Placing Dental Implants Where Bone Does Not Exist!

When I was initially introduced to dental implants in the late 1980’s, most dental practitioners gave them little consideration to dental implants for their patients who lost teeth. At that time, implants were shape like thin blades and they had a success rate hovering around the 50 % retention of those placed. The new root form implants were brought to dentistry by an orthopedic surgeon who stumbled on to the concept of osseointegration. When I was President of the American Society for Geriatric Dentistry, I was introduced to a Dentist from Manhattan, Kansas who at the time was the President of the Academy of Dentistry for the Handicapped. These organizations were in the throes of merging into what would become the Federation of Special Care Organizations in Dentistry. We succeeded in that endeavor and during our frequent meetings, I learned of his passionate interest in dental implants. Dave was so driven, that he flew to Germany to meet the dentist (Dr. Kirsch) who invented the cylinder root form implant called IMZ. He was able to secure visits to Manhattan for Dr. Kirsch to present 3 and 4 day long lectures and clinical demonstrations for multiple years in the early 1990’s. One thing that Dr. Kirsch marveled at was the severity of bone loss in the American population and on procedure he taught us was the ‘Sinus Lift’ procedure that would regrow bone where it had grown before.

A sinus lift, or “sinus augmentation”, is a surgery performed to develop new bone where dental implants can be placed . Several different approaches to generating the bone in the area of the sinus have evolved. In most cases, patients experience little discomfort in the procedure’s aftermath. I even worked the day after I had a sinus lift to place an implant. I would like to share with you a closer look at what a sinus lift entails.

What Is a Sinus Lift?

Some patients needing dental implants in their maxilla have sinuses( open areas in the bone of the upper jaw on either side of the nose ) that that have expanded to occupy bone space formerly inhabited by the roots of the teeth. If there is not enough bone height in their upper jaw, dental implants will not successfully integrate or integrated dental implants may disintegrate when the 3-400 pounds per square inch of chewing pressure is delivered after the implants are restored with chewing surfaces. In these instances, a sinus lift is necessary in order to grow new bone to restore bone to the upper jaw in the area near the molars and premolars so that the dental implant has adequate bone to maintain the implant in function. The “sinus lift” term refers to the fact that the sinus membrane must be elevated, or “lifted”, to make room for the bone graft that’s being added.

Why Is a Sinus Lift Necessary?

There are several reasons why a sinus lift is necessary:

  • The sinuses might occupy and disp lace most of the bone of the upper jaw. This will diminish maxillary bone so that an adequate volume of bone and bone-height space between the bottom of the sinus and the Maxillary gum ridge is not great enough for implants to be placed. There are several reasons for this: one, sinuses often enlarge as we age and replace bone where teeth are missing or even the bone around roots that are still in place. And two, not everyone’s sinuses are the same shape and size.
  • Many people who have lost teeth in their upper jaw lack the bone mass for implants. Unlike the lower jaw, the upper jaw is more prone to lose the alveolar (tooth holding) to sinus occupation.
  • Tooth loss contributes to bone loss. In the absence of teeth, the alveolar bone is gradually reabsorbed into the body. If enough time has passed, there often isn’t enough bone remaining for implants.

The Procedure

A sinus lift begins with cutting of the gum tissue in the spot where the patient’s back teeth once were. This tissue is then raised in order to expose the bone, in which an opening is made to access the sinus membrane which lines the sinus cavity. This access may be placed on the side of the jaw(lateral) or on the top of the alveolar bone (vertical)depending on how much ‘bone height’ is left where the implant is planned for placement Using special tools, the dentist then goes through this hole to push the membrane up and away from the jaw in the case of the lateral access or push bone near the sinus membrane to lift the membrane into the cavity.

In the space previously occupied by the sinus, the dentist places the requisite type and amount of bone material to occupy the previous sinus cavity space. Then the access is covered with bone and sometimes with membranes and the gum is stitched close. Anywhere from 4 – 9 months (depending on the amount of bone required to bolster the jaw) is required for the bone material to integrate with your bone. Often there is enough bone to place the implant at the same time . All of this can be determined when you use the cone beam CT X-Ray to determine bone height, width and the 3-D volume of bone graft needed. Once the dentist is satisfied with said integration, the dental implants can then be placed.

Post-operative care

After a sinus lift, it is common for a patient to have some swelling, along with slight runniness from the nose and/ oozing from the mouth. We recommend that patients refrain from blowing their nose for ten days. Sneezing too hard , can loosen the stitches and cause movement in the bone-graft material. In order to minimize inflammation of the inner lining of the nose, we provide a Claritin prescription. This is a medicine to prevent inflammation and congestion is usually prescribed, as is pain medicine. As mentioned earlier, only a little post-surgery discomfort is expected.

Schedule an Appointment

With over four decades servicing Omaha and the surrounding area, Specialty Dental Care is proficient in a variety of dental procedures. Whether you’re interested in a sinus lift, dental implants, tooth extraction, or just a standard cleaning, our professional team is here for you.