Dizzy/Vertigo After Sinus Lift Bone Graft for Dental Implant

Dizzy_Vertigo After Sinus Lift Bone Graft for Dental Implant

baby tooth for implant (1)Dizziness is a rare complication that can occur in patients that have an internal sinus lift for dental implants in the upper jaw.

This is called vertigo. More accurately it is called benign paroxysmal positional vertigo – BPPV.

In my private practice over the last 14 years I have had extremely few patients that have developed this short-term, reversible vertigo that makes you feel dizzy and at times nauseated. It is much more common in the elderly patient.

Refer to these links to learn more about internal sinus lifting and the basics of sinus bone grafting

If you don’t have 10 mm of bone in the upper jaw, the sinus has likely expanded and baby tooth for implant (2)you will need some type of sinus lift. This will give you an adequate amount of bone height to replace your upper molar teeth.

The procedure is done by using an osteotome instrument and percussion taps from a surgical mallet. This lifts the bone and creates a tent over the top of the implant. Bone is added through the implant hole. The slight tapping of the surgical baby tooth for implant (3)mallet while you are laying down in a possibly hyperextended neck position can temporarily throw off balance in part of your ears. Inside your ears there are inorganic particles similar to crystals called otoliths. Your otoliths can be displaced in the fluid of the semicircular canals of your ears. Since our ears are responsible for balance, the temporary displacement of the otoliths can give you this temporary feeling of vertigo.

otoliths

If you have had a problem with dizziness or vertigo in the past make sure to tell this to your dental implant specialist before having this procedure done.

The diagnosis of this type of vertigo is established by inducing a rapid change from being seated to the left or right head hanging position. If you really have it, your eyes will become a little shaky; that is called nystagmus.  If you don’t get this shaking of the eyes, then you really don’t have vertigo.

Fortunately very few patients develop this and it is a self-limiting disorder. It generally goes away on its own within a month and in fact it usually goes away within 10-14 days. The Epley maneuver is used to treat patients that have vertigo that does not go away.

I like to do what is most likely to prevent this from happening. I am very cognizant of head position during this tapping of the surgical mallet. I believe it is key to be moderately sedated using IV sedation so that you are comfortable throughout the procedure. The benzodiazepine medication that I administer in the IV is often used to treat vertigo. So it is possible that having IV sedation may greatly decrease the chance of developing dizziness after maxillary sinus lifting for implants.

If your body is not stressed and your neck is in a good position, excellent dental surgery techniques will usually limit the force placed on the mallet. This should, in turn, decrease your unlikely chance of dizziness/vertigo after having an internal sinus lift.

Please share your comments and questions below!

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry

Burbank, California


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25 thoughts on “Dizzy/Vertigo After Sinus Lift Bone Graft for Dental Implant

  1. Jere Laukkanen

    Do you believe it is possible to get a neck injury from sinus lift operation, where too much force is placed on the mallet? We have a client who had this operation, her bone was so hard that the obviously too much force was placed on the mallet. She felt her whole body move during the malleting. This operation was performed 2010 and she never recovered like in the cases of BPPV. She had all the BPPV treatments. She has a serius neck trauma visible in the MRI scans. She has had no other traumas. She has been permanently disabled ever since the operation. Before the operation she was totally healthy and the symptoms started during the operation where she almost become unconscious during the malleting.

    We would gladly pay for your consultation.

    Best regards
    Jere Laukkanen
    Office manager
    Law Office Vesa Laukkanen
    Finland

    Reply
    1. RamseyAminDDS Post author

      It sounds crazy that anyone would use that type of force on a human skull. I don’t think this is possible

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  2. Marc

    I am getting a sinus lift (and implant) next week at 2.7.

    Your article scared me a little now. I had a vestibular neuritis a few years ago and it was horrible. Now I am afraid the upcoming sinus lift will cause the particles in my ear to be out of balance again. I read in the published medline article (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872812/), that the surgeon should apply malleting gently to avoid this complication. Is that even possible? To lift the sinus a certain degree of heavy malleting is necessary, isn’t it. That would mean the advice of gentle malleting is kind of useless? Is there anything that could be done during the surgery to minimize the risk? Maybe changing the head/body position a little while malleting is done to ‘reduce’ the hyperextended neck?

    Any help is appreciated.

    Thanks,

    Marc (from Germany)

    Reply
    1. RamseyAminDDS Post author

      This does not happen often but of course it can. Skill and experience are #1 indicating to prevent this occurrence. The technique can also be done through a lateral window approach rather than an internal lifting. The internal lifting often requires some type of mallet. The balloon techniques do not work. The lateral window technique requires no mallet whatsoever.

      I would highly advise that you have IV sedation for this procedure and have intravenous steroids such as dexamethasone.

      Reply
  3. TEHMUL B. KHAMBATTA

    After sinus lift and bone graft or vice versa over six monts back , i having suffering from heavy head, constantly leaky nose and burning discharge trickling from the back of my throat.
    After my experience i would never recommend sinus lift and bone graft to anyone at my age of 70, considering the discomfort i am going through.
    A denture would be a far better, less expensive, cleaner alternative.

    Reply
    1. RamseyAminDDS Post author

      Hi Tehmul,

      What you are experiencing may not be related to your sinus graft. In 17 years of personally doing this procedure I have never seen this before. Was this performed in the United States?

      How he had a postoperative cone beam 3-D scan taken? Is the sinus drainage hole open as it naturally is? Have you visited an ear nose and throat doctor? Was your dentist new at this or very experienced? I have done this on 90-year-old patients without any trouble. Age is not a factor.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  4. Heidi miller

    2 weeks ago I had what I believe is my 3 molar extracted, a sinus lift and a bone graft. They did this because since I was in 5th grade I have not been able to bite on the right side of my mouth. My jaw never grew down, so it has been unlevel. My oral surgeon was going to do a segmented osteotomy, but after some different consultations, the Drs came to the conclusion that the reason my jaw didn’t grow down is because my third molar is ancolosed (or fused to the bone) in my sinus. So when they removed the tooth, there was a hole. They filled it with particulates bone graft and put a membrane on it, but the membrane was exposed because my gums couldn’t be stocked over it. 3 days ago, I began to have air come through the area. I figured out that there is now a hole where the bone graft is supposed to be. My oral surgeon said that my bone should grow in a fill the hole. It’s just really annoying having a hole connected to my sinus. There is not a lot of pain, but I just want to know that it’s actually going to fill in. Any advice?

    Reply
    1. Ramsey Amin DDS

      Hi Heidi,

      It sounds like you have a unique situation with an ankylosed third molar. More than likely when the tooth was removed it created a perforation between your mouth in your sinus. We called us an oral antral perforation. I’m sure your dentist was very skilled at the removal and oftentimes this cannot be avoided. I hope you are not a smoker or a diabetic as this would slow down the potential spontaneous healing of this hole. If it does not close on its own it may require a second surgical procedure to cover over the hole.

      Be sure not to sneeze with an closed mouth for at least 14 days, do not blow your nose hard and do not submerge your head underwater such as in a pool. Do not do any sinus lavages such as a Nettie Pot. See your dentist and consider having a 3-D CBCT to monitor healing. When this is all said and done, you can then have the dental implant to replace your tooth #3 which we called the upper first molar. You may require an internal sinus lift if the bone is still decent.

      These link should help you:
      Upper Molar/Internal Sinus Lift 3-D Scan Real Time Dental Implant Before and After Planning Video –Narrated by Ramsey Amin DDS

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  5. nancy

    Good Morning Dr. Amin,

    I am 3 weeks s/p sinus lift and completed a 10-day course of Clindamycin – there was no tear or puncture of the membrane during the procedure. Sutures were removed after one week and everything looked great. Over the last few days, I have woken with a sinus headache, presumably because while lying flat over night, sinus drainage has not had the benefit of gravity. I have been taking Advil and begin to feel more human several hours into the day. On my way to pick up a decongestant in hopes this will help – don’t want to begin another course of antibiotic if this is simply due to inflammation and swelling post procedure or even allergies – I take Zyrtec every bedtime. Is this just a coincidence or is it common to develop this problem after 2 weeks? Woke up last night with some throbbing at the surgical site which I also thought was odd as otherwise, it looks great and is not swollen. Any thoughts? Thank you!

    Reply
    1. Ramsey Amin DDS

      Did you have an in office 3d scan after the procedure?
      I do this procedure extremely routinely and it is not often that I hear someone have the type of problems your describing. Did you have any growth factors such as L PRF, PRP? IV sedation and intravenous steroids/Antibiotics helped tremendously also.


      Sedation
      Antibiotics for a Tooth Infection, Dental Implant, Bone Graft… Do I Need Them? 

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  6. Victor Drummond

    Hi,

    Thanks for the article, it’s very helpful, especially as I was beginning to feel quite scared of my condition with similar symptoms I have and your information has helped relieve some of the anxiety I was feeling.

    In mid-December 2014 I had sinus uplift surgery AND dental implant fitted at a very reputable surgery in Bangkok (which is 8000 km plane trip from my home on the West coast of Australia)…

    At first I didn’t notice any side effects other than a general feeling of fatigue in the recovery phase after these procedures. Upon flying home some ten days later I am now noticing instance of vertigo, the symptoms of which seem to categorize this as benign paroxysmal positional vertigo, characterized by a short burst of vertigo when in the prone (sleeping) position and turning from left side to right side OR sometimes in the morning after sleep when attempting to stand from sitting on the side of the bed, which when the attack happens I cannot focus my eyes either… Interestingly the vertigo experience does not seem to have effect at any other time such as when sitting, standing or in the normal course of my working day.

    At this stage I’m consulting with my GP plus as of yesterday, making time to swim daily in the ocean again as a way of perhaps “exercising” my middle ear.

    Best regards,

    Victor Drummond
    Australia

    Reply
    1. Ramsey Amin DDS

      Hi Victor,

      Thank you for sharing your story….it is really uncommon. I have placed several thousand implants and internal sinus procedures and have only personally have seen this one or 2 times in the last 15 years. This video shows what this procedure should accomplish in the internal aspect of your sinus. I think you will really like it! you seem like a very technical person!

      Upper Molar/Internal Sinus Lift 3-D Scan Real Time Dental Implant Before and After Planning Video –Narrated by Ramsey Amin DDS

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  7. Sandy

    I had Maxillary Sinus Lift Surgery 10 days ago and since the surgery I’ve felt nausea, headaches, dizziness, and pain in my ears. I’m 61 years old and I don’t know if age has anything to do with these symptoms after this kind of surgery.
    I went in for my 1 week check up and shared with my Dr stating I’m not a person that has headaches and these kind of symptoms but didn’t get any answer why this was happening.
    If this is going to be a prolong condition, I’m wishing I wouldn’t of had this surgery.
    Thanks
    Sandy

    Reply
    1. Ramsey Amin DDS

      Hi Sandy,

      Feeling dizzy or having vertigo is possibly due to the technique used by your particular dentist. It should pass if this is the cause. It is not uncommon to feel nauseated and have headaches from the postoperative antibiotics. Give it another 10 days and let me know how things are going. Be sure to reference your post exactly so that I know who you are when you ask another question. Preferably cut and paste your previous question into the blog post.

      Hang in there, this is rarely a prolonged condition and I’m sure you will make 100% recovery. Sinus bone grafting is extremely common in my practice. Probably do this several times a week for the last 15 years. I think I have seen at all with regards to complications and the way that patients respond to it. Most people say they had minimal pain and took Tylenol or ibuprofen. I typically use growth factors made from your own blood called PRP, PRF, PDGF and naturally occurring BMP to help with healing. I think it is a combination of so many factors including intravenous steroids that help reduce the chance of this ever occurring to begin with.

      Do I Need PRP/PRF/PDGF/BMP For Dental Implants and Bone grafts?

      Sinus Lift Bone Graft

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

      Reply
  8. steve shep

    Dear Dr Amin,
    I recently had sinus lift surgery using the surgical mallet with novocain only . I have dizziness for 2 weeks now . My oral surgeon said he was unaware that this could be a side effect of the surgery. I went to my ENT and was told it probably was from the surgery .He told me it will go away and to wait it out for three weeks and scheduled another appointment. It was slowly getting better day by day and was 99% gone on monday. Tuesday it was back like it was the 1st day.Is this normal in the process? Should I be getting the Eply ?
    Thank you,
    Steve

    Reply
    1. Ramsey Amin DDS

      Steve,

      Give it time. The dizziness and vertigo should go away on its own. Your oral surgeon did not do anything improper… It just happens very rarely.

      This is one of the big reasons why I stress using IV sedation for an internal sinus lift. In the 15 years that I have done this procedure, I find that the intravenous anti-inflammatory steroid seems to reduce this complication tremendously. It also allows you to heal faster by reducing swelling. Because it is given by IV, it temporarily effects other parts of your body. For instance, if I am removing a tooth on someone that has a painful neck or back, most of the time they tell me a few days later that there neck and back pain went away for several days!! The inner ear may work the same way. I also feel like after having IV sedation, you are forced to rest for several hours without moving around after this significant procedure.

      I would hold off on doing any maneuvers at this point and just give it some time. It should pass on its own.

      For those of you reading this post, strongly consider using IV sedation for this procedure. I have consulted with many dentists on this topic and after informing them of my techniques they seem to have a reduction in their own complications. It also greatly reduces pain

      Details of Sedation

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
      1. steve shep

        Dear Dr Amin,
        Thank you for your quick response. I’m glad you are informing others of the IV option,I wasn’t . Your advice is appreciated. Sounds like you really care about people.
        thanks, Steve

        Reply
  9. Rachel

    Thank you so much for posting this information online. I am 5 days post-op from an internal sinus lift/dental implant, and I have had vertigo since coming home from the procedure. I finally called my surgeon today to make sure it wasn’t a crazy side effect, and he said it was likely from just wearing myself out. I wasn’t pleased with his response, so I’ve been trying to figure out the physiology behind it (I’m a nursing student and can’t help myself) to see if there is anything I can do about it. Your explanation eased my concerns and made perfect sense. I seriously can’t wait for it to resolve and hope it does so soon.

    Reply
  10. Joyce Meredith

    Thank you for the info on vertigo and sinus lift! I just had this procedure done yesterday morning and by the end of the day I was feeling this dizziness and at night as I turned in bed. I was worried and decided to look for more info before I call the Oral Surgeon. I believe I must have some of the particles flying around but not many because I felt much better today, even though is not perfect. Thank you for the piece of mind!

    Reply
    1. Ramsey Amin DDS

      Hello Joyce,

      Was a mallet used in order to lift your sinus? I’m guessing that you’re all okay now considering it has been a few days. Sorry for the delayed reply, I had some time off for the summer.

      The dizziness and/or vertigo only happens typically with the internal sinus lift procedure which is for smaller areas of bone loss. You would think that the larger sinus bone graft done through the lateral window approach would cause this, but it is far more common with the smaller internal type.

      Sinus Lift Bone Graft

      Ramsey A. Amin, D.D.S.

      Reply
  11. Mrs F. Haddad

    Dear Dr Ramsey Amin,

    I had a tooth extraction, followed with bone grafting, in May ’14, as a result of a fractured root canal tooth. Two days after, I started experiencing flu-like and allergy symptoms. I was taking antibiotics then. I followed up several times with my dentist and another dentist – no signs of infections on x-rays. I would like to add that, since I suffer from chronis sinusitis, I had a CT Scan of the sinuses done. Which appeared to be fine, no sign of infection. I was told my issues probably stemmed from the tooth issue.
    It has now been over 2 1/2 months and I am still experiencing the same symptoms on a daily basis, with dizziness/vertigo, nausea, body aches, joint pain, some pain where the tooth was extracted. I am now unable to work.
    I am wondering if this could be due to the bone graft. Have you ever had any patients suffering from similar symptoms, following a tooth extraction with bone graft?

    Many thanks for your response.

    F. Haddad.

    Reply
    1. Ramsey Amin DDS

      Hello Mrs F. Haddad,

      Your symptoms are not likely related to your dental implant procedure. It is not uncommon for patients to have simultaneous medical conditions happening at the same time.

      I recently treated a man for complete upper dental implants with sinus bone grafting. A few months later he became very ill. He ended up having lung cancer and dying one month later. I don’t say this to scare you, but you really should be checked out by a physician as dental implants and bone grafts do not cause the types of symptoms your mentioning.

      I have many other stories just like this from cancer, internal bleeding to undiagnosed HIV.
      Good luck with everything… I’m sure it will turn out well! 😉

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  12. Mrs Shaunna McLaughlin

    Hi, I’m looking for some advice on my front right lateral incisor. I have an apicoectomy done on this tooth 15 years ago. A few months ago a small whitish blister appeared a few mm above this tooth. No real pain but a pressure / aching feeling. My dentist has told me that he thinks that the tooth will need pulled as a root canal and apicoectomy was already done on this tooth..
    My question is this : is this the only possible option ? is there no way to save this tooth.. its at the front so I don’t want a gap at the front of my mouth
    The teeth to the right and left of this tooth are fine so if this infected tooth needs removed I don’t really want these teeth destroyed to make a bridge for the missing tooth. Is it possible to get an implant done? or is the infection in the bone and thus not an option..
    Also, I’m not sure if this is related but over the past month or so I’ve had a pressure feeling in my right ear(same side as infected tooth). My doctor has given me first and second line antibiotics and although these have helped I don’t think its gone completely.. could this be linked?

    Reply
    1. Ramsey Amin DDS

      Hi Shaunna,

      If the tooth has to go, the infection wont prevent you from having a dental implant, but you are likely missing some bone at the apex of the tooth. The ear scenario is likely not linked unless it was a back tooth.

      Good luck,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      Reply