Sinus lift: why it is necessary before a dental implant

In dentoalveolar surgery, one of the most common issues encountered in the posterior upper jaw is a lack of sufficient bone for the placement of a dental implant. In such cases, the solution is a sinus lift procedure.

A sinus lift is a surgical procedure performed as part of dental implant treatment when there is insufficient bone in the upper jaw, either due to tooth loss or bone resorption over time.

Dr Maria Receanu, a specialist in dentoalveolar surgery at DENT ESTET clinics, explains in this article why such a procedure is recommended prior to dental implant placement and offers advice for a speedy recovery.

A sinus lift is a surgical procedure that creates additional bone volume in the posterior maxilla by elevating the floor of the maxillary sinus and inserting bone graft material.

The maxillary sinus is an anatomical cavity situated above the upper premolars and molars. Following tooth extractions or as a result of physiological bone resorption, the bone gradually thins and the sinus ‘descends’. Under these conditions, the bone height becomes insufficient for the successful completion of dental implant treatment.

Find out more about the stages of dental implant treatment.

Types of sinus lift

Depending on the amount of existing bone and the surgical approach, there are two main types:

Internal sinus lift (closed, transcrestal)

This is a minimally invasive technique, recommended when there is a residual bone height of approximately 5–7 mm.

“This type of sinus lift is performed through the same drill hole prepared for the implant, and the implant is usually inserted during the same appointment. Thanks to the minimally invasive technique, swelling is minimal, which means faster healing,” explains Dr Maria Receanu. 

External (open, lateral) sinus lift

It is indicated when the residual bone is less than 4–5 mm and does not allow for optimal primary stability of the implant.

“In the case of an external sinus lift, a lateral window is created in the sinus wall, and the Schneiderian membrane is carefully peeled back. After the bone graft material has been placed, the implant can be inserted either immediately or 6–9 months after the procedure, depending on the degree of stability achieved,” explains Dr Maria Receanu.

Find out more about the cost of a sinus lift.

When is a sinus lift recommended?

A sinus lift is recommended in the following situations:

• Long-standing edentulism (tooth loss) in the lateral maxillary region;
• Significant pneumatisation of the maxillary sinus – the alveolar bone that supported the teeth is resorbed (shrinks), and the sinus expands into the freed-up space;
• Post-extraction bone resorption;
• Treatment plan involving implants in areas with insufficient bone height.

At DENT ESTET clinics, the recommendation for such a procedure is based on a clinical examination and imaging investigations, such as panoramic X-rays and computed tomography (CBCT).

To achieve primary stability upon placement, a dental implant requires sufficient bone volume and adequate bone density. 

Without these elements, the implant cannot be stable, thus increasing the risk of failure and potentially even perforating the sinus membrane. The sinus lift procedure creates a secure bony foundation, allowing for the correct integration of the implant and, consequently, increasing the success rate of the treatment.

“The aim of the procedure is not merely to ‘add bone’, but to create the ideal conditions for the implant to be stable, functional and durable over time. In modern implantology, proper planning and adherence to the stages are essential. If a sinus lift is required, this means that the treatment is correctly tailored to the clinical situation, not that it is a complicated case,” explains Dr Maria Receanu.

Recovery following a sinus lift is generally straightforward and well tolerated by patients, particularly when the procedure is performed using minimally invasive techniques.

In the first 24–72 hours after the procedure, the following may occur:

• swelling in the cheek area;
• mild discomfort or sinus pressure;
• a feeling of nasal congestion;
• rarely, minor nosebleeds.

Pain is usually moderate and can be managed with anti-inflammatory medication recommended by your doctor.

Over the next 3–7 days following the procedure, the swelling begins to subside and the discomfort decreases significantly. If an external sinus lift has been performed, recovery may be slightly slower compared to the internal procedure.

How long does it take to heal completely?

Soft tissue healing takes approximately 7–14 days. However, the formation of new bone (integration of the graft material) takes longer:

• between 4–6 months in most cases;
• sometimes up to 8–9 months, depending on the volume and type of graft.

After this period, the implant can be inserted if it was not inserted at the same time.

Important recommendations during the healing period

To protect the sinus membrane and the bone graft material, it is important:

• not to blow your nose for 10–14 days
• to sneeze with your mouth open
• avoid flying for approximately 2 weeks
• avoid strenuous physical activity in the first few days
• to follow the prescribed course of antibiotics and anti-inflammatory medication. 

When should you contact your doctor? 

It is important to tell your doctor if you experience: 

• severe pain that does not respond to medication
• fever
• purulent nasal discharge
• heavy bleeding
• swelling that worsens after 3–4 days.

These situations are rare, but require assessment.