Bone Grafting and Sinus Lift

• Whether a graft is needed is decided by imaging and examination together
• Closed or open sinus lift for bone height in the upper back jaw
• The method is chosen according to the remaining bone height and sinus health
• The implant is placed in the same appointment if possible, or after the graft has healed if not

In short: A bone graft is a surgical support used to increase the volume of jawbone that has resorbed; a sinus lift raises the sinus floor in the upper back jaw to make room for an implant. It is not needed in every implant patient; the need is determined by three-dimensional imaging and examination.

What is it?

An implant can stay healthy for a long time only when it is surrounded by enough bone. If bone volume is insufficient, the area where the implant will sit is prepared first. A bone graft is a procedure in which a bone-like material is placed in the deficient area, creating the conditions for the body to fill that area with its own bone. A sinus lift is the gentle lifting of the membrane at the floor of the sinus cavity, located above the molar teeth in the upper jaw, and placing graft material beneath it. The two procedures can be done independently of each other or as parts of the same plan.

For the implant itself and the general assessment criteria, see the dental implant treatment page; here we focus only on bone preparation.

When is it needed?

The most common cause of bone deficiency is tooth loss itself: when chewing forces are no longer transmitted to the bone, the bone in that area gradually resorbs. Advanced gum disease, infections at the root tip, difficult extractions, injuries and long-term use of removable dentures can also contribute to bone loss.

• Insufficient width or height: If enough bone thickness cannot be left around the chosen implant, a graft comes into consideration.
• Upper back jaw: When teeth are lost, the sinus cavity can expand downwards and bone height decreases. In this area a sinus lift is considered for an implant.
• Socket preservation after extraction: In some cases, a graft is placed in the socket when the tooth is removed to prevent the bone from collapsing.

The decision is not made by looking at a panoramic X-ray alone; bone height and width, the anatomy of the sinus floor and sinus health are examined with three-dimensional imaging. If there is an active sinus infection, that is treated first.

Methods

Types of bone graft. Graft material is generally described in four groups: bone taken from the patient's own body, processed human-derived bone, processed animal-derived bone and synthetic materials. Which one is chosen is planned according to the size of the deficiency, the area and the patient's condition. The graft is often covered with a thin membrane that protects bone regeneration. Each material has different advantages and limitations; the reasons for the choice are explained at the examination.

Sinus lift. There are two basic approaches:

• Closed method: While the implant site is being prepared, the sinus floor is gently pushed upwards through this site. If the remaining bone height allows it, the implant can often be placed in the same appointment.
• Open method: A small bone window is opened on the side of the jaw, the sinus membrane is carefully lifted and graft is placed in the space created. It is preferred when more bone gain is needed; the implant is placed in the same appointment or after the graft has matured, depending on the situation.

The remaining bone height is the main factor that determines which method is chosen and whether the implant can be placed in the same appointment. In some cases, options such as a short implant, a tilted implant or a partial denture, without touching the sinus at all, are also considered.

Process and healing

1. Examination and imaging: Your general medical history, the medicines you use, smoking habits and three-dimensional imaging are assessed together.
2. Planning: The type of graft, the method and the timing of the implant are determined; possible risks are explained before the procedure.
3. Surgery: The procedure is done under local anaesthesia. Where a patient has dental fear or finds it hard to cooperate (children and adults alike), sedation or, if needed, general anaesthesia can be discussed with the dentist.
4. Healing: Time is needed for the graft to turn into bone. This period varies with the size of the graft, the method and the individual's healing rate; no fixed timetable is promised in advance.
5. Implant and prosthesis: Once the graft has matured (or in the same appointment if suitable), the implant is placed, and after it has integrated, the prosthesis is made.

In the first days, swelling, tenderness, limited mouth opening and, after sinus procedures, slight blood-tinged discharge from the nose are expected. After a sinus lift it is important not to blow your nose forcefully, to keep your mouth open when sneezing, not to use a straw and to avoid air travel for a certain period, because pressure changes inside the sinus can affect the area where the graft sits. Smoking and alcohol have a negative effect on healing. The written instructions given for oral care, cold application and a soft diet in the first days should be followed.

Risks

As with any surgical procedure, swelling, pain, bleeding and infection can occur. In a sinus lift, a tear of the sinus membrane (uncommon, and usually managed during the procedure), sinus infection and a graft that does not mature as expected are also possible. If the graft does not form enough bone, the plan may need to be changed or the procedure repeated. Increasing pain, high fever, a bad smell or taste, discharge from the surgical site and persistent blockage of one side of the nose are signs that should be reported to your dentist immediately.

Visit plan for patients from abroad

In treatments that require a graft, time must be allowed for the bone to mature, so the plan is often split into two visits: the first for examination, imaging and surgery; the second for the implant and prosthesis stages after the graft has matured. In cases where bone preparation and the implant can be done in the same appointment, the number of visits may change. A panoramic X-ray or CT scan can be shared for a remote preliminary assessment; the final method is determined by the examination at the clinic. For details, see the process for international patients page. Where bone is insufficient throughout the jaw, the All-on-4 concept is also considered as an option that does not need grafting.

Frequently asked questions

The information on this site is for general guidance only; diagnosis and treatment require an examination by a dentist.