Sinus Lift or No Lift?

Dr. Meniga asks:
Recently, we had a discussion in my dental implant study club about the placement of a 10 mm dental implant fixture in 9 mm wide bone under maxillary sinus.

Some of my colleagues think that a crestal sinus lift should be performed first. Some of my other colleagues (including myself) prefer the stabilisation of a dental implant in the sinus floor in spite of possible laceration of Schneiderian membrane. In other words, no sinus lift. What are your experiences? What are your protocols?

94 thoughts on: Sinus Lift or No Lift?

  1. d-r ivo says:

    I have to solve the same case as soon as possible.My opinion is without sinus lift,but I’ll be glad to be shared and other protocols.

  2. Anonymous says:

    When you said 9mm wide bone, I assume you mean 9mm deep. If my assumption is right, then use a self trading implant and prepare the hole 1 to 2 mm short of the sinus. Screw in the implant and then there will be an infracture towards the end. An infracture this way up to 3mm is quite safe. The Schneiderian membrane has great powers of osseogenesis and after 2 months an Xray will show that bone will have formed over the end of your fixture.

  3. satish joshi says:

    whether you infracture bone with osteotomes or IMPLANTS or bone taps outcome is same,CRESTAL SINUS FLOOR LIFT”.
    then why not use better approach where you can place graft material between your implants and membrane with traditional crestal approach with osteotomes.
    instead of expecting bone fill from membrane only YOU CAN PLACE REAL BONE GRAFT.
    Also inadvertent exposed part of implant in sinus cavity, particularly rough macro surfaced can be a source of chronic sinusitis.

  4. MS says:

    I would place the implant without the sinus lift, if the implant is 10mm long and you’ve got 9mm of bone. Protruding the implant by 1-3mm into the sinus isn’t going to make any difference, the sinus membrane will just heal over the top of the implant again. The membrane obviously has a great potential to heal. It is my belief that most so-called ‘sinus lifts’ make a break in the membrane anyway and this seldom causes a problem.
    Don’t let anyone telll you taht the patient is going to rattle – this is just nonsense!

  5. satish joshi says:

    Last post advocates leaving 1 mm of implant protruding in sinus with membrane cover( Again I am not against this approach). So in sense only 9 mm of implant is supported by bone- implant contact.Then why not place 8.5 mm implant, .5 mm deeper to engage cortical plate of floor of sinus and get better anchorage for implant and not to worry about sinus involvement at all.

  6. MS says:

    I agree completely with Mr. Joshi’s previous comment – use a shorter implant and avoid the problem altogether.
    The question is, what do you do when you have, say 6mm of bone under the sinus (with good width)? Personally I would use an 8mm implant (of ample girth),protrude it 2 mm into the sinus, ensure that I have primary stability and probably do it 2-stage. And only in patients with no history of sinus pathology.

  7. Alejandro Berg says:

    Dr Meniga:
    Maybe instead of debating wether to do or not the sinus lift just by pass it and use an endopore implant that will work perfectly for a molar or premolar with as little as 5mm (in a 5×5 format) or 7mm (7×4.1). Isnt it much simpler?.
    By the way no real sinus needed in the case you mentioned.

  8. Dr. R Mosery says:

    I have cases that are going on five years where I had 8 mm of bone or even 7 mm of bone, using osteotomes and following through with irradiated cancellous bone or DFDB into this same opening then placing my implant into this.It gave me a beautiful result time and again.If you think you could place these little mushroom implants that are quite wide and stumpy short to solve your problem you’re being misled.I have had excellent results for the past seven years of placing and restoring and just restoring for the past 13 years. I always adhered to the basic protocols based on sound dental principles you learned in dental school ie:crown to root ratio etc.These osteotome cases work great if not abused.
    PS. It should be required of anyone posting to put their name where they put their wise remarks otherwise it undermines the integrity of the discussion.

  9. Anonymous says:

    It appears that these comments are form individuals that don’t have the sound principles of implant surgery. How could one make an assumption that bone is surrounding the 1 to 2 mm of exposed implant into the sinus? I think that we should focus on evidence base treatment modalities for our patient’s.

  10. MS says:

    Having bone around the 1-2mm of implant that protrudes into the sinus is not important – the sinus membrane effectively seals it off from the sinus cavity with the advantage that the implant has bi-cortical stability. I do not believe that so-called internal sinus lifts will produce bone around the part of the implant protruding into the sinus in most cases. Membrane coverage – yes. Bone – no.
    It is the integrity of the bone that surrounds that rest of the implant that is important-the bone to implant contact area. As we all know, some implant designs have a fantastic surface area due to their design (Bicon for instance)whereas others (Straumann and copies) do not. An 8mm Bicon, I have heard has the same surface area as an 11 or 12mm Straumann of the same diameter. Added to this, the large fins on Bicon and similar implants designs allow cancellous bone growth between the fins to provide a further mechanical advantage.
    These are not just principles of “sound implant surgery”, but also common sense!

  11. Gary D Kitzis, DMD says:

    I would do an osteotome sinus lift. You can easily get 3mm and with experience get 5 to 8mm of sinus floor elevation in certain cases. The key is not to tear the sinus membrane in the drilling phase of the osteotomy. I often use osteotomes in the maxilla (type 3 and 4 bone) to replace the final drill diameter or to elevate the membrane a few millimeters. A bone graft showing elevation of the sinus floor can easily be performed through the osteotomy that can clearly be seen on a radiograph.

  12. Anonymous says:

    As an oral and maxillofacial surgeon I perform many sinus grafts and simultaneous implant placements. (We work in the sinus all the time in many procedures.) It is a standard procedure graft simulaneously when there is enough bone to stabilize the implant. Some times a separate staged graft is needed. Exposing the sinus floor to the implant is also not a problem. we expose much more than that with our zygoma implants with no infection issues. remember we must keep in mind evidence driven techniques based on science and not anecdotal experience and speculation!!!

  13. Andrej Meniga, DDS,PhD says:

    Thank you very much to the OMS from the last post. I can’t agree more and I think the most important is the primary stability of an implant in relation to the sinus.

  14. Terence Lau says:

    Why not just place a 9mm or 7mm long endopore implant instead with better long term results proven over 10-12 year studies?

  15. satish joshi says:

    I am not an oral surgeon,and I do not place zygoma implants but I do know each and every implant exposed in sinus does not cause problem.
    I leave in NEW YORK city.In NY there is one group called ‘POLLAR BEAR’GROUP people in sixties and seventies.Those people in midwinter in single digit temperature go to Coney Island beach and dive into ice cold Atlantic ocean in only underwears, after bathing, come out smiling.Does it mean every NEW YORKER can do that. I do not think so.I may end with hypothermia or severe cold or may be pnuemonia.
    If I am sailing in same ice clod water in a boat, and if there is a fire on a boat, and I have no option but to jump in water.Will I do it.You bet.
    But if boat is large enough and fire can be contained,and I have a option of staying on boat.Would I still jump.
    Of course not.
    Zygoma implant is a must expose case.
    this discussion is about a case with 9 mm bone height.
    not a must expose case.
    Then why one should play Hero?
    Violate sinus?
    Does it make sense?
    When you have option not to violate sinus, why would you do it?

  16. satish joshi says:

    I have no problem with sinus graft with crestal approach and place longer implants if needed.
    By stabilizing 10 mm implant with 9 mm of implant in bone and let 1 mm implant left in sinus covered with membrane will still be a 9 mm implant for crown /root ratio not

  17. MS says:

    I don’t believe that crown/root ratio is as important as implant-bone surface area/root ratio. Surface area of integration is in IMO more important than implant length. What do you think?

  18. satish joshi says:

    to MS
    You are right.
    The point I am making is different.
    There won’t be much difference in using 10mm implant with 1 mm protruding in the sinus and 8.5 mm w/o violating sinus or using Endopore 7mm which can provide much more implant/root surface.

  19. MS says:

    So it’s agreed. Avoid the sinus if possible by using shorter large surface area implants. However protruding by a mm or two into the sinus isn’t going to cause much trouble, and in 9mm of bone, fiddling around with some sort of sinus lift procedure probably isn’t necessary if using a 10mm implant and stability is good.

  20. peter says:

    There seem to be a few “issues” here in the UK with Endopore ( Numerous recent studies seem to indicate that length of implant is not as critcal as the top 4 to 5 threads cope with the majority of the load stress. The crestal plate is vital, so 8mm, supracrestally placed should be good especially if the system has good bio-mechanical properties (stress breaking).Repneumatization can lead to the appearance of the implants being “in ” the sinus but if you scan the full picture looks different. There are rarely problems if the lining is raised ,as the osteotomy site is sealed with the implant.

  21. Peter Gilfedder says:

    I can’t remember the reference but there was a study done using an intra-sinus camera to look at the floor of the sinus while implants were being placed.
    40% of the implants had burst through the membrane unknown to the operator but the % of complications in this 40% was the same as the 60% which had not perforated. I am quoting from memory but I think the study was roughly what I’ve said. So this study at least, suggests that we shouldn’t be paranoid about accidental perforations.

  22. Anonymous says:

    All we’re doing is perforating the membrane and then filling the hole up with an inert object -the implant. The membrane will just heal itself over the top.

  23. Andrej Meniga,DDS,PhD says:

    Dear patient,
    this is an academic debate on the principles which diferentiate the need for a sinus lift or a standard implantation procedure in the cases with limited amount of bone. Depending on the implant system type, some kind of sinus lifting technique should be performed in the cases with less than 8.0 mm of bone from the edentulous ridge to the sinus floor.

  24. alvaro ordonez says:

    You have the perfect case for summers technique.
    You will benefit so much for placing the implants with osteotomes in this case.
    The nine mm of bone already present in that wide ridge will allow you to implode a great ammount of bone and in the process of doing that the density of the bone will be improved because of the spreading effect of the osteotomes, therefore improving the bone quality.
    Bone height is important to increase surface area, so if you can increase that height to 11.5 or even 13 (which is easy with the ammount of bone already present go for it!
    You could also use threaded bone spreaders like the meisengers, biolock, MIS etc,they are easy to use and have the same benefits of the classic osteotomes with the advantage that you dont hammer your patient, they work well in improving bone height if you keep vertical pressure as you use them, use them with the ratchet, not with the motor and allow enough time for the bone to expand and move (take advantage of the plasticity of bone).
    Placing a 5 mm implant is a lack of resources, specially having 9 mm of bone present!
    placing ten mm implant will be fine but use osteotomes anyway after the pilot drill and increase the diameter as much as you can.

  25. piezo1 says:

    I want to reply to Alvaro Ordonez:
    Have you ever tried those threaded bone spreaders? A colleague told me that in D3 – D4 bone they work perfectly, but if you have to tap a D2 – D3 they simply rotate without any lifting action. In a word, they work in a “surplace” way.
    I’ d like to know your opinion.

  26. Andrej Meniga says:

    The coleague is probably right, but it doesn’t make sense to spread type 2 bone! Summers sinus lifting or stabilisation of an implant in the cortical bone of the sinus is what the discussion is about.

  27. DanS says:

    The IADR 2004 abstract below studied failures in the posterior maxilla. they loked at 54 implants with/56 implants without sinus lift. Although there were more early failures in the first group, all failures were 10mm or less in length. There were no failures that were 12mm or longer. This is only one study, but I think in most cases you will be very lucky to have 12 mm of vertical bone height without the sinus lift. Longer was better in this study. I advise the lift if needed, based on this evidence. Abstract below

    0841 Early implant failure rates in the posterior maxilla

    J.R. FRIEDBERG, T. VOGIATZI, D. PERDIKIS, and E. IOANNIDOU, University of Connecticut Health Center, Farmington, USA
    Introduction: Implant placement in the posterior maxilla could be challenging due to the bone quality and bone quantity. Frequently, the bone in the area is type IV and the bone quantity is limited by the presence of the maxillary sinus. Objectives: The purpose of this study was the retrospective analysis of the early implant failures in the posterior maxilla with or without sinus floor elevation. Methods: The study population consists of patients that had implants in the posterior maxilla at the dental clinics of the University of Connecticut Health Center in 1999-2002. The authors reviewed the patient records. The case was excluded when there was no pretreatment periapical radiograph. Results: There were 51 patients (28 females and 23 males) that received 110 implants. 34 sinus floor elevations were performed. 54 implants (group 1) were placed posterior maxilla after sinus floor elevation and 56 implants (group 2) were placed in posterior maxilla without sinus floor elevation. 26 sinus floor elevations were performed with the 2-step antrostomy, 1 sinus floor elevation was performed with the 1-step antrostomy and 12 sinus floor elevations were performed with the osteotome technique. 9 out of 110 implants failed (8.1%). 2 out of 9 failures were late and 7 failures were early. The overall early failure rate was 6.36%. Within the group 1, the early failure rate was 10.7%. Within group 2, the early failure rate was 1.8%. Analysis of the implant length revealed: 8 10mm-implants and 1 8mm-implant failed. No implant with length °Ý12 mm failed in any of the groups. Conclusions: The overall early failure rate in the posterior maxilla was 6.36%. All the implants that failed were short. The study was supported by ITI Foundation Award 306/2003.

  28. piezo1 says:

    To Andrej Meniga: well, in D2 bone you don’t have to spread of course, but if you have to perform a sinus lift and you encounter a D2-type bone?
    I think threaded bone spreaders are suitable just in case of low density bone; obviously, even if you use Summers’ osteotomes in D2 bone, you have to use the mallet in a not so “gentle” fashion! ;-)))

  29. trenton says:

    I think if you have 9mm of bone you can place a 5.0 x 8.0mm Bicon implant or if you have a nice width you can place a 6.0 x 5.7mm Bicon implant, they works really good

  30. enio says:

    My wife need to have 2 implants in the upper left. Her dentist told me she needs sinus lift, and bone draft.her chin, and I am affraid it could thin her chin bone, and eventually causing deformation of her chin and fracture.

  31. Andrej Meniga says:

    In my opinion, if there is no major sinus lift needed, as it may be the situation, an artificial bone graft alone or mixed with the bone from the external oblique line of the lower jaw, could be much more gentle procedure for your or my wife.

  32. satish joshi says:

    to enio

    Harvesing autogenous bone from chin is prety safe procedure.It does not leave deficient or disfigured chin as you fear.
    Mostly clinician fills the defect with some kind of bone graft before closing wound.
    Most untoward effect is numb or dull feeing in lower anterior teeth if they are present.
    Harvesing from chin is relatively safe procedure in skilled hands.
    All other complications like
    excessive bleeding,infection,pain swelling etc remains same as other harvesing surgeries.
    But as suggested by Dr. Meniga there are other alternative bone graft materials are available but auotogenous bone is THE BEST BONE.

  33. Anonymous says:

    I am a periodontist who has placed implants since 1986. I average about 400-600 implants/year. Some of these questions and comments are disturbing. You can’t answer these questions without seeing the patient. What type bone do they have? What is the occlusion like? Do they have parafuctional habits?Is there only one fixture being placed? etc. All I can say is that many patients are going to get into trouble because everone now is placing implants.

  34. satish joshi says:

    last comment,
    wake up.
    We are not trying to do any treatment planning here.
    Of course proper treatment planning must have all necessary diagnostic tools in front of us.
    We are adressing a SPECIFIC question raised by a spouse for his wife out of his concern.
    By the way I teach in post graduate implant program for many years.
    I think you did not read question put forword by Mr.Enio.

  35. satish joshi says:

    3to 6 cc of bone is required for lateral window approach,and I think patient’s husband is not sure about the difference between crestal and lateral approach.
    Because I don’t think clinician would open flap over chin just to obtain little bone less than .5 cc for crestal approach.That much can easily harvested from tuberosity area of same side.

  36. Andrej Meniga says:

    According to my knowledge, even if a major sinus lift should be preformed you need xenograft or allograft to act as a filler in combination with autogenous bone. In the same time you avoid problems from the harvesting site. And you DO NOT NEED 3-6 ccm of mr. Enio’s wife bone for placing two implants.

  37. Anonymous says:

    A Biocon Rep states that an 8mm Bicon Implant has more surface area than a 11-12 mm Straumann Implant points out a couple of problems. First Struamann does not have an 11mm implant. Seems to me if you are going to quote a fact you would be able to definitively set the parameters. (ie a 12mm Struamann implant) Second, do they have a study that proves this claim. when a Straumann rep points out the difference in surface area between an 8mm Straumann SLA implant and a 10mm 3i Osseotite implant they can actually produce a study. In addition, they can produce a study regarding torque removal values demonstrating that the body is actually using the surface area created in the manufacturing process. I have never seen a Bicon study that demonstrates superior surface area over another implant system and they don’t list an abstract on their website that makes this claim. Is it like an Astra rep which compares their surface to the old Struamann TPS when talking about surface area, with a study mind you, and the reps are so new that they don’t know that Straumann has not sold that Implant for 7 years. Maybe that is why you don’t find that abstract on their webpage?

  38. Terence Lau says:

    As I stated earlier in this blog, if you have 9mm of bone, why not place a 4.1mm x 9mm Innova Endopore. Using the proprietary, precise fitting osteotomes which, when properly employed, not only lifts the sinus (should it be necessary), but serves to compress D3/D4 bone to D2 bone at the same time! Also, this sintered porous surfaced truncated cone displays the greatest surface area of any implant, thus crown to root ratio is unimportant. The procedure is made so simple due to this ingenious system!

  39. Anonymous says:

    The Bicon and other similar implant designs OBVIOUSLY have a larger surface area – just open your eyes and look at the darn things compared to those skinny Straumanns!

  40. Anonymous says:

    There is quite some concern in the UK at the moment re accelerated late bone loss around Endopore implants….thought to be due to this ‘sintered porous surface’. Interesting discussion on – think you have to be a member to view though..

  41. Rui Pinto Cardoso says:

    There are 3 types of implant placement and sinus aproach. 1-4 mm of bone – sinus lift with lateral window; 4-8 mm of bone – non traumatic sinus lift with osteotome and bone placing trought the hole; 8 -12 mm only osteotome; >12 mm bur or osteotome.

  42. Andrej Meniga says:

    Dear colleagues, I am happy that I provoked a discussion that had so many responds in such a short time. I would like to reveal my point of view on the subject. First of all, if you have a limited bone hight under the sinus you usually deal with a soft bone. You can’t spread and lift in the same time, but you can underprepare the osteotomy for TAPERED SCREW IMPLANT TYPE to get a primary stability. It would make no difference if you lifted the upper part of the bony “cork” or stuck the implant with apical threads into the sinus floor. This is hardly attainable with paralel wall or any other implant type except tapered screw with about 40 Ncm insertion torque. The optimal technique for sinus lift depends mostly on the type of the implant used and quality/quantity of the bone left! What do you think Jerry?

  43. MS says:

    Dr. Meniga, I often find that those with limited bone height under the antrum have very hard bone, often because they had the tooth out a long time ago and most of the softer alveolar bone has resorbed away. You’re still left with the upper and lower cortices too.
    I agree with the idea that a tapered screw or push-fit tapered implant would probably give the most primary stability. But as you say, the implant type and its thread pattern etc. would influence the technique used. Some seemingly parallel implants have a very agressive thread towards their apex to improve primary stability and some -Straumann for instance have hardly any thread at all.

  44. Anonymous says:

    I would like to know the success rate of implants that have harvested bone from the chin versus the tibiaio.Akron, Oh

  45. Peter Munns says:

    I am a periodontist and have been using the Localised Management of the Sinus Floor Technique, as described by Bruschi et al, for the past six years with a 99.5% success rate. The technique uses ostetomes to raise the sinus floor and can be used with as little as 4mm of bone and utilises no bone grafting materials. So long as primary stability of the implant is obtained the implants can be loaded at six months.

  46. Terence Lau says:

    I lecture for Innova and have heard all the rumors about these implants ranging from…”they aren’t really osseointegrated…just enveloped in soft tissue” to “they always fail”!!! I can tell you, after having placed thousands of Endopores and thousands of screw implants from every other company thoughout the last ten years, these porous coated implants have the same success rate as all the other implants! In addition, they require less bone volume in order to accomplish the support of individually restored molars and bi’s in the posterior maxilla and mandible! It is just a matter of learning a few simple techniques which can be easily attained with proper training!

  47. Andrej Meniga says:

    Let’s come back to the topic: Dr. Lau, since you lecture for Innova, would you recommend a new Hybrid implant for the sinus lifting technique used by coleague Munns above your post (Localised Management of the Sinus Floor Technique as described by Bruschi et al)?

  48. Dr. Emad salloum says:

    whenever you have a 10 mm length with a 4.5mm dia. go ahead and place the implants anchoring the cortical floor of the sinus even if you accidently have a tiny tear in the chendrian membrane , I have more than 40 successfull cases for more than 5 years after loading implants with such lengths and diam.without need for sinus lift

  49. Dr. Rueda says:

    I will use a short implant, like endopore 5mm x 7 mm.
    If you don´t use these implants then perform a sinus lift with osteotomes.

  50. Charles Mitchum says:

    My wife had an implant with a sinus lift 12 days ago and has developed severe sinus infection which is being treated by an ENT. It seems obvious that the infecation was caused by be implant, but dentist says unlikely as the implant is healing nicely and looks good based on xrays. Cadaver bone was used in the implant. What is prognosis and how common is infection.

  51. Andrej Meniga says:

    Severe infections after sinus lifting are rare if antibiotics are prescribed. You have to wait for the osseointegration of an implant to be sure about the prognosis. If further symptomes occure during healing period (at least 6 months in your wifes’ case) that means an implant or the bone act as a foreign body and should be removed. Good luck!

  52. SMSDDSMDT says:

    Lets not forget the systemic health of the host. You dont mean to say implants cause infections. Infection is a known risk factor in most any invassive protocal..

  53. David H says:

    I have read many comments if sinus lift is necessary when 8-9mm bone is available. Most studies have shown that the larger the implant, the better the final outcome. If you can do a sinus lift and get more anchorage, you, “theoretically” speaking, will have a better prognosis. Is a benefit that you shouldn´t let go. Much is still in discussion to “try” other options or implants when we still don´t have enough evidence (or at least, with no so much bias in the studies) as to compromise your practice. But, as the 1986 periodontist posted, all the other clinical examinations will give you a better diagnosis to decide wich best case scenario works for you.

  54. Dr. Chin Lim says:

    Hi! I just place 4 implants in the maxillary region. Preop panoramics on the premolar shows I have an 14mm bone height. I place a 13 mm implant and post op panoramics which my patient took week after shows I have intruded to the sinus for about 2 to 3 mm. All of the 4 implants have
    very good primary stabilty. The restoration of this patient will be implant supported denture which I will load in 6 weeks. I am planning to load the implants that is is into the sinus after 6 months, but will “soft load” it with silicon soft liner with the rest of the implants.
    I am I doing the right thing?

  55. Andrej Meniga says:

    From my experience, if you have a primary stability and 3/4 of an implant in a bone, you can expect the success. The only hazard could be overloading with the denture, but the same situation would be if you have placed four implants in the bone only. I am sure you are doing the right thing, maybe wait a little bit more for a secundary stability (osseointegration).

  56. Jackson Bean, DDS says:

    Remember the dip that occurs in integration right around when you are speaking of loading them so I’d be careful. Unless of course you are using Staumann or Astra I’d hold off another three weeks to be safe.


  57. mgborguet says:

    Does a successfull internal lift cause a patient to sneeze every 20 mintues and if so what should the patient do to stop the sneezing?

  58. JBarnett says:

    Great site. I have been very happy and successful with the osteotome technique for the last 6 years or so. I have only seen 2 Bicon implants (on a lower ridge) and was surprised how well they looked. But I’m not sure one can say Bicon have better initial stabilization than threaded implants when Bicon implants are just pushed into place vs being screwed into place.

  59. Dr. Bill Woods says:

    I have been placing implants for about 2 years. I have about six osteotome related maxillary implants. Even with 10mm of bone, I will still try to get another 2-3mm and place a 13mm implant. It has everything to do with the patient. 10mm is a rule of thumb for me. In the molar region, I will place a 6 X 10 and sit it on the floor. My belief is that the last few mm may have some support in some situations and others not so. But, in my view, even if there isnt 3mm of support, there is 3mm of the patients own biology to allow for some additional ptotection from the antral environment. Cant justify it statistically, but thats what I believe. Bill

  60. Dr. Kimsey says:

    I would place one implant from the buccal and a second implant from the lingual both perpendicular to the occlusal plane. Each implant would have an abutment at a right angle to the implant going occusally hten they are joined at the crest with a single crown. I have done this technique about twenty times when there is not a lot of bone either in height or especially in width as you need no bone grafting. In the 120 years of practice it has never failed.

  61. alvaro ordonez says:

    to piezo1
    Yes I have used hand bone spreaders since 2001, I have the ones made by Biolok, Meisenger and MIS.
    In fact I designed a set that was specially made for sinus elevation and presented in clinical iinovations at the AAO 2005, look for the abstract.
    The matter is, that to use those expanders you need to have enough height of bone and good lateral walls to have anchorage of the screw so you can create vertical lift to deform the floor of the sinus! and you need to practice the technique a thousand times on baby ribs so you dont perforated your first 10 patients (believe me it happened to me!)it is technique sensitive, specially when you want to achieve additional heights beyond the first 2 to three mm (I have been able to gain up to 6 mm with those expanders but it is a long story).
    so the answer is yes, they work for 2 to 3 mm increase of height if the right conditions are present and if you create controlled vertical pressure as you use them

  62. Bryan says:

    Hello, I am a patient and my Doctor has recogmended a sinus lift before he will do the implant procedure. My concern is that I am a Pilot and have a history of sinusitis. The problem is with #13. I’m leaning towards going with a bridge vs the implant with the sinus lift. Are my concerns founded? Any help would be appreciated. Thank you.

  63. Dr Reynolds says:

    Historically i have placed numerous implants into 8mm – 10mm height of maxillary bone using 11mmm implants achieving bicortical fixation but no doubt breaching the sinus membrane. But once I mastered the lateral approach sinus lift I now routinely perform this procedure in such cases. It enables me to confirm membrane integrity prior to placing the graft (i now use 100% Bio-Oss and Bio-Gide) and simultaneous placement of 13mm implants. Providing a piezosurgery technique is employed tears to the membrane can be almost elliminated. Why risk membrane perforation? Why use a Summers approach when it can be difficult to confirm membrane integrity? Evidence suggest that success rates are comparable to implants placed in 100% bone whn using the lateral approach. If i have 8mm of residual bone i now will load at 4 months providing i can splnt to adjacent implants and to date have had no problems.

  64. Erika B. says:

    I am a patient, with three upper back teeth that have had years of periodontal problems. The roots are somewhat exposed , the teeth have become wobbly and sensitive, and I’ve been told by my (GP)dentist that I need to have them taken out asap.
    My (GP)dentist also does implants and only uses cadaver bone for sinus lifts.
    In the recent past, I have had implants by another specialist who only believes in using autogenous bone. My grafts and implants done by this doctor,were very successful.
    I am concerned, especially since I have had periodontal disease in , that the cadaver bone might not work as well and I don’t want to have to have it taken out in the future.
    I wouldn’t even hesitate in going back to the (implant specialist) doctor who I was/am happy with, with the exception that his practice is about 90 miles away from my area, and my general practice dentist who has started doing implants, is nearby.
    Would it be more risk to accept the cadaver bone graft?
    Should I just go back to the implant specialist doctor that I know I’m very happy with?

  65. Andrej Meniga, DDS, PhD says:

    Dear Erika,
    as a patient I wouldn’t experiment with a nearby GP, I would travel 90 miles 🙂

  66. Ina says:

    I am a patient, and my dentist recommended a 10mm implant with a sinus lift. The dentist insisted that the the failure statistics is much higher on a 7 mm implants.

    In the past I had a problem with my sinus when a very tightly made bridge was placed in my mouth. I was having a problem until the bridge was removed and re-done.
    I told my dentist that I prefer a 7 mm implant which allows to avoid using a sinus lift.
    The dentist said she would use only a 10 mm post, or I should go to somebody else.
    What you would recommend for me to do? Thanks.

  67. dr T says:

    I think you need to have a good sniusgraft with a implant of 10mmwhich is surrounded by bone or graft material, because of your sinusproblems in the past. But I think I woul go for the short implants and leave the sinus at rest. maybe there is a little more faillures of these short implants but you don’t need to surgeries. It is your decision and your mouth, but why not doing a secon opnion by an expert inimplants?

  68. Dr SS says:

    Most interesting discussions
    May I suggest that in bone of the height being discussed where we are undecided to go for a LAteral window or an “internal”type sinus lift ..
    Use 2 shorter implants to replace the molar
    After all we are replacing molars in this area most of the time
    Biomechanics are very favorable ..2 implants have more surface area than one and internal tripodisation is huge and stability regardless of system is massive
    More logical in many ways
    Also bicortical fixation is a pretty major factor
    Standard posterior maxillary techniques are with osteotomes in any case so density is improved

  69. Dinh X. Bui says:

    Use the osteotome lift with simultaneous placement of implant. Now I would use the osteotome lift when I have arount 8mm bone height. Osteotome lift is much more comfortable to the patient postop than the regular sinus lift with the lateral/anterior approach. Patient leaving the ops looking like there is no surgery in his or her mouth. I have done numerous case of conventional sinus lift along with osteotome lift, they both works wonderfully. However, in the case of osteotome lift, many of my patient don’t even have to take pain medication. Moreover, you can even do the osteotome lift flapless,i.e., no flap raising and no suturing, which result in faster healing.

  70. Dan Holtzclaw, DDS, MS says:

    Winkler (2000) in the Annals of Peridontology reviewed implant success related to length and diameter out to 36 months. Data clearly shows that implants 10mm or less have lower success rates. The Bicon and Endopore folks may dispute this. I have never used their products, so I cannot comment on those implants. Back to the question. With proper training, the closed sinus lift is a relatively simple procedure and will allow you to place a longer implant in this situation. Additionally, it will boost your bottom line as you will, of course, charge for the procedure. Most likely, if you are talking about a 9mm residual apicocoronal ridge thickness, you are in the posterior maxilla. Bone quality in this region is typically poor. You are already behind the curve in a situation such as this. Why compound your chances for failure by placing a short implant? Do the grafts, place the larger implant, and feel confident that you have done all you can to set the patient up for success.

  71. Nicholas Toscano DDS MS says:

    Dr. Holtzclaw I myself am a fan of longer lenghth implants whenever possible and I agree with the rest of your comments on closed sinus lifting. I feel Winkler review while good, doesn’t look at some of the advantages of some short implant systems.

    Deporter has shown in several studys the high success of short implants using the endopore implants. He has even shown that it is the implant surface that has a great impact on the success of short implants. Deporter showed that the endopore surface was more favorable in a short implant length vs long.

    In my practice I do what is needed to get the optimal implant length, but I feel there may be a place for short implants in practice. More research is needed in this area.

    Deporter et al. Further data on the predictability of the indirect sinus elevation procedure used with short, sintered, porous-surfaced dental implants.Int J Periodontics Restorative Dent. 2005 Dec;25(6):585-93
    The object of this report was to provide further data supporting the use of short (primarily 7-mm-long) dental implants with a sintered, porous-surface geometry to treat the posterior maxilla using the indirect, osteotome-mediated, localized sinus elevation procedure. Records were available for 104 Endopore implants (Innova) in 70 patients, for whom the majority of implants had been placed in the location of the maxillary first molar. The mean initial subantral bone height before implant placement was 4.2 mm, with a range of 2 to 6.7 mm, and all implants were placed using hand osteotomes and a graft of bovine hydroxyapatite. After an average time in function of 3.14 years, only two implants had been lost, both as a result of unusual circumstances. It is concluded that the use of short, sintered, porous-surfaced implants and localized indirect sinus elevation is a predictable and minimally invasive approach to manage the posterior maxilla with minimal preoperative subantral bone height.

    Cooper LF, Deporter D, Wennerberg A, Hämmerle C.
    What physical and/or biochemical characteristics of roughened endosseous implant surfaces particularly enhance their bone-implant contact capability?Cooper LF, Deporter D, Wennerberg A, Hämmerle C.Int J Oral Maxillofac Implants. 2005 Mar-Apr;20(2):307-12.

  72. Lisa says:

    I am a patient and just had a sinus lift less than two weeks ago. I had sever pain for the first few days and then started to have sinusitis symptons after that. Is my experience so far normal? My concern is if I will develope long term sinusitis. What is the statistic of patients who actually developed long term sinusitis after sinus lift? Please help – I am so very worry.

    Many thanks.

  73. Dr ahmad says:

    Dear doctors,

    i have faced many situations like this, but i always use the internal technique with the introduction of Bio-oss or any DFDBA material. the resultes untill now are great and the procdure is safe and an extra 3-5 minutes is worth to be on the safe side.

  74. Robert J. Miller says:

    One can debate the virtues of shorter implants with macroporous surfaces vs longer implants for stability in the posterior maxilla. But you are missing one of the major advantages of raising the sinus floor and placing the body of the implant through the apical osteotomy. When we speak of the pneumatized sinus, this is generally an edentulous area with atrophic bone. Initial stability and bone to implant contact can be significantly to dramatically reduced. A trans-floor osteotomy allows the implant to engage the cortical plate that is the sinus floor. Those who have placed an implant that contacts the sinus floor and then have tried to torque the implant just a bit farther have often experienced stripping of the bone. When threads can move through and engage the cortical zone, implant stability and torque values rise demonstrably. This is why longer implants in sinus lift cases have higher success rates.

  75. peter fairbairn says:

    Sure, we have used only synthetics for the last 3 years with better results and NO post op pain.New materials in Europe have changed the situation.

  76. MKozacko says:

    Great discussion here. I’ve enjoyed reading everybody’s opinions on sinus lifts. There really is no consensus on exactly when and how to perform a sinus lift, this is why it’s good to hear different opinions on the subject.

    Here’s my usual protocol. If I have around 8mm of verticle bone (assuming good bone width) then I usually won’t perform a sinus lift. I’ll usually place a Nobel Biocare 8.5 mm tapered implant, but I really think the implant type is irrelevant here. I always under prep my posterior maxillary implant sites to assure good initial stability. Osteotomes seem to work well in this region, but I personally haven’t had a need to use them. Between 3 and 7 mm of bone, I will usually simultaneously place an implant with a lateral wall sinus lift (assuming I have excellent initial implant stability). In these cases I’ll usually use either cadaver or bovine bone (Lifenet or BioOss). The problem that I have with the osteotome sinus lift (internal) technique is the potential of an unrealized membrane tear and subsequent ostium obstruction with free floating bone graft material. I’m not condemning this technique, I just personally prefer the lateral wall technique and direct visualization of the sinus membrane. With less than 3 mm of bone, I’ll usually use autogenous bone with possible simultaneous implant placement. If I can’t get good initial implant stability, I’ll only perform the sinus lift and then go back in 6 – 9 months and place the implant(s). I usually remove a block of bone from the ramus and run it through my bone mill. Ramus scrapers seem OK, but just a little tedious for me. I’ll use chin if I need a larger quantity of bone, but it’s rare that I can’t harvest enough bone from the ramus (or bilateral ramus) region. Plus I have a couple of permanent parasthesias from chin grafts and their not really too happy about it. On rare occasions I will harvest from the tibia or anterior hip, but only in severe bilateral bone deficiencies (these cases are really beyond the scope of this discussion).

  77. Deb Scott says:

    My husband is having implants and the oral surgeon told him he needed a sinus lift. He has had bone grafts done 4 months ago and is now scheduled for the sinus lift and the implants to be placed at the same time. He was told that after this surgery he would have to wait for 6 months to actually have the posts placed with the teeth. Is this “normal” procedure?

  78. anil.k says:

    Hi Dr’s,
    what procedure would be the best for a patient with 8mm height for a single molar.what would be the best procedure compared to BICON METHOD,SUMMERS TECHNIQUE,MODIFIED SHEPERD INTERNAL SINUS LIFT.
    Please advice.

  79. R. Hughes says:

    Anil, probably a Sommers will do the trick. With 8mm. you should at least gain 4-5 mm. more with a Sommers method and still have room for more and have a great implant.

  80. R. Hughes says:

    If you perf the membrane you will have bone grow up to 4mm. up the implant portion that has perfed the sinus. An implant with a rounded apex does better with bone growing over the implant in the mx sinus.

  81. Anna says:

    Excuse me, I have heard recently about swiss basal implants Dr. Stefan Ihde who widely uses in his practice such implants says that this method can help us avoid bone augmentation. What do you think about this idea?

  82. JH says:

    I was wondering if anyone know the success rates of an implant that is placed in the maxilla after perforation of the membrane? Is is possible to just back up a couple of mm and place an implant or what is the implant is placed into the sinus a couple of mm with good stability?

  83. MGBorguet says:

    How successful is an internal sinus lift for a non smoker male for site development on a pt. with a maxillary 1st molar site ranging from 6mm to 4mm of bone height?
    Does chronic sinusitis and very thick membrane 7mm on ct scan both sides effect outcome?
    Clear him with ENT first?

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