Internal Sinus Lift Procedure: What to Expect

Dental implants are a reliable and long-lasting solution for replacing missing teeth. However, successful implant placement requires adequate bone volume in the jaw to ensure stability and integration. 

In the posterior upper jaw, bone loss is common due to tooth loss and the natural expansion of the sinus cavity, known as sinus pneumatization. When bone height is insufficient, an internal sinus lift procedure can be performed to augment the bone and create a suitable foundation for dental implants.

At Brighton Implant Clinic, we specialize in advanced restorative and implant dentistry, including internal sinus lift procedures. Our experienced team utilizes state-of-the-art technology and techniques to provide personalized care and optimal outcomes for our patients.

Understanding the Internal Sinus Lift Procedure

An internal sinus lift, also known as a transcrestal sinus lift, is a minimally invasive surgical technique used to increase bone height in the posterior maxilla (upper jaw) to support dental implants.

Unlike the lateral (external) sinus lift approach, which involves creating a window in the lateral wall of the sinus, the internal sinus lift is performed through the existing tooth socket or a small opening in the alveolar ridge.

This procedure involves gently elevating the sinus membrane (Schneiderian membrane) and placing bone graft material beneath it to promote new bone formation. The internal sinus lift is typically indicated when there is at least 4-6 mm of residual bone height, allowing for simultaneous implant placement in many cases.

Indications for the Procedure

The internal sinus lift is recommended for patients who:

• Have insufficient bone height in the posterior maxilla due to tooth loss and sinus pneumatization.
• Require dental implants in the upper premolar or molar regions.
• Prefer a less invasive approach with reduced healing time compared to the lateral sinus lift.
  
  

By augmenting the bone in the posterior maxilla, the internal sinus lift enables the placement of dental implants in areas that would otherwise be unsuitable due to inadequate bone volume.

Preoperative Assessment and Planning

A thorough preoperative assessment is essential to determine the suitability of an internal sinus lift. Diagnostic imaging, such as panoramic radiographs and cone-beam computed tomography (CBCT), is used to evaluate:

• The height and width of the residual alveolar bone.
• The anatomy and health of the maxillary sinus.
• The presence of any sinus pathology or anatomical variations.
  
  

CBCT imaging provides detailed three-dimensional views, allowing for precise planning of the surgical approach and implant placement.

Treatment Planning

Based on the diagnostic findings, a customized treatment plan is developed. Factors considered include:

• The amount of residual bone height.
• The need for simultaneous or staged implant placement.
• The type and volume of bone graft material required.
  
  

In cases where residual bone height is less than 4 mm, alternative approaches such as the lateral sinus lift or the use of short implants may be considered.

Internal Sinus Lift Procedure in 6 Steps

The internal sinus lift procedure involves the following steps:

1. Anesthesia: Local anesthesia is administered to ensure patient comfort during the procedure. Sedation may be used for anxious patients.
2. Osteotomy Preparation: A small opening is created in the alveolar ridge at the planned implant site using specialized instruments.
3. Sinus Membrane Elevation: The sinus floor is gently fractured, and the Schneiderian membrane is carefully elevated using osteotomes or hydraulic pressure techniques.
4. Bone Graft Placement: Bone graft material is inserted into the space created beneath the elevated sinus membrane to promote new bone growth.
5. Implant Placement: If sufficient primary stability can be achieved, a dental implant is placed simultaneously. Otherwise, implant placement is delayed until the graft has integrated.
6. Closure: The surgical site is closed with sutures, and postoperative instructions are provided.
   
   

Materials Used

Various bone graft materials can be used in internal sinus lift procedures, including:

• Autografts: Bone harvested from the patient's own body.
• Allografts: Donor bone from a human source.
• Xenografts: Bone from an animal source, typically bovine.
• Alloplasts: Synthetic bone substitutes.
  
  

The choice of graft material depends on factors such as the patient's preferences, the volume of bone required, and the clinician's experience.

Postoperative Care and Recovery

After the procedure, patients are advised to:

• Avoid blowing their nose or sneezing forcefully for at least two weeks to prevent displacement of the graft material.
• Refrain from using straws, smoking, or engaging in strenuous activities.
• Take prescribed medications, including antibiotics and pain relievers, as directed.
• Maintain good oral hygiene while avoiding the surgical site during brushing.

Healing Timeline

Initial healing typically occurs within 1-2 weeks, with swelling and discomfort subsiding during this period. Complete integration of the bone graft material and formation of new bone can take several months. Dental implants are usually placed after 4-9 months, depending on the individual's healing response and the amount of bone regenerated.

Regular follow-up appointments are scheduled to monitor healing and ensure the success of the procedure.

Potential Risks and Complications

While the internal sinus lift is generally safe and effective, potential risks and complications include:

• Sinus Membrane Perforation: A tear in the sinus membrane can occur during elevation. Small perforations may heal spontaneously, while larger ones may require repair or delay of the procedure.
• Infection: As with any surgical procedure, there is a risk of infection. Adhering to postoperative care instructions and taking prescribed antibiotics can minimize this risk.
• Graft Failure: Failure of the bone graft to integrate may necessitate additional grafting procedures.
• Implant Failure: In rare cases, the dental implant may fail to osseointegrate, requiring removal and replacement.
  
  

Patients are encouraged to report any unusual symptoms, such as persistent pain, swelling, or nasal discharge, to their dental professional promptly.

Advantages of the Internal Sinus Lift Approach

The internal sinus lift offers several benefits compared to the lateral approach:

• Minimally Invasive: The procedure is less invasive, resulting in reduced postoperative discomfort and faster recovery.
• Simultaneous Implant Placement: In many cases, the dental implant can be placed during the same procedure, shortening the overall treatment timeline.
• Lower Risk of Complications: The internal approach has a lower incidence of sinus membrane perforation and other complications.
• Cost-Effective: The reduced surgical time and need for fewer appointments can make the internal sinus lift a more cost-effective option for patients.

Integration with Dental Implant Placement

The timing of dental implant placement following an internal sinus lift depends primarily on the residual bone volume and the stability that can be achieved during the procedure. 

In many cases, when there is enough existing bone height - typically 4 mm or more - and the implant achieves adequate primary stability, it is possible to place the dental implant during the same surgical session as the sinus lift. This approach not only reduces overall treatment time but also minimizes the number of surgeries required.

However, in situations where the bone quality is insufficient to support immediate implant stability, the placement is typically delayed. In such cases, the grafted bone is allowed to heal and integrate with the existing bone over a period of approximately 4 to 9 months. This delay ensures that a strong, stable foundation is in place before introducing the implant, thereby improving the long-term success rate.

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Ultimately, the decision between simultaneous and delayed implant placement is made based on careful clinical evaluation, radiographic imaging, and the patient’s unique anatomical and health profile. The goal is always to maximize the success of the implant while minimizing potential risks.

Long-Term Outcomes and Success Rates

The internal sinus lift procedure, particularly when executed using the osteotome technique, has demonstrated high success rates in dental implantology. A systematic review encompassing 13 studies reported an overall survival rate of 97% for implants placed using indirect approaches like the osteotome technique. Another long-term study observed a 15-year implant survival rate of 98.3% following maxillary sinus augmentation. ​

These findings underscore the predictability and efficacy of the internal sinus lift in facilitating successful dental implant placement in the posterior maxilla. The procedure's minimally invasive nature, coupled with advancements in surgical techniques and graft materials, contributes to its favorable outcomes.​

It's important to note that patient-specific factors, such as bone quality, sinus anatomy, and adherence to postoperative care, play a crucial role in the long-term success of the implants. Regular follow-ups and maintenance are essential to monitor the integration of the implant and the health of the surrounding tissues.​

Brighton Implant Clinic's Expertise in Internal Sinus Lifts

At Brighton Implant Clinic, we pride ourselves on our proficiency in advanced implant procedures, including internal sinus lifts. Our team of experienced dental professionals utilizes state-of-the-art technology and evidence-based techniques to ensure optimal patient outcomes.​

We understand that each patient's anatomical and clinical situation is unique. Therefore, we conduct comprehensive assessments, including CBCT imaging, to tailor treatment plans that address individual needs. Our commitment to patient-centered care ensures that procedures like the internal sinus lift are performed with precision, minimizing risks and enhancing success rates.​

Our clinic's dedication to continuous education and adoption of innovative practices positions us at the forefront of implant dentistry. We strive to provide our patients with the highest standard of care, restoring function and aesthetics to their smiles.​

Frequently Asked Questions (FAQs)

Is the internal sinus lift procedure painful?

The internal sinus lift is generally well-tolerated. Local anesthesia is administered to ensure comfort during the procedure. Postoperative discomfort is typically mild and can be managed with over-the-counter pain relievers.​

How long does the healing process take?

Initial healing occurs within a few weeks. However, complete integration of the bone graft and readiness for implant placement may take 4 to 9 months, depending on individual healing responses.​

Can I return to work immediately after the procedure?

Most patients can resume normal activities within a day or two. It's advisable to avoid strenuous activities for a short period to facilitate optimal healing.​

What are the signs of complications I should watch for?

Persistent swelling, pain, or signs of infection, such as fever or unusual discharge, should be reported to your dental professional promptly.​

Is the internal sinus lift suitable for everyone needing dental implants?

The procedure is ideal for patients with moderate bone loss in the upper jaw. However, individual assessments are necessary to determine suitability, considering factors like sinus anatomy and overall health.​

Conclusion

The internal sinus lift procedure stands as a reliable and minimally invasive solution for patients requiring dental implants in the posterior upper jaw with insufficient bone height. With high success rates and a favorable safety profile, it enables the placement of stable and long-lasting implants.​

At Brighton Implant Clinic, our expertise in performing internal sinus lifts ensures that patients receive personalized care tailored to their specific needs. Through meticulous planning and advanced techniques, we aim to restore function and aesthetics, enhancing our patients' quality of life.​

If you're considering dental implants and suspect you may need a sinus lift, we invite you to schedule a consultation with our experienced team. Together, we can explore the best treatment options to achieve your oral health goals.