Sinus lift types: lateral window and crestal Periodontal treatment
A lateral window sinus lift reaches the sinus floor through a small window in the side of the upper jaw, and a crestal (osteotome) lift raises the floor through the implant hole from below. Reviews draw the line at 5 mm of bone under the sinus: above it a crestal lift, at or below it a lateral window.
How do lateral and crestal sinus lifts differ?
A lateral window lift opens a small window in the cheek side of the sinus to raise the lining and pack graft beneath it; a crestal lift taps the sinus floor up through the implant site and places the implant at the same visit.
| Lateral window | Crestal (osteotome) | |
|---|---|---|
| Access | Window in the side wall of the sinus | Through the implant site in the ridge |
| Bone under the sinus | 5 mm or less | More than 5 mm |
| Height added | About 8 mm in a comparison | Around 3 mm in an NHS hospital's protocol |
| Implant timing | Same visit if the bone holds it, or 4 to 12 months later | Same visit |
| Final crown | After the graft and implant heal | 3 to 6 months after surgery |
Tatum first suggested the crestal approach, and Summers later described the tapered osteotome technique that remains in use. Both are normally done under local anesthetic as outpatient surgery. Sinus lift explains when a lift is needed.
How much bone does a crestal sinus lift need?
A crestal sinus lift is most predictable when more than 5 mm of bone remains between the ridge and the sinus floor and the floor is fairly flat. A multicenter study of the bone-added osteotome technique tracked implant survival by starting bone height.
| Bone under the sinus before surgery | Implant survival |
|---|---|
| 5 mm or more | 96% or higher |
| 4 mm or less | 85.7% |
With 5 mm or less, reviews indicate the lateral window with a graft. Implants go in with a lateral graft when the remaining bone gives them primary stability. Short implants of 6 mm or less placed with an osteotome lift had lower survival. Contraindications to the crestal approach can be local, intraoral or medical. Patients are usually advised to take antibiotic cover and use antiseptic rinses afterward. Implant candidates covers the other options for the upper back jaw.
What is the success rate of a sinus lift?
Implants placed with a sinus lift survive at high rates in systematic reviews, with low yearly loss over the long term.
| Result | Value |
|---|---|
| Lateral window, implant survival at 3 years | 90.1% |
| Lateral window, rough-surface implants with a membrane over the window, at 3 years | 98.3% |
| Crestal, implant survival at 3 years | 92.8% |
| Lateral window, yearly implant loss over 5 or more years | 0.43% |
| Patient-based implant survival at 5 years | 95% |
Long-term implant loss did not differ between autogenous bone and bone substitutes, or between implants placed with the graft and later. Smokers had 1.87 times the risk of implant failure in grafted sinuses in a pooled analysis, and prospective studies alone did not confirm the difference. A membrane over the lateral window increased new bone formation in a meta-analysis. How long implants last covers survival in general.
How common is a sinus membrane tear?
A tear of the sinus lining is the most common complication of a sinus lift, occurring in about 20% to 25% of lateral window procedures. Crestal lifts tore the lining in 3.8% of patients. Piezoelectric instruments had a tear rate of 8% in a meta-analysis of lateral window surgery. Rotating instruments in the same analysis had a rate of 24%.
Sinus septa and less than 3.5 mm of remaining bone raise the risk. A torn membrane that is handled and repaired shows implant survival comparable to an intact membrane. The surgeon stitches or patches a tear, and if the repair fails, the surgeon may stop and redo the lift after the lining heals, usually a few months later. A healed lining tends to be thicker and stronger. Bone graft failure covers other complications.
What should you avoid after a sinus lift?
Nose blowing, straws, smoking, vigorous rinsing, flying and wind instruments are the things to avoid after a sinus lift, because each puts pressure on the sinus. The precautions last at least 1 week.
- Do not blow your nose for 2 weeks; wipe it gently.
- Sneeze with your mouth open.
- No air travel for at least 2 weeks.
- No strenuous exercise for 2 weeks.
- Take antibiotics and decongestants as prescribed.
- An NHS hospital adds menthol steam inhalations for 10 days.
Some drainage from the sinus is common and gradually stops, and the sinus can feel full or blocked for some weeks. Call the surgeon if you feel air pass through the site, if graft material seems dislodged after a sneeze, or if you develop a fever. Bone graft recovery covers the weeks after surgery.
Questions
Is a sinus lift the same as a bone graft?
A sinus lift is a type of bone graft. The graft goes between the jaw and the lifted sinus lining to add height in the upper back jaw, while ridge augmentation adds bone to the outside of the ridge. The same materials are used, and the most common in sinus lifts at an NHS hospital is bovine bone mineral.
Is a sinus lift painful?
Most sinus lifts are done awake under local anesthetic and are not normally painful. Afterward, simple painkillers such as ibuprofen or paracetamol usually control the pain, and swelling is at its worst after two days. Patients feel back to normal after 2 to 3 weeks, according to an NHS hospital leaflet.
How long does a sinus lift take?
The surgery takes 45 minutes to 2 hours, depending on complexity. Stitches are removed at about 1 week. When the lift is done before the implant, the graft meshes with the patient's own bone for 4 to 9 months first. A crestal lift places the implant at the same visit.
Can a sinus lift be done without a bone graft?
Yes, in some cases. In a comparison, lifting the lining through a lateral window without graft material gained 7.9 mm of bone height. An autogenous graft gained 8.3 mm, and the difference was not significant. With the crestal method, adding graft material produced significantly more bone gain in a prospective study.
What are the alternatives to a sinus lift?
Alternatives include a shorter implant where enough bone exists, angled implants placed next to the sinus, zygomatic or pterygoid implants anchored in facial bones, fewer implants placed further forward, a bridge, or a denture. The risk of implant failure rises as implant length decreases. Angled implants matched conventional implants at 5 years in an NHS hospital's summary.
Can a sinus lift cause vertigo?
Benign paroxysmal positional vertigo is a reported complication of the crestal (osteotome) technique. An NHS hospital leaflet describes vertigo after sinus lifts as rare and temporary. Nasal bleeding, a blocked nose and bruising are also reported after crestal lifts. Tell the surgeon if dizziness starts after surgery.
Sources
- Cambridge University Hospitals NHS Foundation Trust. Sinus lift procedures. Patient information 2024
- Starch-Jensen T, Jensen JD. Maxillary sinus floor augmentation: a review of selected treatment modalities. J Oral Maxillofac Res 2017
- Pjetursson BE, Lang NP. Sinus floor elevation utilizing the transalveolar approach. Periodontol 2000 2014
- Rosen PS et al. The bone-added osteotome sinus floor elevation technique: multicenter retrospective report. Int J Oral Maxillofac Implants 1999
- Pjetursson BE et al. A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation. J Clin Periodontol 2008
- Tan WC et al. Success of sinus floor elevation and survival of implants, part II: transalveolar technique. J Clin Periodontol 2008
- Raghoebar GM et al. Long-term effectiveness of maxillary sinus floor augmentation: a systematic review and meta-analysis. J Clin Periodontol 2019
- Starch-Jensen T et al. A systematic review and meta-analysis of long-term studies (five or more years) assessing maxillary sinus floor augmentation. Int J Oral Maxillofac Surg 2018
- Starch-Jensen T et al. Maxillary sinus floor augmentation with or without barrier membrane coverage of the lateral window: a systematic review and meta-analysis. J Oral Maxillofac Res 2019
- Chambrone L et al. Effects of tobacco smoking on the survival rate of dental implants placed in areas of maxillary sinus floor augmentation: a systematic review. Clin Oral Implants Res 2014
- Molina A et al. Complications in sinus lifting procedures: classification and management. Periodontol 2000 2022
- Jordi C et al. Membrane perforation rate in lateral maxillary sinus floor augmentation using conventional rotating instruments and piezoelectric device: a meta-analysis. Int J Implant Dent 2018
- Al-Dajani M. Incidence, risk factors, and complications of Schneiderian membrane perforation in sinus lift surgery: a meta-analysis. Implant Dent 2016
- McGill University Oral and Maxillofacial Surgery. Bone graft and sinus lift post-operative instructions
- American Academy of Periodontology. Dental implant procedures: sinus augmentation and ridge modification
Bone grafting Read next
Socket preservation after extractionSocket preservation places bone graft material in a tooth socket at the extraction visit, usually under a collagen membrane or sponge, to limit shrinking of the jaw ridge as it heals.Ridge augmentationRidge augmentation rebuilds a jaw ridge that is too thin or too short for an implant, adding width (horizontal) or height (vertical) with particulate grafts under a membrane, bone blocks, ridge splitting or tenting screws.Guided bone regeneration (GBR)Guided bone regeneration (GBR) covers a bone graft with a barrier membrane that keeps soft tissue cells out of the defect, so bone-forming cells from the surrounding jaw can fill it.
PRF and growth factorsPRF and PRP are concentrates spun from the patient's own blood, and Emdogain, rhPDGF-BB (GEM 21S) and rhBMP-2 (INFUSE) are FDA-approved biologics added to periodontal or bone grafts.
Periodontal regenerationPeriodontal regeneration regrows the bone, ligament and root cementum that hold a tooth, in deep bone defects beside a root (intrabony defects) and between the roots of molars (furcations).Bone graft failureA dental bone graft fails when infection, exposure through the gum or poor healing leaves too little new bone for an implant.