Sinus Lift

When a sinus lift may be considered

• Upper back teeth have been lost, and the bone below the sinus is too shallow for an implant of the planned length. The hospital leaflet notes that many people who have lost their upper back teeth do not have enough bone for implants¹.
• An implant at the back of the upper jaw is the option you prefer, after the alternatives have been explained. Replacing two or more teeth with implants is covered on the implants for several missing teeth page.

When another step comes first

• Sinus problems. Sinusitis, a blocked nose or previous sinus surgery are assessed first. An active sinus infection is treated before the operation. If symptoms or the scan call for it, an ear, nose and throat assessment is requested.
• Infection in the mouth and untreated gum disease. These are treated first.
• Uncontrolled medical conditions. If your blood sugar is not under control, or a new symptom needs to be investigated first, surgery is postponed.

What is associated with higher risk

• Smoking. The hospital leaflet says that the risk of the graft failing is higher in some people, especially in smokers¹. Smoking is also associated with poorer wound healing.
• Bone-strengthening medicines (such as bisphosphonates or denosumab), diabetes, a history of gum disease, and radiotherapy to the head and neck. Each needs a careful look at your medical history, and sometimes planning with your own doctors. In a review of people with implants, death of an area of jaw bone (osteonecrosis) was more likely in those taking bisphosphonates². The certainty of that evidence is very low. What studies report for each is set out on the bone grafting page. Tell us about every medicine you take, including any blood thinner. Do not stop or change your blood thinner unless your doctor or dentist tells you to³. Do not stop any other medicine without asking the doctor who prescribed it.

Suitability is decided by an examination, a 3D scan and your medical history. A view given from photographs or X-rays you send is only preliminary; it is not a treatment plan.

Before a sinus lift is planned, the dentist examines your mouth and takes your medical history. A 3D scan (cone beam CT) shows how much bone is left below the sinus and the shape of the sinus floor. It can also show some signs of sinus disease, such as a thickened lining. Recommendations on 3D scans in implant dentistry say a scan could be justified for diagnosis and planning before surgery⁴. European guidelines add that a scan should be used only when the question cannot be answered adequately by lower-dose ordinary X-rays⁵. The dose of a 3D scan is generally higher than that of ordinary dental X-rays and lower than that of a medical CT scan⁵. It also varies widely between machines and settings.

The teeth next to the sinus are checked as well. Sinus symptoms and toothache can overlap: toothache is listed among the symptoms of sinusitis⁶. A review looked at sinus infections from teeth that spread beyond the sinus. The most common source was infection at the root tips of upper molars⁷. Such a tooth is treated before a sinus lift.

We also ask about sinusitis, a blocked nose, previous sinus surgery and conditions that stop the sinus draining. If needed, and with your permission, we contact your family doctor or the doctor who treats your condition. The plan is given in writing, with the approach, the graft material, the reasoning and the alternatives. Ask for a copy of your scan; it is part of your record.

There are two main approaches. Which one suits you depends mainly on how much bone is left below the sinus.

Through a window in the side of the jaw

This is the lateral approach, also called an open sinus lift (açık sinüs lifting in Turkish). A small window is opened in the side wall of the jaw, on the cheek side. The sinus lining is lifted, graft material is packed beneath it, and a covering membrane may be placed. Where there is no usable bone, the hospital leaflet says the implant is not normally placed until the bone has healed¹. That means a second operation. Where some bone is left, the implant can be placed in the same operation.

Through the hole prepared for the implant

This is the crestal approach, also called a closed sinus lift (kapalı sinüs lifting). In the technique the leaflet describes, the floor of the sinus is gently tapped upwards through the implant site, and graft material may be added. The implant is placed at the same time. The leaflet describes it for cases where only about 3 millimetres of extra bone height is needed¹. Ask which technique and instruments your dentist would use.

The study figures on this page for implant loss and for tears in the lining come from side-window sinus lifts. They do not describe the approach through the implant site. For that approach, this page gives only the hospital leaflet's figures.

Graft materials

Graft material can be your own bone, or it can be prepared from a human donor or an animal source (cattle or pigs). It can also be fully synthetic. The graft creates a scaffold for your own bone to grow into¹. If your own bone is used, ask where it will be taken from. If it is taken from a second site, a second wound is opened, with its own pain and swelling. Covering membranes can also be of animal origin. For some patients this is decisive, for religious or personal reasons. Before you consent, you are told which graft and which membrane will be used and where they come from.

No graft material has been shown to be better than the others at preventing implant loss. A review of sinus floor augmentation found no significant difference⁸ in implant loss between your own bone and bone substitutes. It does not show that every material works equally well. Ask your dentist to explain, from your own scan, why the proposed material is right for you.

A sinus lift without graft material has also been reported. A review of 16 articles reported implant survival at 48 to 60 months of follow-up. It was 96 per cent without graft material⁹ and 99.6 per cent with graft material, counted per implant. These are published figures, not our own. The review's published summary reports no direct statistical comparison of these two rates; we could not access the full text. So the difference is not a proven advantage for either approach.

Instruments

The window can be cut with rotating instruments or with an ultrasonic (piezoelectric) device. A review of 69 studies of mixed design reported tears in 24 per cent with rotating instruments and 8 per cent with the ultrasonic device¹⁰. Its authors note that studies without a comparison group were included. A review of four randomised trials found fewer tears with the ultrasonic device, but the difference was not significant¹¹. The evidence was too weak to confirm it. So it is not established that one instrument causes fewer tears than the other. The ultrasonic device added an average of 3.43 minutes to surgery.

A sinus lift is usually done under local anaesthetic, with you awake. At the hospital that wrote the leaflet, sedation or general anaesthesia is used only when surgery will be difficult or when multiple procedures are required¹. The leaflet also says the procedure may take 45 minutes to two hours¹, depending on its complexity.

If you would like conscious sedation, ask whether it is suitable for you. This is assessed first from your medical history and medicines. A 2022 Turkish regulation on private dental facilities covers where sedation may be given. Under it, treatment under sedation or general anaesthesia may not be carried out in a single-dentist practice (muayenehane) or a polyclinic (poliklinik)¹². Your written plan names the place where any sedation is given; ask who will give it. A UK national standard for sedation in dentistry sets an escort rule. For adults, it requires a responsible adult to take you home after every form of sedation other than inhalation sedation¹³. If an escort cannot be assured, it says, treatment under sedation must not be given. Ask us whether the method planned for you needs an escort. More is on the conscious sedation page.

The number of visits, the gaps between them and the waiting periods are given in your written plan; they vary from patient to patient.

Whether the implant goes in during the sinus lift or in a later operation depends mainly on how much bone is left below the sinus. It also depends on how firmly the implant holds when it is placed. A review of sinus floor augmentation found no significant difference⁸ in implant loss between same-session and later placement. That does not show the two routes are equivalent for every patient.

How long the graft needs before an implant, or before the teeth are fitted, varies. The hospital leaflet gives its own patients a figure for the side-window sinus lift. It says the graft can take 4 to 9 months¹ to join with the patient's own bone before implants are placed. The time depends on the amount of bone needed and the graft material used, it adds. Another passage gives 4 to 12 months¹ for bone to grow into the graft. From the sinus lift to the finished teeth, it gives 6 to 12 months, sometimes longer¹. These figures describe that hospital's practice. They are not a rule, and they are not our timetable. Your own waiting time is set after the examination and given in your written plan. Ask how it compares with these figures, and why.

Risks

The figures in this section come from published studies and from one hospital leaflet, not from our own records. The leaflet does not say where its figures come from, or whether they count patients or operations.

• A tear in the sinus lining. This is the main risk during the operation. A review of 10 studies looked at side-window sinus lifts with graft material. The average tear rate was 29.42 per cent¹⁴. The earlier studies it cites report 16 to 56 per cent. The hospital leaflet gives a 19 per cent chance with the side-window approach and 3.8 per cent through the implant site¹. It does not say where these figures come from. A tear is usually repaired in the same session. If the repair is not reliable, the procedure may be stopped and done again once the lining has healed. The leaflet says that healing usually takes a few months. In the review, implant survival was 97.1 per cent after a repaired tear and 97.7 per cent with no tear; the difference was not significant. Some of its studies describe problems after surgery, such as sinusitis. The review does not compare these problems between torn and intact linings, so it does not show that a tear has no drawbacks.
• Infection. Infection can develop in the graft or the sinus. The leaflet gives a 2.9 per cent chance with the side-window approach and 0.8 per cent through the implant site¹. A longer-term infection may mean the graft has to be removed.
• Sinusitis. Inflammation of the sinus can follow the operation. We have found no sourced figure for how often it happens after a sinus lift.
• The graft not taking. Stitches can open and the graft can become exposed; the leaflet gives 3 per cent for graft exposure¹. Part or all of the graft may be lost, or too little bone may form for an implant. The leaflet gives 1.9 per cent for no graft remaining after a side-window sinus lift, and 1 per cent for too little bone. Once the area has healed, the sinus lift can be repeated, or the plan changed to an option that needs less bone.
• Numbness. The cheek, upper gums and teeth on the treated side may feel numb after surgery. The leaflet says this is usually temporary but, very rarely, can be permanent¹.
• An opening between the mouth and the sinus. The leaflet lists this among the rare but serious problems.
• Other effects. Swelling, bruising and pain are expected in the first days, and a nosebleed can happen. Your sinus may feel full or blocked for some weeks¹. The leaflet lists vertigo, a spinning kind of dizziness, as rare and temporary¹. Tell us if it happens.

Benefits

• The aim is to gain the bone an implant needs at the back of the upper jaw. The implant can then be placed at the planned length. Sometimes the bone gained is not enough, and a further procedure or a different plan is needed.
• Implant loss after sinus floor augmentation has been reported as low. In 11 prospective studies, which followed patients forward in time for at least five years, annual loss was 0.43 per cent per implant⁸. In these studies the remaining bone height was 6 millimetres or less, and the side-window technique was used.

These rates come from published studies, not from our own records. They are outcomes observed in studies, not promises, and they are averages of studies from different countries and different groups of patients. What happens in your case depends on your bone, your sinus, your habits and your care.

A sinus lift is not the only way to replace upper back teeth. Your dentist should discuss each option with you, including leaving the gap.

• A shorter implant. This needs enough bone without a sinus lift. The hospital leaflet says the risk of implant failure increases as the implant length decreases¹. It calls the success rates good, but says complications are potentially more likely than with longer implants placed after a sinus lift. Several short implants might be an alternative, it adds. A Cochrane review looked at the shrunken (resorbed) lower jaw. There, short implants appear to be a better option¹⁵ than building the bone up in height. That finding concerns the lower jaw, not the upper jaw.
• Fewer implants, placed further forward or at an angle. Implants placed in front of the sinus, or angled alongside it, can avoid a sinus lift. Grafting may still be needed around the other implants, the leaflet notes. More of the chewing force then goes through fewer implants¹. It says this can potentially lead to more frequent problems with the implants and with the bridge or denture. In a jaw with no teeth, this is the idea behind the designs on the All-on-6 page.
• Zygomatic implants. When the upper jaw has very little bone, long implants anchored in the cheekbone may be considered; they are not a routine option. A Cochrane review describes the procedure as technically demanding¹⁶ and notes that it may be associated with serious complications. Its trial evidence comes from only two small trials. In one, zygomatic implants were lost less often, but had more complications¹⁶, than ordinary implants placed after bone grafting. Of the problems in the tissues around these implants, inflammation of the sinus is the one reported most often¹⁷. The hospital leaflet says the surgery is more complicated than ordinary implant placement, and not all surgeons can provide it¹. See full-mouth implant treatment.
• A bridge on your own teeth. A conventional bridge needs the neighbouring teeth to be reduced to hold it. An adhesive bridge is bonded to a neighbouring tooth and needs very little or no grinding. A bridge usually replaces only one or two teeth¹. The options are compared on the dental implant treatment page.
• A removable denture. It needs no surgery. Ask how it compares with an implant for comfort, chewing and care.
• Leaving the gap. If you have enough working teeth, the hospital leaflet notes that it might be better to accept the gap¹. Ask what leaving the gap would mean for you.

Before you decide, you can ask another dentist for a second opinion on whether you need a sinus lift and on your plan. The Turkish regulation on patient rights gives you the right to ask for other doctors' opinions¹⁸. You can say no, or ask to stop, at any stage, including after the examination. If you refuse or stop a treatment, its possible consequences are explained to you and a written record is made¹⁸.

What is usual

The hospital leaflet describes normal healing after a sinus lift. Swelling is at its worst after two days¹, and bruising over the cheek can spread to the lower jaw. It says patients can expect to feel back to normal after two to three weeks. It adds that pain is usually controlled with simple painkillers such as ibuprofen and paracetamol. If you take a blood thinner or other regular medicines, ask your dentist which painkiller is suitable for you and how much to take. Your sinus may feel full or blocked for some weeks, and a nosebleed can happen.

Protecting the sinus

• Do not blow your nose. The hospital leaflet advises not blowing your nose for two weeks¹ after the operation. Follow your own written instructions for how long.
• The leaflet asks patients to get in touch if they think bony material may have been dislodged after sneezing or blowing the nose¹. Ask whether your written instructions add other rules, for example on sneezing or drinking through a straw.
• Take the medicines you are prescribed. The leaflet lists antibiotics and decongestants¹ among the medicines that may be prescribed after the operation.
• Do not fly until your dentist says you can. A 2023 review suggests waiting at least two, and ideally six, weeks¹⁹ after a sinus lift before flying. That assumes there is no pain, swelling or bleeding where you were treated. After an implant alone, it suggests at least 72 hours. The authors say the research is limited and comes mostly from military aviation. They call these intervals a starting point for the dentist's decision.
• Choose soft, lukewarm food, and avoid chewing on the area. Keep brushing; clean the area gently, the way your dentist shows you.
• Smoking is associated with poorer healing. Do not smoke during the healing period, and ask your dentist how long to stop for.
• If you had sedation, do not drive or operate machinery for as long as the sedation team tells you. Before you go home, you and your escort should have written aftercare instructions and know how to reach the clinic, including out of hours.

Later reviews

When the crown or bridge is fitted, an X-ray and measurements of the gum pockets around the implant are taken as a baseline²⁰. Later changes are judged against that record. Your review interval is set by your risk and given in writing.

After surgery, or at any time later, contact us if any of the following happens. The hospital leaflet gives similar reasons to get in touch¹.

• Swelling or pain that gets worse after the second day, or pain that does not ease over time
• Bleeding that does not stop, or bright red bleeding that keeps flowing
• A high temperature, or feeling generally unwell
• A bad smell or pus from the area, stitches opening, or graft material showing through the gum
• You think graft material has come loose after sneezing or blowing your nose
• Discharge from the nose, a blocked nose or pain over the cheek on the treated side that does not settle
• Liquid coming out of your nose when you drink, or air passing between your mouth and nose
• Numbness of the cheek, gum or lip that lasts longer than you were told to expect

Sinus symptoms on the treated side. Contact the dentist who carried out your sinus lift first, even if the symptoms seem to come from your nose. Guidance for dentists on sinusitis says that when it is suspected, a dental cause should be ruled out first²¹. If you cannot reach that dentist, see another dentist or a doctor. Tell any doctor you see about your sinus lift, and show them your records.

Emergencies. If you have any of the signs below, do not wait for a reply. Go to the nearest hospital emergency department or call 112. These signs need emergency medical help²², not a dental appointment.

• It is hard to breathe, speak or swallow
• There is a lot of swelling in your mouth, or it is hard to open your mouth
• Your eye is swollen or painful, or your eyesight changes suddenly
• Your neck is swollen²³

Who carries out the sinus lift

Your written plan names the dentist who will carry out the sinus lift. If you ask, the clinic must tell you the identity, role and title of the dentists and staff who treat you¹⁸. The Turkish Dental Association's website has a search of registered dentists by name and province²⁴. A name missing from the search does not prove anything on its own. Ask how often the dentist carries out sinus lifts, how often problems have occurred, and which approach they would use for you. We do not yet publish sinus-lift figures of our own.

The plan in writing

Your written plan states whether you need a sinus lift and why, and the approach. It says whether the implant goes in at the same time, and gives the alternatives. It names the graft material and membrane and where they come from. It also states what the plan covers and does not cover, and how many visits are needed. A view given from photographs or X-rays you send is preliminary; the plan is made after the examination and 3D scan. Before the operation, the dentist who will carry it out explains it to you in plain language¹⁸.

Private dental clinics must obtain a consent form for every intervention¹². The form is signed in two copies, and one copy is for the patient¹⁸; ask for yours. Ask, in writing, what happens if the lining tears and the operation is stopped, or if the graft does not take.

Your records

You may examine your file and records and obtain a copy¹⁸. Ask for a record that says which approach was used and whether the lining tore. It should list the graft material and membrane, with their brand names and batch numbers, and the implant system if an implant was placed. Ask for your X-rays and scan as well. Any dentist or doctor who sees you later needs this record.

This page does not quote fees. The main factors in a plan are these:

• The approach, and whether the implant goes in at the same time
• The type and amount of graft material
• Whether a membrane is used
• Sedation
• The number of visits and the review programme

Ask in writing what your plan includes, and who pays for further treatment if there is a complication.