Open and closed sinus lift

Sinus lifting is a type of osteoplasty that involves building up spongy bone tissue. The procedure is performed only in the lateral section of the upper jaw and is carried out using either an open or closed method. Specialists from the Dent-House family dentistry clinic in Odessa explain the differences between the techniques, preparation for surgery, and the nuances of the rehabilitation period.

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The difference between open and closed sinus lifting

Both of these procedures have the same goal — to fill the bone tissue deficiency in the maxillary sinus area for subsequent dental implant placement. Insufficient bone volume can be caused by both individual characteristics of the maxillary sinuses and jaw atrophy as a result of prolonged tooth loss.

If the bone height is insufficient, implant placement will simply be impossible, as there will be nothing to mount the titanium screws into. The method for performing the procedure of bone augmentation of the alveolar process in the upper jaw is selected based on many factors. The thickness of the bone wall in the area of the intended implantation plays a primary role. The main indication for sinus lifting is bone tissue height less than 6-8 mm.

The difference between open and closed sinus lifting lies in the invasiveness of these techniques.

• The former involves a greater degree of intervention, so open sinus lift is more traumatic and requires a longer recovery period after the procedure.
• Closed sinus lift, on the contrary, is less invasive and in most cases is combined with single-stage implantation.

Diagnosis and preparation for sinus lift

In order to select and plan a specific procedure, the doctor must conduct a detailed examination of the patient. At the Dent-House clinic in Odessa, all available modern technological solutions are used for this purpose. For example, the clinic has the latest Gendex dental tomograph. It is used to take high-quality 3D images of the jaw and maxillary sinuses.

Creating a 3D model of the area to be operated on is an important step in preparing for surgery. With the help of a 3D model, the dentist can assess the condition and thickness of the upper jawbone, study the structure of the maxillary sinuses, and calculate the amount of bone material needed for osteoplasty.

A 3D image also allows for effective planning of all necessary procedures, which ultimately helps to reduce the risk of complications and the rehabilitation period after sinus lifting.

In addition to computed tomography, the patient will undergo a series of other examinations. To rule out contraindications to surgery (severe systemic diseases, blood clotting disorders, allergy to anesthetics), a complete blood count and additional tests are prescribed to assess the patient’s overall health.

Before sinus lifting, it is mandatory to perform a complete sanitation of the oral cavity with the removal of plaque and tartar. If necessary, treatment of identified inflammatory processes is performed. Such preparation is mandatory to eliminate sources of infection and prevent postoperative complications.

Contraindications for sinus lift

Most contraindications to surgery are relative and can be corrected during the preparatory stage. These include ENT diseases that must be treated before sinus lift:

• infectious foci in anatomical proximity to the maxillary sinus;
• polyps, papillomas, sinus cysts.

A recent maxillary sinusotomy is also a temporary limitation.

Absolute contraindications include conditions in which surgery is impossible in principle. They are rare and are associated with impaired function of the maxillary sinus:

• malignant neoplasms in this area or on the face;
• chronic recurrent incurable rhinitis;
• scar tissue deformities after surgery or trauma;
• multiple septums, sinus deformities.

Dental contraindications, i.e., infectious processes in the oral cavity: in the teeth and their roots, periodontal tissues, and mucous membranes, can be separated into a separate group. Sinus lifting is performed only after all inflammation has been eliminated.

General contraindications to surgical intervention include:

• blood clotting disorders;
• anemia;
• decompensated diabetes mellitus;
• thyroid disorders;
• oncological pathology;
• heart disease.

For women, this list is supplemented by pregnancy and lactation, as well as menstruation.

Open sinus lift

The decision to perform an open sinus lift is usually made in cases of severe bone atrophy, when the bone height is less than 5 millimeters. The operation allows the bone volume to be increased by 5–6 millimeters in the molar/premolar area.

To access the maxillary sinus, the doctor makes a small incision in the gum on the front wall of the maxilla. Bone material is inserted into this surgical window. The protocol for this procedure does not involve simultaneous implantation. Implants are placed after the osteoplastic material has healed, no earlier than 4-6 months later.

Stages of surgical intervention in open sinus lifting:

• administration of a local anesthetic;
• incision of soft tissues where the gums meet the cheek;
• creation of an opening in the bone to access the wall of the maxillary sinus;
• the doctor carefully lifts the sinus mucosa to insert a collagen membrane into the space created (it is designed to protect the operated area from infection and create a new sinus border);
• Bone material is inserted under the membrane.
• In the final stage, the soft tissues are sutured.

After the operation, the patient is prescribed antibacterial and anti-inflammatory medications. In exceptional cases, simultaneous implantation is possible with open sinus lifting: in the complete absence of contraindications, excellent tissue condition, etc. However, most often, after osteoplasty and before the installation of a dental implant, about six months must pass.

Closed sinus lift

This procedure is optimal when a small amount of bone tissue needs to be built up. It is performed when the bone height is 7 millimeters. This allows an average of 2-3 mm to be added to the chewing area of the upper jaw. Less invasiveness is achieved by introducing the osteoplastic material through a vertical puncture rather than an incision.

Stages of closed sinus lift:

• administration of a local anesthetic;
• perforation of the gum;
• a small hole is drilled in the bone through which the bottom of the maxillary sinus is lifted;
• bone material is introduced into the resulting cavity;
• Then the implant is inserted immediately;
• The wound is sutured.

Closed sinus lifting is performed faster than open sinus lifting, this operation is cheaper, and the recovery period after it is shorter.

Rehabilitation after osteoplasty

For a faster and easier recovery after surgery, doctors recommend following a number of recommendations:

• The first meal after a sinus lift should be no earlier than 3-4 hours after the procedure, and the food should be soft and warm.
• Avoid spicy foods and hard foods in the first few days.
• Food and drinks should not be too hot or too cold.
• Refrain from alcohol and limit your consumption of tea and coffee.
• do not use dental floss or a toothbrush during the first 24 hours;
• Avoid hot baths, saunas, and steam rooms (for 2 weeks after open sinus lift surgery and 10 days after closed sinus lift surgery).
• Refrain from strenuous physical activity for several days after the procedure.

Special attention should be paid to actions that cause increased pressure inside the nose. For example, after the operation, you should not sneeze, cough, or blow your nose. Sneezing is particularly difficult to control. Therefore, do not cover your mouth when sneezing.

Also, for at least a month after the operation, you should not swim or dive, play wind instruments, or fly on an airplane.

We recommend sleeping on raised pillows. To reduce swelling, you can apply ice to your cheek (no more than 5 minutes at a time, with breaks). Under no circumstances should you use hot compresses. Your doctor will tell you about all the details of your recovery during your appointment.

You can find out how much a sinus lift costs in Odessa at the Dent-House clinic, where procedures of any complexity are performed effectively, quickly, and painlessly. You can make an appointment with a specialist in any convenient way: by phone or by filling out the appointment form on the website. Numerous reviews from our patients will help you verify the quality of our work.