Toothless areas’ bone loss as a result of tooth extraction in the rear region of Maxilla, the sinus membrane around the nose advances towards the jawbone is located and thins the bone over time due to the effect of gravity. There is a need of quality, strength and volume of bone in order to place the implant to this area. There must be an adequate height and wideness of bone in the area where the implant is aimed to be placed. At this point, increasing the volume, strength and quality of bone is necessary for the long-term success of the implant.
After the tooth extraction operation, sinus membrane comes down. At the same time bone thinning upwards begins due to tooth extraction. Consequently, there is a vertical bone loss in the toothless area. In case the period without tooth loss a long while, bone loss also increases and there may be no bone left to place the implant. Hence, maxillofacial surgeon must perform a detailed bone analysis.
There are 2 types of operations to strengthen the weak bone on Maxilla’s toothless rear region where implant placement will be done.
During the closed sinus operations
During the closed sinus operations, the implant anchor is opened with special tools designed for this procedure and the bone tissue located in sinus basis is elevated to the sinus cavity. Artificial bone material is filled into the area opened from this move, then the implant is anchored and operation is concluded. Recovery period is similar with regular implant procedures. Closed sinus procedure is usually preferred in cases where bone thinning is minimal and there is less need for artificial bone filling material.
During the open sinus operation
During the open sinus operation, a window is opened to the side of the sinus wall and the procedure is based on filling the sinus cavity with artificial bone filling material from the side. This process takes about 10 minutes. After injecting the bone powder filling, it is covered with a resorbable protective membrane and covered with gum tissue. The wait period following sinus operations is generally between 4-6 months, this is how long it takes for the injected artificial bone material to fuse into natural bone tissue. The resulting bone structure would be able to support an implant. Implant and crown is installed afterwards.
Open sinus operations are usually performed in cases where bone thinning is excessive and there is a bigger need to transplant bone tissue.
Is sinus operation harmful?
Oral & Maxillofacial Surgeon have received speciality training regarding sinus operations. The success rate is quite high as long as the operation is performed in sterile operation conditions, with proper methods and quality materials and is a beneficial operation. It is also necessary to ensure the strength of the bone tissue that the implants will be anchored to.
How is the post-operation recovery?
In order to prevent bleedings, during the first 24h period following the operation the patient must refrain from spitting, must not consume drink or food that is too hot or too cold, and finally must not take hot showers. In case of swelling around the operated area, cold/ ice compress can be applied to prevent swelling.
Oral hygiene is crucial in post-surgery to prevent infections. Prescribed drugs must be taken as written and doctor’s recommendations must be closely followed. The schedule of drugs taken or the brand names of drugs must not be changed without the doctor’s knowledge, any prescribed drugs must be taken exactly as the doctor recommends. It is not recommended to smoke post-operation.
It is not advised to open the mouth too wide or to stretch the lips and cheeks to try and see the surgery area, as this may cause the stitches to come off. Blowing the nose with pressure may also cause the stitches to come off. Care must be taken not to sneeze while the mouth is open.
When are the implants placed after the operation?
Depending on the bone height of the patient, the sinus operation can be an open or a closed one. The implant can be placed together with the sinus operation, the total process of sinus operation surgery, implant anchoring and mounting of the veneer crown can take between 3 weeks to 10 months. If the bone tissue is extremely thin, the implant operation can wait for 4-6 months for the formation of sufficiently strong bone tissue.
What complications can arise during the operation?
Every surgical operation carries with it some risk of complications. During a sinus operation, complications such as breaching of the sinus basin, infection, increase in bone thinning, nose bleeding, sharp pain in neighboring teeth, arterial bleeding inside the sinus and sinus infection discharge to the mouth may occur. The most frequent problem encountered during sinus operations is the breaching of sinus membrane.
Sinus membrane, even if breached during operation may require immediate attention and may need to be repaired. Sinus membrane may tear if the membrane tissue is too thin. If these tears and breaches are small enough, they can be left to heal for themselves under the doctor’s monitoring before continuing with the operation. If these tears are large, the operation may need to be postponed, or if there is increased risk of infection, the membrane is repaired with special tools to control the risk of infection.