Sinus Grafting by Dr Chan Joon Yee This procedure is performed for patients who do not have enough bone to place implants for their upper back teeth. This situation occurs quite frequently because there is a natural anatomic feature called the maxillary sinus which is located just above the roots of the upper back teeth (see below). When teeth are lost for a long period of time, the bone gets thinner and thinner until the bone between the roof of the mouth the sinus becomes too thin to accomodate even the shortest implants. Implants cannot be placed with their tips protruding into the space of the sinus. The solution to this problem is an additional surgical procedure called sinus grafting. Simply put, bone or bone forming material is placed into the sinus to lift or push the floor of the sinus upwards. With a thicker floor, implants can be placed into the back of the upper jaw without ending up in the sinus space. This surgery can now be safely performed together with implant placement. This procedure involves the opening of a window in the upper jaw to approach the sinus from the side. Just beneath the thin layer of bone that forms the side of the sinus cavity, is a thin "inner skin" or membrane quite similar to the membrane that lines the inner aspect of an eggshell. The surgeon will take care to break only the bone and not the membrane that lines the sinus. Sinus membrane lifted off bone to form a "pouch" With the window opened, the next step is to create a "pouch" to contain the bone. To do that, the surgeon must delicately tease the thin and fragile membrane away from the bone. With a significant part of the membrane being separated from bone, the membrane can balloon inwards or outwards depending on the pressure. The next step is to pack bone forming material into the sinus. The material will be contained by the intact sinus membrane inside the sinus. Externally, the bone forming material is kept in place when the gums are stitched together. Sufficient bone forming material is packed into the window in the jaw as shown by the diagram above. The above diagram shows what it looks like after the grafting. The orginal thin layer of bone has been thickened almost 5 times. This is an exaggeration. Most of the time, the floor of the sinus only needs to be raised by a few mm. The new bone is shown by the orange zone in the diagram above. Implants can now be placed without perforating the sinus. Live Surgery Pictures An oval-shaped window was cut out from just under the cheek bone. Care was taken to cut only the bone and not the membrane. It's like breaking an eggshell without tearing the membrane. A delicate procedure. Tht thin bone over the window was lifted off the sinus membrane. The intact sinus membrane was then gently separated from the bone on the inner aspect of the sinus. Bone graft material is packed into the sinus. The intact membrane acts as a barrier. 2 Osstem GSII implants were then placed. Sinus grafting and implant placement can be simultaneously done. Xray results of a bilateral sinus grafting with simultaneous placement of 2 implants on each side. Surgery performed by Dr Chan at our own facility at Lucky Plaza. Dr Chan performing sinus grafting with simultaneous implant placement at Day Surgery International at Paragon (now defuct). Patients who wish to be under general anaesthesia can choose to have their surgical procedures carried out over there. Back To Dental Implants Main Page

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