What is a Sinus?
The maxillary sinuses are essentially empty, air-filled spaces located behind your cheeks and on top of the upper teeth. Often the roots of the upper teeth extend up into the sinuses. When these upper teeth are removed, all that typically remains is a paper thin layer of bone separating the maxillary sinus from the mouth. Dental implants naturally require sufficient bone to hold them in place. In such instances, the appropriate bone foundation must be created to enable dental implants to be the placed. Historically, the upper back region represented the most challenging area to successfully place dental implants due to the often insufficient quantity and quality of bone and the close proximity of the sinus.
Only a generation ago, few options were available aside from wearing loose dentures. Sinus bone grafting followed by the placement of dental implants has made it possible for today’s patients to enjoy the benefits of complete reestablishment of oral function.
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The Sinus Augmentation Procedure
The key to successful and lasting dental implant treatment lies in the quality and quantity of jawbone into which implants are placed. A sinus augmentation procedure is considered when a lack of bone precludes implant placement in the upper back jaw area. First, the sinus floor is elevated. Thereafter, bone graft material is placed into the space created. Once healing is complete and a solid foundation of bone established, implants can then be successfully placed.
In Dr. Novack’s practice, sinus bone graft surgery represents a routine in office procedure. Dr. Novack has over 20 years experience performing this specialized procedure. Generally 6 months is required for the bone graft to convert to living bone. By increasing the quantity and quality of bone, dental implants can be securely anchored and a predictable and lasting treatment result achieved.
Am I a Candidate for a Sinus Lift Procedure?
A sinus lift may be necessary if you are:
- Missing one or more of your upper back teeth.
- Lacking adequate jawbone in your upper back jaw.
- Missing teeth and the surrounding jawbone ridge due to a birth (congenital) defect or other condition.
- Missing many or all of your upper teeth and would benefit from the improved oral function, support and security that dental implants provide.
How are Sinus Lift Procedures Accomplished?
Lateral Window-Sinus Bone Graft Approach
A Lateral Window- Sinus Lift Bone Graft is the most common sinus bone augmentation procedure. This procedure is ideally suited to manage cases where an extreme lack of jaw bone has occurred leaving little bone between the mouth and sinus. A small incision is made in the gum overlying the region deficient in bone. Thereafter, a small circular window is created in the lateral upper jawbone to expose the membrane lining the sinus cavity. Much like a trap door, the membrane lining the sinus floor is carefully elevated. Donor bone graft is then placed into the space created to reconstruct the upper back jaw region.
To maximize the quality of new bone, Dr. Novack typically employs platelet derived growth factors procured from our patients own blood. These healing elements in our blood accelerate wound healing and aid in the creation of much harder and denser bone. Please refer to the Bone Graft Section which describes the various bone graft options available. Dr. Novack would be glad to share with you which graft material may prove best to manage your situation. After the bone graft has been implanted, the trap door is then covered with the specialized regenerative membrane. This establishes a sheltered site to promote optimal new bone healing. Finally, the overlying gum is precisely reattached with stitches and from there, the healing process begins. Over the next six months, the bone graft is replaced with living bone cells which harden and become part of your jaw. Only when the required foundation of bone has been established would Dr. Novack place your dental implants.
In specific instances, should there be sufficient bone between the upper jaw ridge and the bottom of the sinus to stabilize the implant, sinus augmentation and implant placement can be performed as a single procedure. Alternatively, if there is inadequate bone quality and/or quantity to stabilize the implant, a staged approach is adopted with implants placed only once the necessary bone foundation has been achieved.
Osteotome Sinus Bone Graft Approach
In instances where some measure of bone is present, but still insufficient to offer the necessary foundation to predictably support dental implants, Dr. Novack tends to recommend a less extensive Osteotome Sinus Bone Graft approach. As described above, a Lateral Window-Sinus Bone Graft approach is considered when faced with an extreme paucity of bone.
Similar to a lateral window sinus lift approach, a small incision is made in the gum overlying the area lacking adequate jawbone. Osteotome technique involves the use of graduated metal rods to both compress the residual upper jawbone and move the upper jaw vertically thereby increasing relative bone height. By increasing jawbone height, the goal is to create a solid foundation of sufficient bone height to predictably support dental implant placement. Please refer to the Bone Graft Section which describes the various bone graft options available. Dr. Novack would be glad to share with you which graft material may prove best to manage your situation. Bone graft material is deposited into the space created by the Osteotomes above your upper jaw. Often, Dr. Novack utilizes platelet derived growth factors from our patient’s own blood to stimulate bone formation. Research supports the use of platelets both to provide a better quality of bone and more rapid healing. The bone graft site is then covered with a specialized regenerative membrane to establish a sheltered site necessary for optimal new bone healing. Finally, the overlying gum is precisely reattached with stitches and from there, the healing process begins.
With an Osteotome technique as compared with a Lateral Window Sinus Lift approach smaller volumes of bone graft material are required. Bone healing thus proceeds more rapidly and the site should be ready for implants placement sooner.
Both Lateral Window Sinus Lift and Osteotome approaches have proven very predictable in creating the quality and quantity of bone necessary to enable successful implant placement. In areas almost entirely devoid of bone, Dr. Novack will employ piezosurgery instrumentation to safely and precisely perform this delicate surgery. Please refer to our Piezosurgery Section. Though this melding of technology and compassionate care, our patients routinely experience minimal if any discomfort following these procedures. Dr. Novack will choose the approach and bone graft material that best addresses the specifics of your case. Do not hesitate to contact Dr. Novack personally regarding information on the the options available to return you back to optimal oral health and function.
As with all periodontal treatment, your surgery is performed in Dr. Novack’s clinic. Your comfort and safety are of paramount concern. A local anesthetic will be used to ensure there is no pain during any surgical procedure. Often, our patients request a sedative medication approach to establish and maintain a state of relaxation and calm. Please refer to our Sedation Section which outlines various sedation options available to assist you. Dr. Novack’s philosophy is to ensure that our patient’s treatment is performed in a caring and compassionate manner. Feel free to discuss any questions you may have regarding your care or sedative options with Dr. Novack.