Sinus Elevation
Sinus Elevation (also known as sinus lift or sinus augmentation) is an oral surgery procedure in which bone is added to the upper jaw, or maxilla, in the area of premolars and molars. The goal of the surgery is to graft enough bone material onto the upper jaw to support the base of a dental implant. The procedure is usually performed in the dentist’s office with local anesthesia, requiring up to six months of healing for the sinus elevation to support dental implants.
Although there are different ways to perform this procedure, our doctors use the method performed from inside the patient’s mouth, where the surgeon makes an incision into the gum, or gingiva. 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, 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 from a tissue bank or taken from the patient. Synthetic materials may also be used.
Extractions
Extractions are performed for a wide variety of reasons, including tooth decay that has destroyed enough tooth structure to render the tooth non-restorable. Extractions of impacted or problematic wisdom teeth are routinely performed, as are extractions of some permanent teeth to make space for orthodontic treatment.
Extractions are often categorized as "simple" or "surgical".
Simple extractions are performed on teeth that are visible in the mouth, usually under local anaesthetic, and require only the use of instruments to elevate and/or grasp the visible portion of the tooth. Typically the tooth is lifted using an elevator, and using dental forceps, rocked back and forth until the Periodontal ligament has been sufficiently broken and the supporting alveolar bone has been adequately widened to make the tooth loose enough to remove. Typically, when teeth are removed with forceps, slow, steady pressure is applied with controlled force.
Surgical extractions involve the removal of teeth that cannot be easily accessed, either because they have broken under the gum line or because they have not erupted fully. Surgical extractions almost always require an incision. In a surgical extraction the doctor may elevate the soft tissues covering the tooth and bone and may also remove some of the overlying and/or surrounding jawbone tissue with a drill or osteotome. Frequently, the tooth may be split into multiple pieces to facilitate its removal. Surgical extractions are usually performed under a general anaesthetic.
Following extraction of a tooth, a blood clot forms in the socket, usually within an hour. Bleeding is common in this first hour, but its likelihood decreases quickly as time passes, and is unusual after 24 hours. The raw open wound overlying the dental socket takes about 1 week to heal. Thereafter, the socket will gradually fill in with soft gum tissue over a period of about one to two months.
Bone Grafting
Sometimes when you get dental implants part of the procedure will include a bone graft. Because the dental implants are inserted into the jaw, the dentist must have an adequate structure of existing bone to place the implant. In some people, the bone is simply too narrow and/or shallow to provide a stable foundation for implants. Also, in some cases the original bone might have been suitable for an implant but disease or decay, probably starting with infection from the teeth that were lost or removed, has weakened the bone so that it is unable to support an implant.
Please don’t worry because problems or insufficiencies in the underlying bone structure do not automatically eliminate you as a candidate for dental implants. With modern bone grafting techniques, you can still benefit from the superior qualities of dental implants over dentures or removable bridges.
Membrane Placement
A membrane is used to cover the opening in the bone where the implant will be placed, to keep soft tissue from growing into the site.
Your Options
A bone graft is a way of building up your existing bone so that it can provide a suitable base for implants. The bone in your jaw can be stimulated to grow either through natural or synthetic means. Your dentist will be able to help you determine the best method of bone grafting for your specific case. Some alternatives might be one or a combination of the following:
- Collecting bone from your own mouth as the implant site is prepared, and reusing that bone for grafting purposes. This is the simplest method of bone grafting and can be done from the dental chair.
- Synthetic materials are sometimes used to simulate bone growth or your own blood factors can be used to help promote growth or accelerate the process.
The synthetic material we typically use is called Emdogain™. The development of Straumann® Emdogain™ is based on a breakthrough in the knowledge of the basic biology of tooth development, enamel matrix proteins, a complex of native proteins that play a key role in the development of tooth-supporting tissues.
Comprised of various proteins, which self-assemble to create this matrix, Straumann&ref; Emdogain™ mediates the formation of cementum on the root of the developing tooth, providing a foundation for all necessary tissues associated with a true functional attachment.
Effects at the Cellular Level
By mimicking the biological processes of natural tooth development, Straumann® Emdogain™ forms an insoluble three dimensional extra-cellular matrix. This matrix remains on the root surface for 2-4 weeks and allows for the selective colonization, proliferation and differentiation of cells.
In cases where the top jaw above the back teeth has insufficient bone for holding implants, the sinuses are lifted and bone is inserted into the sinus chambers to grow enough structure to secure dental implants.
The goal in each of these cases is to help the patient grow new and healthy bone tissue that will support the dental implant procedure.
Timetable
In general, you can expect dental implants to take six months to complete. If you are one of those patients who need a bone graft for a successful implant to take place, you are obviously adding another step to the process. The time this will extend your overall treatment will vary depending on the method used, the extent of the bone grafting needed, and the overall state of your oral health and health in general.
What you need to remember is that time invested now in a quality and generally permanent replacement method for missing teeth, is likely time you will not have to spend later having dentures refit and adjusted or replacing bridges which only have a life expectancy of 7-10 years on average.
As well, by building and repairing bone for the replacement of missing teeth, you are likely creating a better environment for any remaining teeth to thrive in. Replacing bottom teeth through bone grafts and dental implants, for instance, may save the top aligning teeth and give you many more years of using them pain free.
Block Grafting
If teeth have been missing for a long period of time the bone will shrink and often times you are left with a knife edge ridge which is not wide enough to place implants. When this occurs we need to re-grow the width of the bone. If the amount of bone loss is very large or very extensive, simple ridge augmentation may not be enough. In this instance the doctor may recommend block grafting.
A block graft is simply a single large block of bone which is screwed to the ridge and allowed to integrate as all bone grafts do. The block needs to heal for 5-8 months prior to implant placement.
Large blocks of bone can be obtained from donor banks. Like all processed bone it is 100% safe and has a well proven record of integration. But the biggest advantage of this type of block graft is that there is no donor site! This saves the patient significant post-operative pain and swelling as well as giving a predictable block of bone every time. Most patients find any additional costs are well worth it in terms of accelerated post-operative healing.