Why You Might Need A Sinus Operation If You Want Dental Implants

As dental implants are becoming more and more common in people of all age groups, patient awareness of procedures that may need to be done alongside implants has also spread. People are aware that they may require some amount of bone grafting or maybe even a membrane placement if their bone is insufficient to support the implant on its own. They are however less aware about the need for sinus surgery during the implant placement procedure. This procedure is also called a sinus lift.

What Is Sinus Lift Surgery?

The sinus that is being referred to here is the maxillary sinus. The anatomical position of this sinus is in close relation to the maxillary upper teeth. The second premolar and the molars are frequently in close proximity to this sinus, although in some rare cases, the sinus can also be in close vicinity to the first premolar.

In certain situations, the patient has an insufficient amount of bone to place a dental implant in the upper arch without puncturing the sinus membrane. For example, the bone height available is 6 mm, which is insufficient for an implant of 10 mm. Such an implant would puncture the sinus membrane unless a sinus lift procedure is performed.

This space is then usually filled with a bone graft to hopefully promote the formation of bone to augment the implant support over time. The entire procedure is performed on the dental chair itself under local anesthesia. There is usually no need for any hospitalization.

The surgery can be performed in two manners:

• An Indirect Sinus Lift
• A Direct Sinus Lift

Indirect Sinus Lift

This is a far less invasive procedure than the direct sinus lift. It is also technically less demanding of the operator and has a higher rate of success. The problem is that this procedure is not sufficient in cases which have a very poor bone height to begin with.

The procedure for an indirect sinus lift is very similar to getting an implant placed. The dentist will drill in a precise manner, ideally getting within 1 mm of the sinus. Bone-cutting drills are substituted for special sinus lift drills, which will remove the last sliver of bone and then use it to "tent" the sinus upwards, thus creating additional space for the implant.

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Depending upon the initial bone level, the dentist may or may not choose to place a bone graft in the area. Once this part of the procedure has been performed, an implant is placed in the mouth and healing is allowed to take place.

The limitations of this procedure include the fact that "tenting" can only be done until a certain point before the sinus membrane will rupture. Think of it like applying pressure on a balloon where after a certain point it will give way and burst (there is no explosion in the sinus however!).  There is also the need for at least 5 mm of bone to provide the primary stability of the implant. This primary stability is considered absolutely paramount to the success of the implant and something that every implant placement must aspire to.

Direct Sinus Lift, Precautions And Potential Complications 

Direct Sinus Lift

This procedure is considered when tenting the sinus membrane will not provide enough space for the placement of the implant. This procedure involves creating a small window into the bone next to the sinus and then accessing it directly, not just through the implant drill.

The idea is to be able to manipulate the sinus membrane and place a large amount of bone graft to allow for the maximum possible bone formation. Since the amount of healing required is more and the procedure is a lot more invasive, the chances of graft rejection are higher.

The procedure is also commonly undertaken in two stages, in which only the direct sinus lift is performed in the first step. Healing is then allowed to take place for a period of four to six months after which re-evaluation through the use of X-ray and CT scan imaging is done.

Can Sinus Surgery Result In Complications?

The procedure is considered absolutely safe and does not carry with it the risk of any long-term complications. In the short term, the surgery carries with it the same risk as any other procedure, namely infection, graft rejection, prolonged bleeding, pain and swelling.

One thing that is extremely common with sinus surgery is a slight inflammatory reaction, leading to some amount of pain within the sinuses. This is usually very mild in nature and is easily manageable with the use of anti-inflammatory medication or decongestants for a few days.

In rare cases, the bone graft placed around the sinus does not heal, which leads to a failure of the implant. Care should be taken to remove the implant at the right time otherwise it can get pushed inside the sinus itself. A surgical procedure to remove it then has to be undertaken in most cases.

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Post-Surgery Care

While patients who just underwent sinus surgery have no major limitations, most doctors do advise them to avoid any heavy physical exertion for a few days. Activities like lifting weights or yoga exercises should be avoided for a few days.

Post-operative medications and pain killers need to be taken for the entire prescribed duration.

Conclusion

Even though dental implants have now been around for a significantly long period of time, doctors are still pushing the boundaries as to the clinical situations in which they can be used. Coupled with an increasing understanding of bone healing and new bone formation, it is likely that clinical situations that could never have envisaged a fixed prosthetic solution, will become relatively easily manageable in future. Sinus surgery will have a role to play in this transition and will be offered to more and more patients around the world.