Dr Mani's Top Tips when considering a sinus lift in preparation for implants

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Sinus Lifts are surgical procedures performed by trained and experienced oral surgeons to increase the volume of bone in the posterior maxilla. The most likely reasons are for either preparation for or during the placement of osseo-integrated dental implants.

Sinus lifts (sinus floor elevation/augmentation) are performed when the space between the floor of the sinus and the crestal bone of the alveolar ridge is not sufficient for a dental implant. If there is not enough bone height then placement of a dental implant could result in failure of the implant or even damage to the sinus. The loss of space is usually associated with the lowering of the sinus floor to do with: Long-term tooth loss without the required treatment, periodontal disease, and trauma.

Patients need extensive assessment and planning prior to considering this surgery as this is certainly not for the amateur implantologist.

The assessment phase should not be taken lightly and good investigation carried out. CT scans are a must for me and simply having just a panoramic x-ray may not allow you see all that is present. Careful examinations of the surgical site, surgical access, and of course general dental and medical histories are fundamental.

Consideration of the graft materials is a point not to miss and must be discussed with the patient in detail as some wish to know ‘‘Where is the bone coming from doc?’’.

My personal favourite is the Bio-Oss large granules, this works great for me and mixing this with some autogenous bone and other growth factors makes a great cocktail for success.

Various biomaterial and growth factors can be used from harvested bone, but assess the size of the lift and be sure to have enough material at hand as some lifts may tend to take a larger amount of graft materials than originally thought, my aim is to always have at least two-four grams of biomaterials ready per lift.

The correct equipment can make your life so much easier and having a piezosurgery is just the answer to that, although adequate training is required to operate this to the best of its ability.

Maintaining the integrity of the Schneider membrane and achieving the desired lift volume are the key aims of the sinus lift procedure but various inter-surgery checks must be met too. A common complication here is a tear in the sinus membrane so integrity checks throughout.

Ensure the grafted material has good contact with the internal lateral wall of the sinus as this will ensure long term stability and success, alongside knowing that all graft material is well contained in the space that has been created by the lift and there is no void/space for it to leak from.

Once surgery has been completed and the area closed well then healing time is the goal from here, as the most notable risk here being sinusitis which is untreated can lead failure of the whole procedure.

In some cases it is possible to allow the placements of the dental implants at the same time and in some not. Those where this should not be possible my tip would allow healing for at least six months prior entering the grafted site, this will allow the bone graft to mature and better fixation of the implants in the graft sinus space.

Overall Sinus Lifts are a safe, effective and predictable way of allowing us implantologist’s to increase bone in our working zone and if the core credentials of this surgery are met we can achieve our end of the desired goal.... winning smiles !!

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