Sinus Grafting

Type I - Large maxillary sinus

Some patients have a low sinus floor which leads to very little bone height after an extraction

Type II – Small maxillary sinus

Some patients have a high sinus floor which leads to large amounts of bone height after an extraction

In type I sinuses bone grafting is necessary to increase bone heights and allow for implant placement.

 

The procedure

Two methods of sinus grafting are currently available.

Procedure 1 – Crestal approach

Bone can be placed from the crest of bone during implant placement. The normal implant hole is drill and the preparation is stopped 1 mm before entering the sinus. Special instruments are then used to tap the thin shell of bone upwards therefore moving the sinus membrane up and allowing for placement of a bone graft into the space. The implant is then placed into the prepared bone immediately. This is the simplest method and has a low rate of complications. It is commonly used when a minimum of 5 mm of bone height is present.

 

 

Procedure 2 – Lateral approach

Bone can be placed from lateral aspect. A small window is made in the side of the sinus wall with special instruments. The sinus membrane is moved upwards therefore allowing for placement of a bone graft into the space. The implant can be placed into the space immediately or the graft is left to consolidate for 4-6 months. The implant can then be placed following this period of healing. This is a more complex approach and carries a 4-7% complication rate i.e. infection or graft rejection. If this occurs then removal of the graft and or implant are required. It is commonly used when less than 4 mm of bone height is present.

 

 

Complications

Complications (infection/graft rejections) with sinus grafting are rare. However, in some patients (particularly smokers and uncontrolled diabetics) sinus grafting can fail and lead to acute infections which are managed by removal of the graft and or implant, cleaning of the sinus and antibiotic therapy. In extremely rare cases chronic infections can occur. Long-term antibiotics and decongestants can be used to address this problem. A referral to an ENT surgeon in instances can be indicated.