Bone grafting - Sinus lift

Guided Bone Regeneration, Bone Grafting Procedures

After tooth extraction, the bone surrounding the teeth gradually begins to resorb (as it is no longer subjected to physiological chewing forces). This process is most intense during the first six months after tooth removal. Certain pathological conditions, such as bone loss due to periodontal disease (periodontitis), inflammatory processes caused by dead teeth, cysts, or injuries, can further exacerbate this process. Therefore, prevention and the timely replacement of lost teeth are crucial.Unfortunately, we often encounter cases where there is insufficient bone to place an implant or to ensure the long-term stability of the implant. However, there is no need to worry, as there are numerous routine procedures available to create adequate bone for implants. In general, various methods and materials are used to create an environment or framework that promotes bone formation. To accurately assess bone quantity and quality, a specialized dental CBCT scan is required. Surgeries are typically performed under local anesthesia, but sedation or conscious sedation is also an option.

Sinus Lift

In the upper jaw, the roots of the upper posterior teeth are often separated from the sinus cavity by only a few millimeters of bone. After tooth extraction, the amount of this thin bone decreases even further. In such cases, a sinus lift may be necessary to create sufficient bone for implantation.

Internal Sinus Lift (Closed Sinus Lift)

This surgical procedure is used in milder cases. During the preparation of the implant site, the sinus membrane is lifted through the drilled hole, and bone graft material is placed underneath it. The implant is then inserted.

External Sinus Lift (Open Sinus Lift)

In cases of significant bone loss, a flap is created (intraoral exposure), and a bone window is prepared on the outer wall of the sinus. Through this window, the sinus membrane is carefully lifted, and bone graft material is placed underneath it. Finally, the window is covered with a membrane or closed with the gum flap. In some cases (depending on the amount of bone), this can be done simultaneously with implant placement, requiring only one surgery. It is important that the sinus is healthy; if someone has chronic sinusitis or frequent sinus problems, the procedure is not recommended. Postoperative symptoms are usually mild: swelling, pain (manageable with medication), and occasionally nosebleeds. Blowing the nose is prohibited for two weeks after the surgery!In addition to sinus lifts, other bone grafting procedures are also available. Generally, these aim to increase the height or width of the bone at the planned implant site, and various methods are available for this purpose.

Horizontal Augmentation (Lateral Augmentation)

In many cases, the thickness of the bone is insufficient for implantation. Reconstruction can be performed using autologous bone grafts, typically harvested from the lower wisdom tooth region as the donor site. Additionally, commercially available bone grafts and membranes are also used. These materials are generally of animal or human origin, are proven to be safe, and are usually resorbed over time. The role of the granular bone graft material is to create a special framework along which bone regeneration can occur (GBR – guided bone regeneration). The granular bone graft material is typically covered with a special resorbable (or sometimes non-resorbable) membrane to ensure proper coverage and stabilization (this prevents other tissues from growing into the area). This procedure can also be performed simultaneously with implant placement, depending on the existing amount of bone. However, if the bone quantity is so low that simultaneous implant placement is not possible, at least six months of healing is required after the bone grafting procedure to allow for proper bone formation. This is verified with a new CBCT scan before implant placement.