Sinus Lift: Do I Need a Bone Graft Too?
Juan asks:
Can the sinus floor be elevated (closed) using the implant and without bone graft? How many mm can the sinus be elevated without puncturing the membrane?
Dear Juan,
The answer is yes, and it depends.
The sinus floor can be elevated by the implant alone without graft material (bone, TCP, collagen, etc...), but the higher the number of millimeters you elevate it, the more likely a perforation will occur.
Many dentists like utilizing some collagen or graft material to "cushion" the instrument utilized to elevate the membrane and obtain nice, even elevations with radioopaque evidence radiographically.
The generally accepted amount that the sinus can be elevated (closed) with a low risk of perforation is about 3 millimeters, but higher numbers have been achieved.
Hope this helps.
Carlos Boudet, DDS, DICOI
http://www.boudetdds.com
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bone graft without a sinus lift
I went to an oral surgeon today who told me that I would need a bone graft because I don't have enough to secure an implant, but unlike another surgeon, he told me that I wouldn't need a sinus lift even though my sinus cavity is right above the existing bone.
Is this possible? Or do I also need a sinus lift?
Thank you in advance for your response.
bone graft without a sinus lift
This is possible, but to make an informed decision there are several factors to consider. First and foremost is how much bone height there actually is, and where is the bone deficient. It should be noted that a Cone Beam CT scan(see "Implant Topic" entry) can show this very accurately and it sounds like this would be highly recommended in this case. I would also recommend that the restorative dentist be involved in this decision as well, b/c the height of the final restoration (ie crown) is also an important determining factor!
If the bone is deficient at the coronal aspect (ie the tooth end) then "onlay" grafting may be needed and a sinus lift may not be required. If the bone is deficient at the apical aspect (ie the root end) then a sinus lift may be needed. Generally it is advisable to place an implant of at least 10mm length, though in the posterior region of the upper jaw longer may be better, but this is not definite. (Some dentists may recommend placing shorter implants, especially if there is enough width to place a wide diameter implant, but there is not enough long term data to fully support this option, especially in this region of the mouth.)
If a sinus lift is necessary there are at least 2 approaches, either by doing a lift through the implant preparation (osteotomy) or by doing augmentation through a lateral sinus window. The main determinant is how much bone height there is to begin with, Generally if there is between 7 to 9 mm an osteotomy approach may be employed. If there is less than 7mm many surgeons would opt for a lateral window approach. Again a CBCT is the best diagnostic tool to help make this determination.
David E. Azar, DDS, FICOI, MgIDE
New York, NY
http://www.davidazardds.com/
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