Lateral sinus lift - two stage

  • Sinus lift - two-stage
    Access to sinus cavity
  • Sinus lift - two-stage
    Filling with cerabone®
  • Sinus lift - two-stage
    Covering with collprotect® membrane
  • Sinus lift - two-stage
    After healing
  • Sinus lift - two-stage
    Implantation
Sinus lift (also termed sinus floor augmentation) is a surgical technique that aims to thicken (augment) an atrophic sinus floor. According to the lateral approach, a flap is prepared to expose the lateral aspect of the maxillary sinus. Access to the sinus cavity is gained by preparing a window, preferably with a diamond burr or piezo instrument. Subsequently, a space between the membrane and the sinus floor is created by carefully detaching the Schneiderian membrane, which is then filled with a bone graft material (e.g. xenogenic, allogenic, or synthetic). Due to its extremely slow resorption accompanied by a complete osseous integration, xenogenic material cerabone® is an excellent solution for a two-stage sinus lift procedure.

Schneiderian membrane perforation

If a small perforation (<5 mm) of the Schneiderian membrane occurs during the sinus floor elevation, a collagen membrane (e.g., Jason® membrane or collprotect® membrane) may be used to cover the perforation site. Please make sure that the patient does not sneeze for two weeks and prescribe antibiotics and swelling prophylaxis (e.g., xylometazoline). Do not continue the treatment or the sinus lift procedure in case of acute sinusitis with presence of pus.

Particle size

The use of large particles (e.g., cerabone® 1–2 mm, maxresorb® 0.8–1.5 mm) is recommended for the sinus lift technique. The increased space between the particles ensures a better vascularization and improves the regeneration of larger defects.
Two-stage sinus lift with cerabone®
Sinus lift with cerabone®

The reliability and high predictability of grafting materials for the sinus lift procedure are well documented. In addition, long-term volume stability is of much importance when the time period between the sinus lift procedure and the implantation is long. Thus, in the two-stage procedure, a healing time of 6–9 months should be anticipated before implant insertion following augmentation with cerabone® or maxresorb®. When applying an allogenic material, such as maxgraft®, it is recommended to mix it with cerabone® or maxresorb®. Applied materials should be mechanically stable during the first months to keep the Schneiderian membrane lifted until the space underneath is filled with new bone matrix. A too-fast resorption of the allogenic material could lead to a loss of volume, which may in turn affect the stability of relatively long implants.

Placement of a Jason® fleece prior to application of relatively sharp bone graft granules protects the Schneiderian membrane from damage and offers a cost-effective alternative to a barrier membrane. If a small perforation of the Schneiderian membrane is already present, a collagen membrane (e.g. collprotect®) may be used to seal the perforation.

In order to promote an undisturbed healing, it is recommended to cover the sinus window with either a Jason® fleece or a membrane (e.g. collprotect® membrane). If an additional lateral augmentation is planned, it is recommended to cover the augmentation site with a slowly resorbable membrane, which is more suitable for the reduced width of the ridge. The Jason® membrane stabilizes the augmentation site and ensures a long-term barrier function, ideal for an undisturbed osseous regeneration.

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