Sinus Lift Procedure • Cost • Risks

Sinus Lift is a surgical dental bone grafting procedure (Sinus Augmentation), usually performed in preparation of dental implants placement in the area of the back upper jaw.

A sinus augmentation may increase significantly the treatment cost, but it is the only solution for patients without enough bone in the sinus area to become eligible for dental implants.

The purpose of a sinus lift procedure is to raise the maxillary sinus floor and provide adequate depth of jaw bone for a successful placement of dental implants. Sinus lifts make possible the use of implants for replacing missing upper molars for patients who would have no other option than the traditional bridges or dentures.

The maxillary sinus is a cavity located above the upper jaw at the upper cheek area. During sinus augmentation the sinus membrane is lifted and dental bone graft material is placed between the upper ridge of the jaw and the floor of the maxillary sinus. The procedure is performed under local anaesthesia by a specialist dentist, a maxillofacial surgeon or a periodontist.

The cost of a typical sinus lift for placing a single implant can range from $500 to $2,500. If extensive sinus augmentation is needed for placing multiple implants in both sides of the jaw, the total cost may be up to $20,000. Cost of sinus lifts is relatively higher if the "lateral window" technique has to be used, instead of the less invasive "internal sinus lift" technique.

It is difficult to estimate an average cost of a sinus augmentation treatment. There are big variations depending on the amount of bone loss, the extend of the area to be grafted and the specific surgical technique to be used. Other factors such as expertise and geographic location of the dentist also affect the cost as they do for any other dental treatment.

The need for a sinus lift operation can raise significantly the cost of dental implants. It is important that the dentist identifies the problem early, otherwise it could increase even more the length and cost of treatment.

Is Sinus Lift covered by Dental Insurance?

Before starting the treatment, you should check with your dental insurance if sinus lift costs are included in the covered benefits and ask your dentist to get it pre-authorized.. Unfortunately, most dental insurance companies do not cover the cost of sinus augmentation & bone grafting despite its necessity for implant placement. Only some high premium insurance plans may cover part of the cost.

In cases when there is extensive bone loss caused by accident, injury or medical conditions other than dental health issues, a medical insurance may cover the sinus lift cost, if there is a medically necessity.

The dental implant dentist will recommend a sinus lift procedure when the X-rays or CT-scans show that there is not enough bone in the upper jaw to support the implants. If the depth of the jawbone under the sinuses is not adequate, the implant may penetrate into the sinus cavity. A sinus membrane perforation may cause infection that could lead to implant failure.

When the distance between the lower ridge of the maxilla (upper jaw) and the floor of the sinus cavity is too small to place a dental implant of proper length, a sinus lift or sinus augmentation procedure must be performed, in order to restore the necessary bone depth.

Conditions that make necessary a sinus lift include:

• Facial bones anatomy. If a person has a combination of a small upper jaw and relatively large maxillary sinus, the available bone depth over the back teeth is not sufficient for the placement of implants.
• Bone loss due to gum disease. Advanced periodontal disease (periodontitis) can cause extensive loss of bone structure around the infected teeth. When the tooth is lost or has to be extracted, the remaining bone may not be enough to support dental implants. The upper jaw has by nature less bone density than the lower jaw especially over upper back teeth, making it more vulnerable to bone loss.
• Bone resorption due to missing teeth. When a tooth is lost, the body thinks that the bone is no longer needed there and starts a resorption process to recover the bone minerals, which can cause significant bone loss. People who have lost their upper molars, without replacing them soon, are the more seriously affected and may need a sinus lift before they can replace lost teeth with dental implants.
• Bone loss due to other factors. In some cases a bone deficiency may be associated with a previous surgical procedure such as a difficult tooth extraction or the removal of a cyst or tumor.

A CT-scan is recommended before a sinus lift operation, in order to have a clear 3D-image of the jawbone and sinus for the best preparation and design of the surgical procedure. Depending on the findings the dentist will decide which type of sinus lift procedure and bone graft material is more suitable.

Sinus augmentation is a dental bone grafting procedure. If an autogenous bone graft will be taken from the patient's chin the surgical procedure can be at the same appointment as the sinus lift. If the bone graft has to be taken from the patient's hip the procedure must be performed in a hospital. Many dentists prefer the use of allografts or xenografts in order to 'save' the patient from one more surgical procedure.

Sinus augmentation is actually a combination of a sinus lift operation and a bone grafting procedure. The most popular techniques that oral surgeons use for performing a sinus lift operation are:

• Lateral window approach and
  
• Osteotome approach (internal sinus lift).

Today, there are several surgical techniques developed for a sinus lift procedure. Dentists decide which is more suitable for each patient based on their training and the characteristics of the individual case.

Technique 1. Lateral Window approach - Traditional Approach

• ❶ An incision is done in the gum tissue to expose the bone on the buccal (cheek) side of the jaw right above the area that the implant will be placed and a little higher from the sinus floor.
• ❷ A small 'window' is cut on the bone in a way that a 'trap' door is created hanging from the top.
• ❸ This piece of bone is pushed gently inwards and upwards into the sinus cavity.
• ❹ The bone's movement carries the sinus membrane higher, lifting the sinus floor. The first phase of the sinus lift is now completed.
  
• ❺ The empty space created underneath the bone window is filled with bone graft material.
• ❻ The gum tissue is put back in place and stitched.
• ❼ The bone graft material will eventually form new bone tissue and increase the bone mass around the implantation area.
  

Technique 2. The Osteotome approach - "Internal Sinus Lift Procedure"

The technique is used when the depth of the jaw is enough for placing a stable implant and only little extra bone (1-3mm) is needed in order to prevent sinus perforation. This type of sinus lift procedure is less invasive causing less surgical trauma than the 'lateral window' approach. Another advantage of the 'internal sinus lift' technique is that it can be done at the same time the dental implant is placed.

• ❶ The osteotome sinus lift utilizes the same opening that is used for placing the dental implant.
• ❷ The surgeon uses a sharp osteotome to create an indentation on the bone
• ❸ A sinus lift osteotome is then placed into the socket and the sinus floor is gently pushed up until it is cracked free. It is then pushed further to lift the sinus membrane and create the desired height.
  
• ❹ The required quantity of bone graft material is placed into the sinus lift.
• ❺ The implant can be placed immediately after the sinus lift bone grafting has completed.
  

Sinus lifts performed with either of these techniques have been shown to greatly increase the success rate of dental implant procedures.

The time between a sinus lift and the placement of dental implants may be different by case:

• Immediate placement and loading. If the sinus lift was performed only for preventing a possible penetration into the sinus cavity but there is adequate quantity of bone to provide proper initial stability, both implant and restoration can be placed immediately after the sinus lift.
• Immediate placement but delayed loading. If the stability is marginal the dentist will place the implant but may wait some months before it is loaded with the final restoration.
• Delayed placement and loading. If the existing bone "wall" is too thin, the patient must wait after the sinus lift until the bone graft has matured, for four to twelve months, depending on the graft material that was used (autogenous graft materials usually integrate faster then allografts or xenografts). Only then the dental implant can be placed safely (a second surgery is required).

Sinus lift is a surgical procedure and requires proper post operative care to avoid complications:

• Bite down and maintain firm pressure on the gauze pack that was placed at the end of your surgery for at least 30 minutes. For the next hours some bleeding from the mouth or nose is normal.
• Some swelling and pain can be expected for a few days after the sinus lift procedure but without causing any major discomfort.
• Apply ice in the areas where the surgery was done to minimize symptoms.
• Take the prescribed pain medication to relieve pain, and antibiotics to help prevent infection.
• Avoid blowing the nose or sneezing forcefully for several weeks after surgery as this could cause the bone graft material to move away of the implantation area.
• Do not brush your teeth next to the surgery site for the next 2 days.
• Do not drink with a straw or drink carbonated liquids for the next 3 days.
• DO NOT SMOKE.
• A follow-up visit to the dentist will be scheduled after a week or two, for the stitches to be removed and the dentist to monitor the healing progress.

The dentist must be contacted if swelling, bleeding or pain does not subside after one or two days from the sinus lift operation, or if any fever develops.

The success rate of dental implants after a sinus augmentation is very high with an implant survival rate of about 95%, but as with any invasive surgical procedure there is a small possibility of complications in 2.5-3% of cases. The risk of sinus lift complications is mostly related with the expertise of the dentist performing the sinus lift and the patient's compliance with the post-operative instructions. Possible complications include:

• Sinus perforation - The most common complication during sinus lift procedures is perforation or puncture of the sinus membrane. A tear in the membrane can allow bacteria to invade in the sinus cavity and cause an infection. If a perforation occurs, the dentist will try to either stitch the membrane or place a patch over it. An antibiotic will be prescribed to prevent any infection. The bone grafting will have to be postponed until the trauma has healed, if the bone graft material can not be contained in place. The sinus lift can be repeated in a few months after the membrane has healed.
• Bone graft displacement - The patient should avoid blowing the nose or sneezing forcefully for several weeks after surgery as this could cause the bone graft material to move away of the implantation area. In case of allergies, to minimize the risk of sinus lift failure, the procedure must be scheduled at a season of the year when symptoms are at a minimum.
• Infection - The risk of infection exists as in any other surgical procedure.