Sinus Augmentation
Creating Room for Upper Implants

Accurate pre-operative planning is the most important step in sinus augmentation. We take a cone-beam CT (CBCT) scan to precisely measure the residual bone height between the alveolar ridge and the sinus floor, map the sinus anatomy (including any septae, anatomical variations, or chronic sinus pathology that could complicate surgery), and plan the implant position and diameter before the surgical date. Attempting sinus augmentation based on a 2D panoramic X-ray alone significantly increases the risk of complications — CBCT is our standard of care for all sinus cases.

The surgical approach depends primarily on the amount of existing bone beneath the sinus floor. When 4-6mm or more of residual bone is available, we often use the crestal (osteotome) approach — a less invasive technique that condenses bone upward through the implant site to gently elevate the sinus floor by 1-4mm, allowing a simultaneous implant placement. When residual bone is less than 4-5mm, the lateral window approach is required — this provides full surgical access for significant bone volume augmentation. We select the approach that is most predictable for your specific anatomy.

For the lateral window approach, a small bony access window is created in the outer wall of the maxillary sinus. The Schneider membrane — the delicate mucosal lining of the sinus floor — is carefully elevated away from the bone to create a space between the membrane and the sinus floor. This elevation must be performed with extreme care: a perforation of the Schneider membrane is the most common intraoperative complication and can compromise the graft if not managed correctly. We use fine, purpose-designed instruments and proceed methodically to maintain membrane integrity throughout.

The space created by elevating the sinus membrane is carefully packed with bone graft material. We use a combination of xenograft (bovine-derived) or allograft material for volume, and may supplement with the patient's own platelet-rich fibrin (PRF) for biological growth factors that enhance healing. A resorbable collagen membrane is placed over the lateral window to contain the graft material and prevent soft tissue ingrowth. The access window is then closed with sutures. The graft material gradually integrates and remodels into the patient's own bone over the following months.

Bone graft maturation inside the sinus takes time. For lateral window sinus lifts with significant augmentation, we typically wait 6-9 months before placing the implant — allowing the graft to fully consolidate and remodel into dense, load-bearing bone. For smaller crestal lifts with simultaneous implant placement, healing follows the standard implant timeline. A post-operative CBCT at 6 months confirms the extent and density of bone formation before implant placement. Once the implant is placed in mature graft bone, long-term success rates are equivalent to implants placed in native bone.