Definition and objectives

There are two techniques for sinus filling depending on the bone volume to be regenerated: sinus filling by crestal route and sinus filling by lateral route.

After a dental extraction, the sinuses may grow naturally and the volume available for the upper molars is often not enough to allow an implant to be inserted. It is therefore necessary to displace the sinus.

Bone filling is carried out before or at the same time as insertion of an implant.

Prior to surgery

Insertion of an implant is usually carried out under local anaesthetic. It is important to eat prior to surgery. Have breakfast or lunch as usual. In the case of general anaesthesia, follow the advice given by your anaesthetist. You will normally be asked to fast.

Take your usual medication unless instructed otherwise.

Take you premedication, decided on in the course of your preoperative consultation, and follow the instructions provided by your dental surgeon.

If your dental surgeon gives you medication to stop anxiety, you must not drive as the medication may cause drowsiness.

The risks of failure and complications are higher in smokers (over 10%). It is therefore advisable to stop smoking definitively before this type of treatment and to speak to your dental surgeon about this.

The operation

- First technique: sinus filling by crestal route

The operation is carried out under local anaesthesia. The sinus floor is drilled at the crest point where the implant is to be inserted. A round, metal instrument (osteotome) is used to lift the sinus floor. Filling material is inserted to push back the sinus.

The implant is inserted in the same session or 4 to 6 months after surgery.

Sinus filling by crestal route is indicated when only in cases where a small amount of bone around the implant needs to be regenerated.

- Second technique: sinus filling by lateral route

The operation is carried out under local anaesthesia. In this case, the lateral wall of the sinus is drilled. A window is demarcated and the wall is pushed into the sinus to create a space. This space is filled with a filling material which can be covered by a membrane.

The implant is inserted during the same session or 4 to 6 months after surgery.

After the operation

A number of activities must be avoided after surgery. You have just had surgery. It is important to take the follow advice:

- After the operation, be careful not to bite numb sites: cheeks, lips, tongue.

- Avoid smoking.

- Avoid extreme physical exertion.

- Do not consume hot food or drinks.

- Avoid prolonged exposure to the sun.

- For the first two nights, sleep in a semi-upright position to help overnight drainage from the operated area.

If you feel pain, take the prescribed analgesics at regular intervals.

Swelling and oedema may appear 2-3 days after surgery and can last for a week. This is a normal postoperative reaction and varies from one person to another. External application to the cheek of ice wrapped in a towel for several hours after the operation will help reduce this swelling and possibly even the pain.

Haematoma (red patches) can also occur a few days after surgery and disappears in 5 to 10 days. It will change colour during this period and take on a brown or green shade of colour.

Finally, there may be a slight discharge for a few days after surgery. In the case of real bleeding, only compression for 30 to 60 minutes, accurately timed, applied to the haemorrhaging zone will allow a blood clot to form.

If possible, do not work the day after surgery and rest at home.

Possible complications

There are basically two types of complication linked to this type of surgery:

- Perforation of the sinus membrane

During the operation, perforation of the sinus membrane may occur. If this is only slight, the dental surgeon can repair it. If is more serious, the operation is stopped and the site closed up. This failure is relative as the operation can be carried out again 3 to 4 months later.

- Infection

While there are very few cases of this (less than 5%), an infection can occur and this is why the operation is carried out with antibiotic administration. In the case of infection, the dental surgeon may re-operate to clean the surgery site. This can compromise the volume of regenerated bone and a second graft may be necessary.

Result

Sinus filling is an operation carried out by a dental surgeon with specific training. More and more surgeons are trained in this technique and this operation is becoming more common. These are reliable surgery techniques that are highly standardised and have been used for many years (the first publications date back to 1980).