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Medical Forum / General / Dentistry / May 2006

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Implant / Sinus lift question

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Jim - 24 May 2006 02:42 GMT
Hi, haven't been here for awhile, thank goodness! (meaning I have not
had any dental problems)

Right now I have a couple things on the agenda and here is one. I'd
appreciate any feedback:

I am getting 5 implants very soon. Had a CT scan on my jaw using a
stent (sp?), and the CT scan came back saying I need a sinus lift in
order to do the implant on the right upper side. This would be a
2-tooth implant in the back.

The other implants I planned to get were one on the lower right, and
two on the lower left. I now have nothing to chew on, have had my teeth
this way most of my life, except that until a few months ago, I had #18
which helped a lot, but it had to get extracted, so now I am left with
little to chew on, thus the implants.

My question is: how dangerous is a "sinus lift", what is it (I'll look
on google but if anyone can explain it or point me to a good link,
easily, that would be nice), and how necessary is it that I get these
upper right implants? Basically I have lived without them for 35 years,
but I now do realize that not having certain teeth puts stress on the
other teeth and causes problems. If I get all but the upper two, I will
be able to chew on my left side, at least.

I was planning to get these upper two along with the other 3, but the
idea of a sinus lift scares me. I already have sinus problems - have
had sinusitis and allergic rhinitis all my life - and am also not sure
I can afford a sinus lift.

I will be discussing these concerns with my oral surgeon student on
Thursday but was hoping for some extra feedback and info about this,
here.

Thanks for any advice, info, questions to ask, etc...
bubbles - 24 May 2006 19:20 GMT
> Hi, haven't been here for awhile, thank goodness! (meaning I have not
> had any dental problems)
[quoted text clipped - 31 lines]
>
> Thanks for any advice, info, questions to ask, etc...
bubbles - 24 May 2006 19:20 GMT
> Hi, haven't been here for awhile, thank goodness! (meaning I have not
> had any dental problems)
[quoted text clipped - 31 lines]
>
> Thanks for any advice, info, questions to ask, etc...
bubbles - 24 May 2006 19:23 GMT
Hi Jim,

Can't tell you much about sinus lifts, but I can point you to a great
link: http://www.netdds.net/CoreContent2ID1.html.  Click on "Implant
Dentistry 2" on the top menu and then got to Bone Grafting.  A new page
will open up that discusses all dental implant related bonegrafting
procedures (some of the images are a bit gory)

Good Luck,

Fred
Alexander Vasserman DDS - 25 May 2006 07:37 GMT
1) you should make sure the surgeon knows you have a history of
sinusitis as this can be a negative factor towards implant success in
the long run. I does not mean you should not do the procedure, just be
prepared for possible (no one knows for sure) undesired outcomes of the
proposed treatment.

Sinuses are large spaces inside the bones of your face which are
responsible for equalizing atmospheric pressure around you. These
chambers are lined with a membrane. When you get a cold/flu these
chambers fill with fluid from your nose and give you that stuffy
congested feeling.
People that have allergies, sinusitis, frequent colds, deviated nasal
septom and have constricted nasal  openings have very large sinus
spaces. The reason is that over time the bone shrinks in the upper jaw
to allow more room for larger sinus space. When doing implants this
presents a problem in that implants need to be screwed into bone
through the length of the implant to prevent it from spining. The more
bone you have around the implant the better the success of
osseointergration(bone attaching to the implant and making it anchor
solid). If you do not have enough bone height for the size of the
implant than (thank goodness for modern dentistry we can place more
bone from a jar(--either your own bone, from another dead person, or
from a cow--)  there by making the sinus chamber smaller.) you need a
procedure called a sinus lift.
A sinus lift envolves lifting the membrane carefully without tearing
(it as a tear is difficult to heal and when you get a cold stuff will
be draining into your mouth or when you drink liquids will flow out of
your nose) and placing more ground up bone chips under the membrane
thus increasing the overall height of the bone so that an implant can
be placed there and everything grows together solid. There are 2 ways
of doing a sinus lift one involves a lot of tapping and is probably the
easiest to do and the other involves making a window into the chamber
without tearing the membrane gently lifting it and packing lots of
bone.
If you're young it is nice to have implants vs denture especially when
we have modern dentistry giving us the ability to do this predictably.
I've done the first type of sinus lift and I can say that patients do
not feel any pain. There is usually a little swelling 48 hours post up
but then this goes down and everything is well.
Whether you get 1st or second type of sinus lift depends on you having
enough bone for the procedure in question. For the first type of
procedure you need at least 5mm of bone height on the x-ray.
good luck
JimSocal - 25 May 2006 09:09 GMT
>1) you should make sure the surgeon knows you have a history of
>sinusitis as this can be a negative factor towards implant success in
[quoted text clipped - 39 lines]
>procedure you need at least 5mm of bone height on the x-ray.
>good luck
Thanks a lot.
I am very concerned about screwing around with my sinuses, and will be
making this very clear to the oral surgeon.

I read there is a type of implant specifically designed for people
that need sinus lifts, which , according to the article I read,

"...can be placed in as little as 5.0mm of bone. They are called
Endopore and Innova Corporation fabricates them. There surface is
composed of thousands of tiny titanium spheres. This is the same
technology used by many orthopedic surgeons for hip replacement. These
tiny spheres tremendously increase the surface area, they also allow
the bone to function under tension.

In 2.0-3.0mm of bone a properly trained skilled surgeon can create the
opening for the implant push the floor of the sinus up through this
opening, place the bone graft and then the implant. This procedure is
referred to as a sinus lift through crestal approach. It is much more
conservative than the sinus lift procedure you referred to."

Then the article goes on to say:

"Finally, a spark erosion precision partial denture is another option.
There is nothing on the roof of your mouth. It is virtually
undetectable. After you place it in your mouth a"jewelry like" clasp
is closed and it is extremely rigid."

Do you know about these alternatives?

By the way, I paid $440 for a CT scan and $over $250 for a stent to
wear during the scan, just to make sure my bones can accept the
implants. After looking at this my surgeon informed me that I would
probably need a bone graft and sinus lift on the right upper side. He
said he would be discussing this with colleagues to make sure and I
will discuss the findings with him tomorrow.

But I am leaning towards going with one of these alternatives instead
of getting a bone graft and sinus lift; it just seems to invasive.
Alexander Vasserman DDS - 26 May 2006 07:20 GMT
Thanks a lot.
I am very concerned about screwing around with my sinuses, and will be
making this very clear to the oral surgeon.

I read there is a type of implant specifically designed for people
that need sinus lifts, which , according to the article I read,

"...can be placed in as little as 5.0mm of bone. They are called
Endopore and Innova Corporation fabricates them. There surface is
composed of thousands of tiny titanium spheres. This is the same
technology used by many orthopedic surgeons for hip replacement. These
tiny spheres tremendously increase the surface area, they also allow
the bone to function under tension.

This is not a very good implant. The surface is not good it should have
the texture similar to a golf ball also you want to have a thread and a
microthread to stabilize the implant. After placing any implant there
is a risk of bone resorbtion this can be up to 3mm if you only have 5mm
of bone there will be nothing left to hold the implant. You need to
leave the technical aspects of the procedure up to the oral surgeon,
there is a lot of marketing claims out there for all sorts of implants
and gadgets and you need to go to somebody who is familiar with what
works and what the majority of the industry uses as a standard.

In 2.0-3.0mm of bone a properly trained skilled surgeon can create the
opening for the implant push the floor of the sinus up through this
opening, place the bone graft and then the implant. This procedure is
referred to as a sinus lift through crestal approach. It is much more
conservative than the sinus lift procedure you referred to."

This is the first type of sinus lift I described.  Again 3mm does not
give you much room for healing, it has nothing to do with being a
skilled surgeon. Anybody who attempts a sinus lift unless they are a
complete idiot, has accumulated the necessary skill otherwise they
would not even attempt the procedure because of risk of failure.

Then the article goes on to say:

"Finally, a spark erosion precision partial denture is another option.
There is nothing on the roof of your mouth. It is virtually
undetectable. After you place it in your mouth a"jewelry like" clasp
is closed and it is extremely rigid."

Do you know about these alternatives?

Yes. there are many types of dentures including spark erosion that when
combined with implants can leave nothing on the roof of your mouth.
Spark erosion is a more ridgit type of prosthesis which depending on
how it is designed, may be too ridgit and work against you.

By the way, I paid $440 for a CT scan

ct scans of the jaws go for $250-$500

and $over $250 for a stent to
wear during the scan, just to make sure my bones can accept the
implants.
the scanning prosthesis is used as a radiographic marker for the ct
scans.
These days the ct scans can be outputed to special treatment planning
software such at "simplant" or "noble guide" from which accurate
surgical stents are made and ate used for precise implant placement.

After looking at this my surgeon informed me that I would
probably need a bone graft and sinus lift on the right upper side. He
said he would be discussing this with colleagues to make sure and I
will discuss the findings with him tomorrow.

But I am leaning towards going with one of these alternatives instead
of getting a bone graft and sinus lift; it just seems to invasive.

If what you are picking for yourself does not sound invasive now, wait
until it fails. Assuming your surgeon and dentist agree to your
proposal. Your surgeon may also not do osteopore implants. There are
other short implant systems other than Osteopore, such as Bicon this
does not mean that it is the best option for you. You need to consider
the size of the tooth the implant will be replacing and the load it
needs to carry. If you sinus expands further naturally after implant
surgery and you have a short implant and have not added bone for
aditional barrier your implant will get loose and fail.
JimSocal - 26 May 2006 22:49 GMT
>>Thanks a lot.
>I am very concerned about screwing around with my sinuses, and will be
[quoted text clipped - 9 lines]
>tiny spheres tremendously increase the surface area, they also allow
>>the bone to function under tension.

>This is not a very good implant. The surface is not good it should have
>the texture similar to a golf ball also you want to have a thread and a
[quoted text clipped - 26 lines]
>
>>Do you know about these alternatives?

>Yes. there are many types of dentures including spark erosion that when
>combined with implants can leave nothing on the roof of your mouth.
[quoted text clipped - 10 lines]
>surgery and you have a short implant and have not added bone for
>aditional barrier your implant will get loose and fail.

Thank you so much for your answers.My student surgeon said what you
just said.

He said he will be giving me the - I'm not sure I wrote this down
right, but - a lateral, crestal approach type of sinus lift, and that
it was more conservative.

I hope I'm not his first one! I assume the prof will be there to do it
or supervise... (Am I playing with too much fire here? by letting a
student do a sinus lift?)

I was only somewhat comfortable with him doing the implant surgery -
he says he has done about 20 - but now a sinus lift? Should I run
screaming from this procedure being done by a student?

Problem is, it's either this or get it done in another country. I
cannot afford regular oral surgeon implant prices, here...

The school is charging me only $4700 for the 5 implants and sinus
lift.
Then the graduate student offic will charge me $850 each for the
crowns.
JimSocal - 26 May 2006 22:55 GMT
One more question:

My student surgeon gave me a "consultation request" to have signed by
a doctor, stating that he planned to do a sinus lift and asking if
this is okay since I have thickened membranes indicating sinusitis.

I said, "Is an allergist okay?" and he said yes but didn't seem too
sure.

Should I give this request to an allergist or to an eye ears nose and
throat doctor? Or does it matter? Which is more likely to really know
the answer, or is it just a risk no matter which way you slice it?
Alexander Vasserman DDS - 27 May 2006 05:48 GMT
He just wants to get clearance for the sinus surgery from your MD or
whom ever diagnosed the sinusiti or allergy. Whether that's an
Allergist or Otolaryngiologist or Family Physician does not really
matter. Unfortunately, unless your allergies and sinusitis are
completely cured (which I doubt even with todays medical technology)
the risk remains.
You just need to be aware that this is a factor that is not in your
favour and no one can control or promise you long term success.
It is analogous to patients who have a history of smoking/drinking
being at risk for lung cancer, etc...
You can't to anything about what was done or an existing condition, you
just need to be aware that these people may develop cancer, etc...   In
your case it is a risk that your implant may fail. It is only a  risk
this does not mean it will happen.
JimSocal - 27 May 2006 20:35 GMT
>He just wants to get clearance for the sinus surgery from your MD or
>whom ever diagnosed the sinusiti or allergy. Whether that's an
[quoted text clipped - 10 lines]
>your case it is a risk that your implant may fail. It is only a  risk
>this does not mean it will happen.
Thank you.

How much of a risk is it that the sinus lift will screw up my sinuses
worse, though? Or cause me pain in the future as a result?

I'm going to try to get the prof to do the sinus lift, or at least be
there looking over the student's shoulder when he does it. This is a
top school, so I would hope they would insure that it is done right!

I was looking up sinus lift on the net and found a few stories of
patients complaining of sinus problems and sinus pain after it; and -
to be fair - also after root canals and extractions.

I'm going to make another thread with this question, but since you are
here,

Is there anything I can do to increase my chances of healing after
surgery and integrating the implants with the bone?

Supplements? calcium? etc.?

Thank you very much for all your info. My surgery for my 5 implants
and sinus lift will be in a few weeks, so I'm trying to settle my
fears and find out what I can do to increase the success of my
implants.
Alexander Vasserman DDS - 29 May 2006 01:19 GMT
The risk is not in screwing up your sinuses, it's failure of the
implant osseointegrating or future loss due to expansion of the sinus
due to sinusitis, etc...

There is usually slight discomfort 48h post-op which deminishes there
after.
The sinus lifts I've done, the patients were very comfortable
afterwards. One patient got on a commercial plane 3 days later.

What you can do to avoid problems:
1 finish the antibiotics, it would be better to start them 1 day before
surgery.
2 avoid any sucking from straw/smoking etc...
3 make sure your sinsitis and allergies are under control before
surgery.
4 follow your surgeons directions and know what to look for if there is
a problem.

Sinus lift procedure is not brain surgery but like any other surgery
you need to allow proper healing.
JimSocal - 30 May 2006 08:09 GMT
>The risk is not in screwing up your sinuses, it's failure of the
>implant osseointegrating or future loss due to expansion of the sinus
[quoted text clipped - 16 lines]
>Sinus lift procedure is not brain surgery but like any other surgery
>you need to allow proper healing.

Thanks so much. I will heed your advice!
 
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