prescribe analgesics, anti-inflammatories, and antibiotics to reduce the discomfort and the possibility of any complication appearing. A complete sinus lift bone graft recovery can take between 4 and 6 months since this is the average time required for the graft material to heal and integrate with natural bone but specifically the sinus lift surgery recovery time will be around a week.

Sinus lift recovery time

Woman holding clock showing nearly 12

Sinus lift recovery time depends on each patient

A sinus lift healing time will vary depending on many factors like the surgeon’s experience, the technique, and each patient’s characteristics in terms of their general health status. But on average the most intense symptoms appear in the first 48 hours after the surgery, after that time they begin to diminish and around 7 or 10 days after the surgery they will have completely disappeared. The minimum sinus lift recovery time is one week. It is important to follow the surgeon’s orders to guarantee a correct recovery and avoid complications during the postoperative period.

Sinus lift post-operative instructions

The surgeon must give the patient the respective sinus lift post-operative instructions to know exactly what to do and what not to do immediately after surgery and the days after. 

These are some of the most frequent recommendations:

  • The patient should not blow their nose for at least a week.
  • If the patient feels the need to sneeze, they should do it with their mouth open to avoid increasing pressure inside the sinus.
  • Do not do strenuous exercise for the first 15 days.
  • No planes or high-speed trains should be taken.
  • A soft diet should be maintained for the first 48 hours or until indicated by the surgeon.
  • The patient should sleep and rest in a semi-sitting position for the first 48 hours to decrease inflammation and nasal bleeding.

Usually, these indications should only be followed during the first 7 or 10 days after surgery, but some specialists may order their patients to keep them for up to a month to avoid possible ruptures of the sinus membrane.

Sinus lift complications

Like any other surgery, there are sinus lift surgery complications or sinus lift risks that patients should be aware of before undergoing the intervention.  It is important not to confuse postoperative symptoms such as inflammation, moderate pain and nosebleeds with sinus lift complications or sinus lift problems. 

Man suffering from toothache against color background, closeup

Sinus lift complications are very rare, but the patient should be aware of them

The most common dental implant sinus lift complications are:

  • Sinus membrane rupture.
  • Sinusitis. 
  • Bone fractures.
  • Infraorbital nerve injuries.
  • Facial bruise.
  • Bone graft infection.
  • Bone necrosis.
  • displacement of implants into the maxillary sinus.

Sinus lift surgery risks can be exponentially decreased by choosing an experienced surgeon and proper technique, as the skill of the surgeon has a lot to do with the success of the procedure. There are many complications of sinus lift surgery that can occur, but the most common sinus lift complication is membrane rupture. When complications of sinus lift, like the membrane rupture, occurs, the surgeon may try to repair it with a resorbable material and then continue with the initial procedure, but when it is not possible to repair it immediately, it will be necessary to cancel the sinus lift surgery and postpone it for at least 40 or 60 days. Outside of membrane rupture, most sinus augmentation complications occur after surgery, so it is essential to follow the medication prescription precisely as these can prevent other complications. Dental sinus lift complications present symptoms that warn the patient that something is not right, so if the symptoms persist after the time stipulated by the surgeon, it is important to go to a consultation to make sure the situation is controlled.

Sinus lift complications symptoms

Some common dental implants sinus lift problems are swelling and pain, but these are normal for the first 7 or 10 days after surgery, in fact, during the first 48 hours post-surgery these symptoms will reach the point of maximum intensity, and then they will start to decline. They do not represent a true complication unless they do not begin to diminish until they disappear completely. When these persist over time and their intensity does not decrease, they might be considered sinus lift complications symptoms and usually indicate that an infection has occurred.

Sinus lift pain

The most common problems after sinus lift are swelling and pain, but these are normal for the first 7 or 10 days after surgery

The most common problems after sinus lift are swelling and pain, but these are normal for the first 7 or 10 days after surgery

The surgery is performed under local anaesthesia or even general anaesthesia if the patient requests it, so there is no such thing as sinus lift surgery pain, but it is possible to feel some sinus lift pain after the effect of the anaesthesia wears off. However, the sinus lift pain ranges from mild to moderate and will begin to decrease as time passes, in addition, the surgeon usually prescribes medications to relieve pain during the days following the surgery. If the pain is intense, the prescribed medications do not relieve it or it does not disappear after a few days, it is necessary to go to the specialist for a consultation.

Sinus lift swelling

Swelling after sinus lift with bone graft is normal, the surgeon should prescribe medications to reduce the discomfort caused by inflammation, it is also advisable to apply ice packs on the surgery area during the first 24 postoperative hours to relieve symptoms. The swelling will reach its peak within 48 hours after surgery and then will begin to decrease, it should disappear completely in the next 7 to 10 days. Swelling after sinus lift should not persist after this time, if the inflammation does not disappear or decrease considerably as the days go by, it will be necessary to consult a specialist.

Sinus lift infection

Postoperative sinus lift infection (sinusitis) is the most common complication, however, it only occurs in a small percentage of sinus lifts. It usually occurs as a consequence of the rupture of the sinus membrane or postoperative obliteration of the nasal ostium. Sinus lift infection symptoms are pain, inflammation, fistula, purulent discharge, suppuration and increased intrasinusal pressure. In the event of sinusitis, the surgeon must treat it with antibiotics.

Sinus lift failure

Although sinus lift success rates are very high, sinus lift failure is possible, however, this is very rare. If this occurs, the surgeon may want to wait for a while until the area heals to repeat the procedure.

Sinus lift success rate

The sinus lift success rate is one of the highest in dental treatments, it is estimated that around 90% of sinus lift surgeries are successful in the long term, something quite similar to the success rate of dental implants.

Sinus lift cost

 The price varies according to the complexity of the case, the type of graft material, and the amount required

The price varies according to the complexity of the case, the type of graft material, and the amount required

How much does a sinus lift cost? The average cost of sinus lift ranges from 600 GBP to 3,000 GBP, the price varies according to the complexity of each case as well as the type of graft material selected and the amount required. Usually, the cost of a sinus lift is included in the budget for dental implant placement but it is advisable to always ask the specialist what is included in the budget. Just like dental implants, the sinus lift procedure cost is not covered for the NHS which means patients will have to pay for it on private consultation.

Sinus lift cost UK

The cost of sinus lift surgery UK is considerably expensive, although it can vary from city to city the difference is minimal. The NHS does not cover these types of procedures, so patients will need to pay for them on their own. The high sinus lift cost UK is the reason why more and more British are looking for more affordable options for their sinus lift and dental implant treatments, and one of the most popular solutions today is dental tourism to get dental treatments abroad.

Sinus lift abroad

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Medical treatment abroad is getting more and more popular. High-quality treatment may be much cheaper in different countries due to different the cost of living

Getting dental treatment abroad has become a fairly common practice today, starting with the fact that it is possible to save up to 60% on dental treatments. But in addition to this, the boom in dental tourism has produced a growing interest in countries that offer dental tourism services and this has caused high-quality standards to be established. Besides, regulatory bodies have become stricter in terms of dental practices, which has led many countries to stand out for the high quality of their dental treatments. Some of the best dental treatments abroad can be found in countries like Poland, Hungary, Czech Republic and Turkey. As proof of that, there are countless dental treatment abroad reviews written by former patients on the internet. 

Summary

Sinus lift surgery allows patients with significant bone loss to rehabilitate their mouth with dental implants, greatly increasing their quality of life. Despite the fact that all surgeries have associated risks, sinus lift has one of the highest success rates in dentistry, up to 90% of the procedures are successful. Sinus lift surgery cost, like implants, is not subsidized by the NHS and the cost in private practice is quite high, for this reason, thousands of British travel every year to receive dental treatments abroad, this may be the ideal option for those who need this type of expensive treatment. However, dental tourism is not for everyone and we recommend doing all the necessary research before making a decision.

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Sources

Deisy E. Quispe-Damián, Carmen T. Castro-Ruiz, Carmen T. Castro-Ruiz. “Surgical Complications Associated to Maxillary Sinus Floor Elevation in Implantology” Odovtos International Journal of Dental Sciences. 2020.

Bassi, Mirko Andreasi PhD, DDS*; Lopez, Michele Antonio MDS; Confalone, Luca DDS; Carinci, Francesco MD. “Hydraulic Sinus Lift Technique in Future Site Development” Implant Dentistry: February 2015 – Volume 24. 

Yuliana Sandoval

Yuliana is a translator and content writer specializing in the health sector. She is currently in her last year of dentistry at Antonio Nariño University (UAN) in Colombia.

She has gained experience over the years working for prestigious medical and dental websites from the UK, USA and Spain writing content in English and Spanish.

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