The prospect of having an artificial tooth surgically implanted into your head can be a daunting one to say the least, but in some cases you may require more treatment then a simple implantation procedure. If you are receiving a dental implant to replace a tooth missing from your top row of teeth, the bone beneath your top row of gums must be both thick and strong enough to support the screws and fixtures necessary to keep an implant in place. If it isn't, you may require a sinus lift to reinforce this layer of bone before your implant can be safely installed.
What is a sinus lift?
When a tooth is lost, the vacant socket of bone that held it in place gradually collapses as it heals, causing a small but significant loss of bone strength and thickness in the affected area. If you have lost a tooth from the top row of teeth in your mouth, this bone collapse can dramatically weaken the maxillae, the bones that form the hard palate and hold your top teeth in place. When this happens, the maxillary sinuses which lie just above the roof of the mouth can widen as the bone degrades, leaving insufficient amounts of maxillary bone to properly support an implant.
If you require a dental implant in your top row of teeth but have suffered from this kind of bone degradation, your dentist may recommend that you have a sinus lift performed. This procedure can take several forms, but the aim of all of them is to lift the maxillary sinus and strengthen the bone beneath enough to properly support an implant.
What does a sinus lift involve?
Before a sinus lift can take place, your dentist will need to inspect the site of the bone loss and check the size and position of your maxillary sinuses—this is generally accomplished with dental X-rays, but in some cases you may have the area CT scanned to check for possible infection sites. Once this has been accomplished, surgery can begin. You may be referred to a specialist oral surgeon for this, but in most cases the operation can be performed by your dentist under local anaesthesia without the need for a hospital visit.
When it comes to the surgery itself, you may undergo one of three different procedures to graft the bone in place:
- Osteotome sinus lifts are the simplest and least invasive procedures and require only a single incision in your gum tissue. A dentist will bore a socket through the bone until they reach the maxillary sinus, at which point they will adjust it with special surgical tools known as osteotomes until it sits higher in the skull. This procedure is intended to promote thickening and strengthening of the maxilla through natural means by providing the bone with more room to grow. However, it can only be used in minor cases of bone loss and is not suitable for more serious cases.
- Traditional sinus augmentation is a more involved procedure than an osteotome lift, and it requires a larger incision (or several incisions) to be made in the gum tissue. Once a 'window' has been formed to the underlying bone, a hole is drilled in the bone until the sinus is reached. A bone graft is inserted into this hole and left to bond with the existing bone structure until the maxilla is strengthened enough to support implants. This procedure carries more risks of complications and infections than an osteotome lift and requires more time to heal. However, it can provide much more strength to badly damaged maxillae.
- Hydraulic sinus condensing is similar to traditional sinus augmentation, but involves the use of hydraulic pressure to lift the sinus instead of traditional implements. This procedure is much less traumatic to the bone and sinuses, meaning that in many cases a dental implant can be installed at the same time as the bone graft. However, this procedure is not offered by many dentists and may be difficult and expensive to arrange.