SINUS AUGMENTATION

Introduction:

Sinus augmentation is also termed as sinus lift, sinus graft, sinus procedure or maxillary sinus floor augmentation.

It is a surgical procedure which aims to increase the amount of bone in the posterior maxilla by lifting the lower Schneiderian membrane (sinus membrane) and placing the bone graft.

The procedure is performed when the floor of the sinus is too close to an area where dental implants are to be placed.  

History:

In 1980, Boyne and James reported on elevation of the maxillary sinus floor in patients with large, pneumatized sinus cavities as preparation for the placement of implants.

In 1994, Summers described a crestal approach, using tapered osteotomes with increasing diameters.

Etiology:

The maxillary sinus grows by a bone remodeling process as age advances. This physiological process is accompanied with increased tooth resorption due to tooth loss that leads to decrease in bone height. The lowering of the sinus can be caused due to long term tooth loss or any trauma or periodontal disease.

Augmentation techniques:

1.     Indirect sinus lift : it is a preferred technique in which at least 5mm of residual bone is present

2.     Direct sinus lift: it is preferred when residual bone is less than 5mm.

Indications:

·        Loss of more than one tooth in the posterior maxilla.

·        Absence of significant amount of bone in the posterior maxilla.

Contraindications:

·        When there are infections

·        When there are some pathological growth

·        If the patient is allergic

·        Excessive tobacco use.

·        Malignant tumors

·        Maxillary cysts

Complications:

Intraoperative complications:

1.     Excessive bleeding

2.     Injury to the infraorbital neurovascular bundle.

3.     Hematoma

4.     Implant migration

5.     Adjacent tooth sensitivity

6.     Sinus membrane perforation

Post-operative complications:

1.     Sinusitis

2.     Grafted sinus infection

Post-operative instructions:

1.     Do not blow your nose

2.     Do not use tobacco

3.     Don’t drink with a straw

4.     Do not lift or pull up the lips to look at the sutures

5.     Sneeze with the mouth open

Recovery:

·        Around three to six months after the sinus augmentation bone to become part of the patient's natural sinus floor bone.

·         Up to six months of healing is sometimes left before implants are attempted.

·        Some of the surgeons perform both the augmentation and dental implant simultaneously, to avoid the necessity of two surgeries.

                                                              
                                                                                                          DR. ANJUSHA SHARDA