When Your Sinus Gets in the Way of Successful Implant Placement

When Your Sinus Gets in the Way of Successful Dental Implant Placement

Successful placement of implants in the posterior maxilla could potentially be compromised by the lack of vertical dimension between the alveolar crest and the floor of the maxillary sinus. Typically, 10mm of vertical bone is required for predictable implant success (Misch 1987) although success can be achieved with less than 20 mm (Fugazzoto 2007). Moreover, bone density in the posterior maxilla is often poor, which could lead to complications during implant fixation. To address these problems, maxillary sinus elevation surgery was developed to increase the amount of bone available for implant placement.

Lateral Window Sinus Lift: A Sinus Augmentation Technique

Implant placement can be performed simultaneously with the sinus elevation procedure or following a healing period that can last

6-9 months. Immediate placement during sinus elevation reduces overall healing time and eliminates another surgical procedure, which can be desirable to patients. The decision to place an implant during sinus augmentation is dependent on the presence of adequate bone volume and quality to provide for initial stability of the implant. Rosen and colleagues (1999) recommended at least 5mm of native bone for immediate implant placement during sinus augmentation. However, more recent studies have found that implant stability can be achieved with less than 5mm (Peleg 2006).

Lateral Window Sinus Augmentation: The lateral approach involves a modified Caldwell-Luc operation to gain access to the sinus cavity. A bony window is created in the lateral maxillary wall, the Schneiderian membrane is elevated, and bone grafting material is a combination of autogenous bone and allograft. An absorbable collagen membrane is placed between the bone graft and the membrane as well as over the bony window.

This technique is usually the preferred method of sinus elevation in situations of poor bone quality and minimal residual bone height because it allows for direct visualization and accurate bone placement and volume at the position of the implant. Also, tearing of the membrane can be easily treated, minimizing contamination of the graft during healing.

For more information about Sinus Augmentation (Lift) procedures or Dental Implant Procedures, contact Joseph R. Nemeth, DDS and Associates at 248.357.3100 or via email at jodi@drnemeth.com. You may also want to visit the practice website at http://www.drnemeth.com.

Michigan Dental Implant Patient Seeks Guidance From Southfield Periodontist

Patient Question: I have been missing a tooth in the back upper right area for quite a while and would like to have it replaced. I would prefer not to have to cap the teeth on either side so an implant seems like the way to go. I was told I would need to "grow bone" in that area. How is that possible?

Anonymous, Farmington Hills, MI

Answer: It sounds like what your doctor is concerned about is getting enough bone in the area requiring the implant. Sometimes when an implant is needed in the posterior areas of the maxilla (upper jaw bone), the sinus cavities get in the way. The sinus is nothing more than a space for air, but if the sinus is very large, it minimizes the amount of bone available to secure an implant; therefore, we need to grow bone.

The procedure, called a sinus augmentation or sinus lift, involves raising a small amount of the membrane lining the sinus (like the membrane inside an egg shell) and filling the empty space with a bone grafting material. We then let this bone grow or mature for approximately six months. At that point the patient will most likely have grown enough bone to support the implant.

Have a similar question? Contact the Michigan Dental Implant Specialists at Joseph R. Nemeth, DDS & Associates at 248.357.3100. Our team of Doctors, Hygienists, Assistants and Business staff are all highly knowledgable in the fields of Periodontics and Dental Implants and will be pleased to answer any and all of your questions or address any concerns. Submit your question online at http://www.drnemeth.com/patientinfo_asktheperiodontist.html.