Multiple Teeth Missing - Sinus Lifts and Bone Grafts

Sinus Lift

A sinus lift is surgery that adds bone to your upper jaw in the area of your molars and premolars. It's sometimes called a sinus augmentation. The bone is added between your jaw and the maxillary sinuses, which are on either side of your nose.

Tooth loss may have led to a loss of bone as well. Once teeth are gone, bone begins to be resorbed (absorbed back into the body). If teeth have been missing for a long time, there often is not enough bone left to place implants.

The maxillary sinus may be too close to the upper jaw for implants to be placed. The shape and the size of this sinus varies from person to person. The sinus also can get larger as you age.

Sinus lifts have become common during the last 15 years as more people get dental implants to replace missing teeth.

Preparation

The bone used in a sinus lift may come from your own body (autogenous bone), from a cadaver (allogeneic bone) or from cow bone (xenograft).

If your own bone will be used in the sinus lift, it will be taken from other areas of your mouth or body. In some cases, the surgeon removes bone from your hip or tibia (the bone beneath the knee).

You will need X-rays taken before your sinus lift so the dentist can study the anatomy of your jaw and sinus. You also may need a special type of computed tomography (CT) scan. This scan will allow the dentist to accurately measure the height and width of your existing bone and to evaluate the health of your sinus.

If you have seasonal allergies, you should schedule the procedure when they are not active.

How It's Done

Your surgeon will cut the gum tissue where your back teeth used to be. The tissue is raised, exposing the bone. A small, oval window is opened in the bone. The membrane lining the sinus on the other side of the window separates your sinus from your jaw. This membrane is gently pushed up and away from your jaw.

Granules of bone-graft material are then packed into the space where the sinus was. The amount of bone used will vary, but usually several millimeters of bone is added above the jaw.

Once the bone is in place, the tissue is closed with stitches. Your implants will be placed four to nine months later. This allows time for the grafted material to mesh with your bone. The amount of time depends on the amount of bone needed.

Follow-Up

After the procedure, you may have some swelling of the area. You may bleed from your mouth or nose. Do not blow your nose or sneeze forcefully. Either one could cause the bone-graft material to move, and loosen the stitches.

Your dentist may give you saline sprays to keep the inner lining of your nose wet and prescribe medicine to prevent congestion and inflammation. You also will be given pain medicine, an antibiotic and an antimicrobial mouthwash to help prevent infection. Most patients have only a little discomfort after a sinus-lift procedure.

You will see the specialist after 7 to 10 days. He or she will evaluate the surgical site and remove stitches if they will not dissolve on their own. You might be asked to return a few more times to make sure the area is healing properly.

After a sinus lift, you need to wait several months for the bony material to harden and integrate with your jaw. Depending on the grafting material used, implants may be placed in four to nine months.

Some specialists have started using proteins called growth factors to help the new bone harden faster. Platelet-rich plasma, which contains the growth factors, is taken from your blood before surgery and mixed with the graft that is placed into your sinus. Human-recombinant bone morphogenetic protein is an engineered protein that is now available. It stimulates bone formation without grafting. The U.S. Food and Drug Administration has approved its use during a sinus lift procedure.

Risks

The main risk of a sinus lift is that the sinus membrane could be punctured or torn. If the membrane is torn during the procedure, the surgeon will either stitch the sinus tear or place a patch over it. If the repair is not successful, your surgeon may stop the procedure and give the hole time to heal.

Your dentist can redo the sinus lift once the membrane has healed. This usually takes a few months. A healed membrane tends to be thicker and stronger, which means a second attempt at a sinus lift is likely to be successful. However, other factors also affect success.

Infection is a risk of any surgical procedure. However, this rarely occurs after sinus lifts.

On rare occasions, the existing bone does not integrate with the bony graft material, and the grafted area does not develop a blood supply. If this happens, any implants placed in this area will fail because there is no live bone for them to attach to. If this happens, you can have the sinus lift procedure repeated.

When To Call a Professional

After a sinus lift, contact your surgeon if:

  • Any swelling or pain gets worse over time. (It should decrease after the first two days or so.)
  • The bleeding does not stop after one to two days.
  • Bleeding is bright red and continuous. (Normal bleeding after this procedure oozes slowly and is dark red with possible clots.)
  • You think the bony material may have been dislodged after sneezing or blowing your nose.
  • Pain does not decrease over time.
  • You develop a fever.
Bone Grafts

A bone graft can create a more solid base for the implant. In bone grafting, a piece of bone is removed from another part of your jaw or your body — your hip, for example — and transplanted to your jawbone. It may take several months for the transplanted bone to grow enough new bone to support a dental implant.

Bone grafting material comes from several sources. Autograft bone is material that is taken from another point in the patient's body and transplanted to the desired site. It is a good graft material since it contains the patient's own cells, and carries no risk of disease transmission.

Where can you get extra bone from?

Bone can be harvested from a number of sources but usually from behind the back teeth in the lower jaw or from the chin. Sometimes it is taken from the hip or shinbone (tibia). When you use your own bone to create new bone in another area of the mouth you will have to contend with the

discomfort created by the donor site as well as the surgical site. Many people feel this is well worth any additional discomfort as your own bone is normally considered the 'gold standard'.

Alternatives to your own bone for grafting

For those who would prefer an easier but slightly slower, solution there are other sources of bone such as bovine (derived from cow), porcine (derived from pig) or synthetic materials that have been specially prepared to make them safe for use in humans. All of these materials, including your own bone, simply provide a scaffold into which new bone will grow in order to be ready to receive dental implants a few months later.

New bone can take anything from 3 to 12 months before it is ready to receive dental implants. Do not be in a hurry to move to the next stage. If you need a large volume of bone it will take longer to mature than a small amount.

Each surgeon will have his or her preferred way of creating new bone. Many of them will also use a supplementary technique called 'guided tissue regeneration'. Using this technique, slow-moving bone cells are given time to fill a space by placing a barrier material between them and the fast moving cells of the soft tissues lining the mouth. This is a 'resorbable barrier' that will disappear naturally a few months after it has done its work.

Does bone grafting affect the length of treatment?

If you need bone grafting, it will almost invariably increase the length of time your treatment will take; however, when successfully applied it will greatly improve the outcome of the implant(s) placed. When used in the front of the mouth it can also allow for creation of much better aesthetics.

Bone grafting requires a considerably higher degree of skill from the operator and is often more complex to perform than the placement of the implant itself.

In certain situations some operators will recommend combining the implant placement with bone grafting and the placement of a barrier membrane all at the same time. This considerably reduces treatment time and can produce results that are difficult to achieve any other way. However, many surgeons will still prefer to carry out bone grafting as a distinct stage, so that the implants are only placed when the bone grafting has been successful.

Whatever method is chosen to improve the bone quantity the time, effort and expense is generally well worthwhile.

If you have lost several teeth, through accident, injury or decay, the chances are you will feel self-conscious about smiling. Dental implants offer a permanent solution to multiple missing teeth, and have several advantages over other tooth replacement products such as unsecured dentures or bridges.

A dental implant is a small titanium screw placed directly in your jaw bone, where it acts as a replacement tooth root. After a healing period the implants provide a solid base on to which crowns, bridges or dentures can be fixed.

In most cases implants can be placed here at Aura Dental under local anaesthetic. We also offer treatment under hypnosis or sedation for anxious and nervous patients. If you have two or more gaps next to each other, it is usually possible for a single implant to support more than one replacement tooth in the form of implant-secured bridges or dentures.

Unlike unsecured bridges or dentures, dental implants are osteoconductive, meaning they support bone growth. This helps to prevent the problem of bone loss that can arise when you lose your teeth, and also provides a strong anchor for your new teeth, enabling you to bite, chew and smile with confidence.

Another advantage of dental implants for multiple missing teeth is that, unlike with traditional dental bridges, no work is required on surrounding teeth, meaning that they maintain all their strength.

Replacing missing teeth is important for several reasons, not least because of the impact gaps in your mouth can have on your self-confidence. Any remaining teeth may also move into the gaps, becoming crooked and harder to clean, which could lead to further dental health problems. You may also find that your diet is restricted as your ability to bite and chew is affected, putting healthy foods such as nuts and apples off the menu.

To book an initial dental implants consultation, please contact a member of our friendly reception team today.



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