Open sinus lifting: operation
Surgery open sinus lifting is performed by the need to strengthen estancias jaw bone before insertion of implants in the place of removed teeth. Surgery bone grafting provides a reliable Foundation for mounting artificial constructs. Due to sufficient volume, thickness and strength of the material used, the implant is well withstand the loads generated during chewing of food.
Consider what it’s like sinus lifting or subantral augmentation. The first such operation ever conducted by American doctors in 1976 She performed in the upper jaw, in which the pneumatic bones of the maxillary sinus — the cavity is lined with mucous membrane walls. The natural thickness of the bone in this area the majority of people small.
Removal of teeth reduces the load on the gums, followed by bone atrophy and pneumatization sinus. This greatly complicates the installation of implants. The term «sinus lifting» is translated as «sinus lift». The operation involves raising its bottom wall and filling the vacant space of the bone mass. In case of insufficient thickness of the bone of the upper jaw to set the prosthesis without an osteoplasty is impossible.
Indications for subantral augmentation, methods
The sinus lift is performed on the upper jaw with insufficient bone volume in the region of the premolars. The need for the surgery arises when individual peculiarities of the structure of the gingival of the patient’s bone or atrophy after tooth extraction. The small thickness of the bone tissue does not allow to put the implant while chewing he will loose, to be screwed into the jaw end of the screw can damage the membrane of the maxillary sinus.
The indication for operation is the data of computer tomography or orthopantomography showing the precise thickness of bone tissue at the injection site of the implant. Osteoplasty is not required if the bone height is 13 mm (in exceptional cases 10 mm).
The surgery is performed under anesthesia using one of two methods:
- Open subantral augmentation. Is performed in cases where the bone height does not exceed 7-8 mm.
- Closed sinus lifting. For the procedure it is necessary that the thickness of the bone layer is reached 7-10 mm.
The open method of subantral augmentation
When the open method is provided by increasing a significant amount of fabric. After surgery a few months is given for bone reconstruction. The progress of surgery:
- the gum tissue in the right plot incised, the resulting flap is pushed aside;
- special surgical cutter drilled a hole in the bone with the lateral side;
- mucosa and periosteum is raised into the cavity of the syringe is injected osteoplastic material;
- it tamped to prevent the formation of voids, the incision is sewn up;
- when the bone material forms a single whole with the surrounding tissues, and the wound finally healed (it would take at least 20 weeks), fortified installs a dental implant.
Private method of bone augmentation
Private method less traumatic. When it is executed placing the implant and increase bone mass are held at the same time. The sequence of stages of operation:
- formed a bed for the implant;
- drilled hole in bone tissue;
- probe with a dome-shaped tip lifts up the mucosa of the maxillary sinus;
- the freed space is placed natural bone taken from the patient or synthetic bone filler in the granules;
- in the finished box usually immediately placed implant.
After the operation it is necessary to preserve an artificial tooth root from heavy loads.
Increase the intensity slowly and carefully. After some time, the transplanted material will get stronger and will provide a solid fixation of the implant.
Contraindications to the appointment of osteoplasty
Sinus lifting is not carried out when the patient has the following diseases:
- malignant neoplasms;
- dependence on psychoactive or narcotic substances;
- cardiovascular pathologies;
- the immune diseases;
- of blood clotting;
- the exacerbation of chronic diseases.
In addition to General there are specific contraindications to osteoplasty. These include acute and chronic inflammatory processes in the paranasal sinuses — sinusitis, sinusitis.
Surgery is not indicated for patients with polyps, congenital multiple partitions in the sinuses. This method of restoring the dentition do not apply to the fragility or changed the structure of the bone.
Contraindication are also anomalous location of the maxillary sinuses and the presence of previously performed surgeries on them. With care runs sinus lifting smokers, since the tobacco use in the postoperative period hard.
Preparing for surgery
The preparatory stages ensure the success of the operation and to prevent the development of complications. The sooner the patient seeks medical assistance after loss of teeth, the less you have time to change the jaw bone and the higher the efficiency correct the problem.
- A thorough examination of the nasal cavity, including radiographs, to detect chronic diseases.
- The study of the structure and height of the mandible for the selection of optimal methods of sinus lifting.
- Virtual pre-execution of operations with the use of special computer programs. This will allow the surgeon to obtain a consistent picture of the structure and arrangement of internal elements.
- Smoking patients should be time to give up tobacco for 2-3 days before surgery.
- If necessary, given oral antibiotics to prevent infection of the paranasal sinuses. Perhaps the use of steroids to eliminate inflammation, edema, accelerating tissue repair in the postoperative period.
- Before surgery it is necessary to cancel long trips and air travel. For control of the body during the rehabilitation period need regular doctor visits.
Sinus lifting is a complicated operation, in some cases accompanied by the occurrence of complications. To reduce the risk of their occurrence is possible, referring to the services of an experienced surgeon and by choosing the clinic where the work is carried out using modern equipment and quality materials. With subantral augmentation may include the following complications:
- Damage to the membrane Schneider. This may contribute to the lack of the doctor of ultrasonic knife. In violation of the integrity of the mucosa it is possible to get an infection in the sinuses with the development of sinusitis or sinusitis.
- The formation of a fistula.
- The occurrence of bleeding, edema, accumulation of fluid in the paranasal sinuses. Swelling and bruising is most pronounced in the first three days after surgery, they pass through two weeks. Reduce their helps applying ice.
- Considerable mobility of the installed implant. This phenomenon is usually associated with the loss or displacement of a certain number of introduced granular material.
- Chronic rhinitis caused by damage to the sinus.
- The retraction of the implant in a maxillary sinus for the correcting of the situation would require the repetition of the operation.
Method of open sinus lifting is more often accompanied by complications. Their reason will usually be of a medical error, the most typical of them — rupture of the mucous membrane of the sinus. To remove this piece of cloth covered with a patch or suture. The detection in the bosom of large walls to them to preserve the integrity of doing separate accesses from different sides. If the internal cavity has penetrated the infection, the need for timely treatment to prevent inflammatory processes. To reduce swelling and pain relief given oral Dexamethasone, painkillers.
What precautions are necessary during the rehabilitation period
Tissue repair in place of surgical intervention takes some time. Healing of the gums takes place in about a week. To improve the course of the rehabilitation period and to prevent the occurrence of complications will allow the following restrictions:
- when sneezing and coughing cover your mouth with a handkerchief or with the hand.
- after surgery, do not blow your nose for about 3-4 weeks to remove accumulating mucus is better to use a napkin;
- do physical activity, do not make sudden movements, limit sports and climb stairs;
- exclude visits to spas, pools, diving into water;
- at the time of discard of travel — occurs when lifting and landing the pressure changes can negatively affect the condition of the transplanted tissue and to remove the places the implant;
- do not eat hard, spicy, cold and hot food, stick to a prescribed diet, refrain from the intake of beverages by means of tubes;
- until complete recovery, refrain from Smoking and drinking alcohol;
- dress for the weather, avoid hypothermia or overheating of the body.
Recommendations for effective tissue repair
Immediately after surgery you can not eat for 2 hours. After this period you should only eat soft foods in a warm state. For chewing, use the opposite place of operative intervention side of the jaw.
At the end of the meal for 3 minutes to do the mouth trays, you can use Chlorhexidine or Miramistin. Please note — it has to be the bath and not rinsing the mouth. While maintaining pain, fever, bleeding of the wound after surgery more than 3 days you need to consult a doctor.
To brushing you can begin the day after the surgery without toothpaste and using only a soft brush. Do not use denture for 2 weeks from surgery day, then go to the clinic for the correction of its design in accordance the incident to tooth row changes.
The cost of the procedures
In determining the price operation takes into account not only its implementation, but the cost of preoperative examination, the bone material. On average when using open method you will have to pay from 35 to 60 thousand rubles. An indoor method of sinus lifting about 2 times cheaper — 15-35 thousand rubles.
Anastasia: For the operation of the long rest. Was afraid of complications, but everything went fine. The worst part is the moment of drilling the bone, then two days felt pain in this place, on his cheek there was a bruise. Took the prescribed medicines from pain, antibiotic and nose drops. After 5 days he felt much better — the bruise was almost invisible, breathe easy, heal.
Alexander: Delayed implant placement, and this had an impact on the thickness of the bone, had to use extension. During surgery pain is not felt, she appeared in a couple of hours, the temperature rose to 37 degrees. A few days had to take pills. On the fourth day the pain and swelling is gone. Happy with the result, the new tooth looks like your own and there is no inconvenience that bring dentures.