Let’s look at a real case. It highlights the importance of getting every step right with dental implants that need sinus lifts.
This patient came in missing several teeth on the upper left and one tooth on the upper right. ( note: dental x-rays read in reverse-right is left, left is right.) On the upper left, there was barely 3 mm of bone left. That’s nowhere near enough for an implant. When this happens, we need to rebuild the area…and that’s where a sinus lift bone graft comes in.
What’s a Sinus Lift Bone Graft?
A large sinus lift is done through a lateral window. In this procedure, I carefully open a window in the side of the upper jaw. I gently lift the sinus membrane and add bone graft material.
The goal: create enough vertical bone so implants can be placed securely. This is a routine procedure in my office, especially for patients who have been missing teeth for a while and have lost bone as a result.
The bone graft material I use is an allograft-donor bone from a human tissue bank most of the time. To improve healing and bone growth, I mix this with L-PRF (Leukocyte-Platelet Rich Fibrin) and PRP (Platelet-Rich Plasma). Both are made from your own blood and are loaded with growth factors that help the graft turn into real, healthy bone.
Why the Waiting Matters
After the sinus lift and graft, we wait. In this case, about four months. This gives the graft time to become strong, living bone. Rushing this step is a recipe for problems later.
Once everything looked solid, I placed four titanium implants at the same time. While the patient was under IV sedation, I also removed the lower left wisdom tooth. This wasn’t just a “while we’re here” move. The wisdom tooth was the first to touch when the patient bit down. It threw off the entire bite.
The Restoration: Where Longevity Is Built
A lot of people focus on the implants themselves, but the real magic is in the details of the final restoration. The custom abutments (the connector pieces) are made from titanium, just like the implants. The crowns are zirconia-strong, natural-looking, and custom-shaped to fit the patient’s gum and bone perfectly.
This isn’t just about looks; a well-designed restoration protects the bone and gums, and helps ensure the implants last.
I see far too many cases where bulky, poorly designed crowns cause gum problems and bone loss down the line…very sad.
Final Thoughts About Sinus Lifts for Implants
Dental implants aren’t “permanent” in the sense that you can forget about them forever. They’re a long-term solution. However, this is true only if every step is done right the first time. This includes everything from bone grafting to the final crown.
If you have questions about sinus lifts, bone grafting, or dental implants in general, I’m here to help.
Hi there,
6 weeks ago today I had upper teeth extracted. Years of a chronic sinus infection weakened my teeth. Factor in oi and osteoporosis i need to reduce mouth problems or risk necrosis from my bone treatments.
The surgeon perforated my sinus cavity as well as a cyst. We were aware of the cyst via ent. Dr. didn’t see a risk of perforation. I get a medical nose job next month. The infection is blocked and the damage to bone and cartilage is moderate.
The extractions were with bone grafts in 4, 8, 9, 13. It ended up being 12 after the perforation.
Not confident the grafts will take due to the infection. I was on antibiotics a few days before the extractions. ENT put me on antibiotics too. I am allergic to penicillin.
IDK what the end result will be. I am healing fine but am noticing a widening of my gums. It feels like swollen gums, in size. But they aren’t swollen. I had swollen gums for 4 years due to the sinus issues. During allergy season the mouth pain is intense somedays. I am allergic to everything they tested me for environmental.
IDK the name of the materials used for the grafts. It was sand sized granules, though.
I finished a round of antibiotics a week ago. They don’t do much but when I start running a temp over 101 I get antibiotics that do knock the infection back a little. Anyway, I take antibiotics 4 to 6 times a year, for sinus infections.
I hope the nose job works well.
I am worried about the widening gums and hope the graft didn’t fail and this is proof. I get a CT in Dec to see.
There is a nodule on my gum next to 9. It’s driving me crazy. No discomfort but my tongue will not leave it alone. It feels huge but likely isn’t as it doesn’t dominate. It’s more like that spot is widening but cone shaped. It’s near the socket but on the front edge of the gum line and socket.
Just wondering if this is something to worry about. My Dr. Is out of town this week. The office is closed, I left a message. It’s a private practice. I am sure someone would have called me if they thought it was something real bad.
However, it is worrying me as I stress over everything going on and want the grafts to be fine so I don’t go through this again.
Should I be worried? Is this a common issue with grafts?
Thank you for your time and consideration,
Darl’s.
Hi Darlie,
It is a bit hard to follow your situation. Extraction with simultaneous bone grafting is a very normal procedure. Delayed healing after bone grafting is not normal. This could be due to any number of factors from technique, materials, immune system/healing deficiencies/type of temporaries that you are wearing over the top… Wearing a denture is the worst.
It is hard to understand what you mean by widening gums.
How is it all going now? Is it improving?
Hello Dr.Amin, I recently had the all on 4 procedure done about 3.5 months , 4 upper and 6 on my lower. Since then 1 implant on the lower has failed which had to be removed and that area bone grafted and my prosthetic was cut to that point. I just recently broke my upper prosthetic right in the middle and its hanging on because the corner implant. There is a big gap from the middle to that corner implant. I believe its a acyrlic material they called it healing teeth. Is it possible to fix the broken bridge the same day or will I have to go without teeth until they are able to fix it? Im afraid of making an appointment because I may not be able to get it fixed same day. Appreciate your help!
It all depends on the office and their abilities. You probably have printed temps or a converted denture. These break all the time compared to milled temps.
Hello Dr. Amin, I went to the consultation and he recommended doing a lateral window sinus lift and implant placement as a single procedure. Does this sound like a good plan? It seems that they are usually done separately, from what I have read on your blog. Many thanks again!
It can most definitely did not be done this way. But keep in mind this is for a provider that has a lot of experience in the sinus lift procedure. It is technically more difficult to do together so if you wanted to take the safest road you can just break up the procedure. Doing an internal sinus lift at the same time is very normal but the lateral window at the same time of implant placement requires a higher skill set.
Hello, I recently had my permanent All-on-4 implant placed for my entire bottom jaw about two months ago. However, since then, I’ve noticed a significant gap between my gum line and the implant. The gap is so large that I can easily fit a straw through it.
I paid $41,000 out of pocket in cash for this procedure, and I feel like this is a poor job either on my dentist’s side or the lab’s. The dentist mentioned that this was done by a new, local lab, which adds to my concerns.
When my temporary implant was first placed, I noticed by that evening that one of the temporary teeth was missing. When I went back to the dentist, I was told it must have fallen off and that I likely swallowed it. The dentist then sculpted and created a “temporary tooth” out of acrylic while I was in the chair and glued it into the temporary implant. Is this normal as well?
When I went back two days ago to have the permanent implant tightened, the dentist did a scan and said it wasn’t due to gum recession. He mentioned he couldn’t screw it down (though he didn’t even try) and suggested I return today to have the implant removed, put my temporary one back in, and send the permanent one to the lab. The plan is for the lab to “add more pink” to the bottom to cover the exposed metal.
Is this a common issue? I feel like corners are being cut, especially since the dentist mentioned that either the lab or he might have made incorrect measurements. Shouldn’t a completely new implant be made in this case? I’m nervous about going back today because I feel like I’m being given the runaround with reassurances that this is “normal” and that “everyone’s metal shows.”
I’ve also developed a lisp, which I never had before. My temporary implant fit snugly against my gums, and I never experienced gaps, discomfort, or issues like this. Now, my jaw is starting to protrude, and by the end of the day, it becomes so sore and painful that I have to lie down. Additionally, the exposed metal is causing severe irritation in my mouth, leading to sores, indentations, swelling, and even a line where the implant is rubbing against my skin, cutting into it.
I’m feeling really concerned and unsure about how to proceed. Any advice or insight would be greatly appreciated.
I am sorry to hear about your troubles. Having a tiny gap underneath a lower bridge is not a bad thing. Sometimes I purposely designed them for people that cannot maintain hygiene or do not have very good dexterity where a purposeful Is designed only on the lower.
If metal is exposed it is likely just the multiunit abutment and not the implant itself. If it is the implant itself then there are bigger problems.
Breakage in my practice is not something normal. The healing teeth prototype that I provide are very strong made of PMMA. Adding more pink is okay as long as the bottom side is shaped to be flat or convex and super easy to clean. As long as there is not a flange to catch food this would be the preferred way. Of course without seeing you it impossible for me to tell all of this. I do know that certain practices or clinics do things in a very quick and hasty fashion and then there are practices that strive for the highest quality possible. At $41,000 for just your lower jaw that would be a very high and practice and hopefully is delivering something very nice. The lisp may be coming from some dental work you had done on the upper jaw?
Thank you for all of the great information. I had a failed RCT & apio on tooth #14. I was losing my best friend to breast cancer last summer, wasn’t thinking clearly, and had the tooth extracted without any prep or plan or implant. It’s been a!most a year, and I have scheduled a consultation with an oral surgeon. It was mentioned by Endo hat sinus lift would be probably be necessary. I am now kicking myself for not planning this more carefully & afraid there will be more complications on getting the implant completed. Plus, the extraction was pretty traumatic & I am afraid of the pain & possibility of failure in this area. Is tooth #14 a difficult tooth for this procedure to be effective? 57 yr female. Thanks and God bless you Dr
I am sorry to hear about your friend. I wrote an entire article dedicated to breast cancer.
As for your tooth #14 a sinus lift is often needed. It is pretty easy to do. Be sure to see somebody that has a lot of experience in this procedure as there are numerous ways to do it. Yes this area can be a bit traumatic so I would suggest that you are sedated for the procedure using IV moderate sedation. It is super common tooth that I do every single day!