All you need to know about Sinus Lifts
When we see patients wanting dental implants in the posterior maxilla, we often encounter this situation:
An enlarged maxillary sinus.
:(
In addition to ridge resorption, there is expansion of the maxillary sinus following extractions — sometimes reducing the available height to <4mm, making it impossible to place implants predictably.
What can we do?
In order to manage these situations, besides using short dental implants (that have questionable long term stability, especially if bone loss occurs around these implants over time), sinus augmentation is needed increase the vertical height of bone.
There are 2 different methods.
Lateral Window
Step 1. Raise a full thickness flap in the posterior maxilla and create a bony window.
Step 2. Elevate the Sinus (“Schneiderian”) membrane.
Step 3. Place bone graft material below the sinus membrane in the sinus cavity.
Crestal Approach
A window is created through the osteotomy site, placing bone graft material beneath the sinus membrane.
So what’s the difference between these two techniques?
Lateral Window
- Direct visualization of the sinus is possible.
- A greater lift is achievable due to direct manipulation of the sinus membrane.
- More complications: Intraosseous artery perforation might occur whilst creating a bony window. The presence of a sinus septum may prevent a lift.
Crestal Approach
- Shorter surgical time — less post surgical complications.
- More condensation of bone is achievable— making it possible to obtain primary stability (which is often lacking in the posterior maxilla due to poor bone quality).
- Reduced risk of sinus perforation.
- Lift is possible even in the presence of a sinus septum.
- The amount of lift possible is less than the lateral window technique.
However, with new devices that use saline and balloons to elevate the sinus membrane, results similar to a lateral window may be possible in the near future.
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