Direct Sinus Lift
The direct sinus lift or the lateral window sinus elevation is a widely used technique when resorption of the alveolar bone which leads to insufficient bone height (No bone to place implant). In such a case dental implants cannot be placed and it goes into the sinus if placed due to insufficient bone. So, a lateral wall sinus elevation seems inevitable.
Direct Sinus Lift X-Ray (Before-After)
Before-Direct sinus lift on left side copy
Direct sinus lift on right side copy- After
Benefits of LWT
- Straight forward technique to get correct amount of bone for dental implant
- Direct visualization of sinus and implant placement and adding the bone are under direct vision
- Highly predictable technique
- Successful regeneration of bone can be expected for placement of the implant
- Implant can be placed simultaneously with the elevation or can also be placed after a healing period (depends on case)
- Immediate placement condenses healing times and eliminates the need for an additional surgical procedure
- The Caldwell-Luc procedure is the lateral window sinus augmentation.
- The access to the sinus cavity is obtained through a bony window created in the lateral maxillary wall after which the Schneiderian membrane is elevated.
- A combination of autogenous bone and the allograft is used for bone grafting. The bone graft and the bony window are divided by an absorbable collagen membrane placed in between them.
- The technique allows direct visualization of the bone and accurate placement and positioning of the implant.
- Any tear in the membrane can be treated easily with collagen membrane.
Antral Balloon Sinus lift Procedure
- Sinus membrane is elevated by using a rubber balloon (antral balloon) instead of manual tools
- This technique has less chances of membrane perforation
(Can refer to Dr. Sudhakara Reddys international article: Antral Balloon Sinus Elevation and Grafting Prior to Dental Implant Placement: Review of 34 Cases. The International Journal of Oral & Maxillofacial Implants 2014;29:414418)
Dr. Sudhakar Reddy, a Maxillofacial surgeon by specialization has vast experience with such a surgical procedures and can make this surgeries very simple. Direct sinus lift procedure will b of maximum 30 minutes to 45 minutes time under local anesthesia. No additional post surgical major instructions.
- Allergic rhinitis
- Extensive use of nasal steroids
- Chronic nasal obstruction
- Chronic hyposmia
- Dental CT scans(CBCT) are performed to determine the anatomy of the sinus along with the pathology.
- Preoperative dosages of systemic antibiotics such as amoxicillin or clindamycin
- A chlorhexidine 0.12 percent rinse is done
- A maxillary vestibular infiltration and Posterior superior alveolar nerve block anaesthesia is administered
- Vertical incisions are performed at least 5 mm away from the osteotomy already planned
- Conventional rotary instruments are used for irrigation and cooling at 800 to 2000rpm
- Light pressure with copious cooling irrigation ensures bone thinning
- Lateral technique is approached through the trap door or access hole
- The opened window is large enough to allow instrumentation access
- Curettes aid the elevation of the sinus membrane from the sinus floor towards the posterior wall, the superior wall and lastly the anterior wall
- The space is then grafted with materials
- Collagen membrane is used to cover the window
- The mucoperiosteal flap is repositioned and sutured
Authored By DR. SUDHAKARA REDDY - Implantologist, Bangalore