Smokers and Sinus Lifts: Thoughts?

I am encountering dilemmas with patients that require sinus lifts and are smokers. Can anyone share their experiences with performing sinus lifts on patients that smoke? It is my understanding that membranes in smokers are very frail and attempts to lift them, end up with severe perforations that are beyond repair. The second issue that goes beyond lifting the membrane is the influence of nicotine and an assault by a gas of higher than the normal temperature on the maturation of any kind of a graft.  Please share your experiences and your thoughts.

6 thoughts on “Smokers and Sinus Lifts: Thoughts?

  1. Daniel R Sweet says:

    Actually, smokers membranes are not frail,, however,, I did one not to long ago that failed in a smoker. I would at least get as many factors in my favor before trying again on a smoker,, and maybe adding more meds.

  2. Alejandro Berg says:

    I have had a long history of sinus lifts, summers, hydraulic,balloon,lateral and any possible variation for the last twenty something years…. Smoking has always been a deterrent when planning. I have had good and bad experiences with smokers. As a general rule either they stop smoking or I don’t elevate, don’t even graft. What you get is not what you would expect. Our latest approach is using fully guided surgery to avoid lifting in smokers, actually avoiding sinus lifts as much as possible. Less work, less complications and much better post op. Of course lifting is part of our daily armamentarium but we have extra reservations when we approach smokers . We only take those committed enough.

  3. Amit Binderman says:

    Our users, those who use AUTOLOGOUS DENTIN GRAFT (KometaBio – Smart Dentin Grinder), report outstanding results of graft acceptance and bone remodeling with heavy smokers. So if you plan on using grafts in the sinus, definitely use autologous grafts and specifically dentin graft that will not resorb as quick. The downside, you would need an extracted tooth from the same patient. Our website has at least 1-2 cases that show results in heavy smokers.

  4. Paul says:

    I have placed implants in heavy smokers in maxilla and mandible (over 10 cigarettes per day) and I have learned from my own experience only that as long as the implant is placed under the cover of the gingiva and allowed to reach total integration before exposure the outcome is positive. What happens afterward is the same that happens to natural dentition to smokers, periodontosis. As long as they are aware of the problems associated with smoking and agree to the treatment I feel that I allowed them the benefit of dental implants and their suicidal intentions are in their domain. Enough is said about detrimental effects of smoking that I consider those that do smoke on a mission I do not understand or relate to. I have never treated anyone with a sinus lift that smokes. If one would try to look for research on that topic the outcome would be very disappointing. Ther is not much written on that subject. The ENT doctors have done some studies of results of sinus surgeries in smokers vs. non-smokers with conclusions that it is hard to extrapolate into sinus lifts, grafts, etc. Hopefully, someone in the dental community will take on that challenge.

  5. Gregory says:

    I have been doing sinus lifts for 18 years. I do not do lateral approach sinus lifts in smokers. Similar to cosmetic surgery, they have to stop smoking to allow revascularization. Either they stop or get a bridge.

  6. Greg Kammeyer, DDS, MS says:

    I do lateral window grafts on smokers that are <10 cigs/day. Smoking is factor that decreases vascularity to the graft. Exercise improves vascularity. Growth factors up regulate Veg F ( PDGF and L-PRF) and not drinking alcohol helps as well (1 drink/day interferes w bone healing). Certainly many other things affect blood flow (prior surgeries, other systemic diseases). Consider the overall health of the patient and what they are willing to do that can help or hinder the result.

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