Sinus augmentation is an oral surgery procedure in which bone is added to the upper jaw, or maxilla

Maxilla

The maxilla is a fusion of two bones along the palatal fissure that form the upper jaw. This is similar to the mandible , which is also a fusion of two halves at the mental symphysis. Sometimes The maxilla (plural: maxillae) is a fusion of two bones along the palatal fissure that form the upper...

, in the area of premolar

Premolar

The premolar teeth or bicuspids are transitional teeth located between the canine and molar teeth. In humans, there are two premolars per quadrant, making eight premolars total in the mouth. They have at least two cusps. Premolars can be considered as a 'transitional tooth' during chewing, or...

 and molar

Molar (tooth)

Molars are the rearmost and most complicated kind of tooth in most mammals. In many mammals they grind food; hence the Latin name mola, "millstone"....

 teeth. The goal of the surgery is to graft enough bone material onto the upper jaw to support the base of a dental implant

Dental implant

A dental implant is a "root" device, usually made of titanium, used in dentistry to support restorations that resemble a tooth or group of teeth to replace missing teeth....

. The procedure is usually performed in the dentist’s office with local anesthesia

Anesthesia

Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...

, requiring up to six months of healing for the sinus augmentation to support dental implants. However, many surgeons perform both the augmentation and dental implant simultaneously, to avoid the necessity of two surgeries.

Training

Sinus augmentation is considered “technique sensitive,” and should be performed only by a highly trained oral surgeon, maxillofacial surgeon, or periodontist.

Surgical Planning

Prior to undergoing sinus augmentation, diagnostics are run to determine the health of the patient’s sinuses. Panoramic X-rays are taken to map out the patients upper jaw and sinuses. In special instances, a computed tomography or CT scan is taken to measure the sinus’s height and width, and to rule out any sinus disease or pathology

Pathology

Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....

.

Basic Procedure

There are multiple ways to perform sinus augmentation. The procedure is performed from inside the patient’s mouth where the surgeon makes an incision into the gum, or gingiva

Gingiva

The gingiva , or gums, consists of the mucosal tissue that lies over the mandible and maxilla inside the mouth.-General description:...

. Once the incision is made, the surgeon then pulls back the gum tissue, exposing the lateral boney wall of the sinus. The surgeon then cuts a "window" to the sinus

Sinus (anatomy)

Sinus is Latin for "bay", "pocket", "curve", or "bosom". In anatomy, the term is used in various contexts.A sinus is a sack or cavity in any organ or tissue, or an abnormal cavity or passage caused by the destruction of tissue...

, which is covered by a thin membrane. The membrane is carefully lifted away, and bone graft material is placed into the newly created space. The bone material can be allogenic (from a tissue bank) or autogenous (taken from the patient). Synthetic materials may also be used.

As an alternative, sinus augmentation can be performed by a less invasive osteotome technique, in which the sinus membranes are lifted by gentle tapping of the sinus floor with the use of osteotome

Osteotome

An osteotome is an instrument used for cutting or preparing bone.The instrument was invented by Bernhard Heine, a German physician in Würzburg, in 1830. Heine's invention was used as a bone saw, especially for opening the skull. It was a kind of chain saw moved by turning a winder.Today osteotomes...

s. The amount of augmentation achieved with the osteotome technique is usually less than what can be achieved with the lateral window.
The goal of this procedure is to stimulate bone growth and form a thicker sinus floor, in order to support dental implants.

Healing Time

It takes about three to six months for the sinus augmentation bone to become part of the patient's natural sinus floor bone.

Risks

A major risk of a sinus augmentation is that the sinus membrane could be pierced or ripped. Remedies, should this occur, include stitching the tear or placing a patch over it; in some cases, the surgery is stopped altogether and the tear is given time to heal, usually three to six months. Oftentimes, the sinus membrane grows back thicker and stronger, making success more likely on the second operation.

Besides tearing of the sinus membrane, there are other risks involved in sinus augmentation surgery. These risks include:

• Infection
• Inflammation
• Pain
• Itching
• Allergic reaction
• Tissue or nerve damage
• Scar formation
• Hematoma
  Hematoma
  A hematoma, or haematoma, is a localized collection of blood outside the blood vessels, usually in liquid form within the tissue. This distinguishes it from an ecchymosis, which is the spread of blood under the skin in a thin layer, commonly called a bruise...
  
  

Patients

Patients who have the following may be good candidates for sinus augmentation.

• Lost more than one tooth in the posterior maxilla.
• Lost a significant amount of bone in the posterior maxilla.
• Missing teeth due to genetics or birth defect.
• Minus most of the maxillary
  Maxilla
  The maxilla is a fusion of two bones along the palatal fissure that form the upper jaw. This is similar to the mandible , which is also a fusion of two halves at the mental symphysis. Sometimes The maxilla (plural: maxillae) is a fusion of two bones along the palatal fissure that form the upper...
  
  teeth and need a strong sinus floor for multiple implants.

Sources

• Boyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg 1980;38:613-616

• Tatum H Jr. Maxillary and sinus implant reconstructions. Dent Clin North Am 1986;30:207-229.

• Lazzara RJ. The sinus elevation procedure in endosseous implant therapy. Curr Opin Periodontol 1996; 3:178-183.

• Summers RB. A new concept in maxillary implant surgery: The osteotome technique. Compendium 1994;15:152, 154-156, 158 passim; quiz 162.

• Summers RB. The osteotome technique: Part 3 – Less invasive methods of elevating the sinus floor. Compendium 1994;15:698, 700, 702-694 passim; quiz 710.

• Zitzmann NU, Scharer P. Sinus elevation procedures in the resorbed posterior maxilla. Comparison of the crestal and lateral approaches. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:8-17.

• Rosen PS, Summers R, Mellado JR, et al. The bone added osteotome sinus floor elevation technique: Multicenter retrospective report of consecutively treated patients. Int J Oral Maxillofac Implants 1999;14:853-858.