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3 Ways To Avoid a Sinus Lift Bone Graft for Dental Implants – Burbank Dentist Explains

Streamlining my patient’s dental implants by reducing time, number of visits and cost are important to me.

The sinus lift bone graft is an extremely common procedure that I do in my office.  In fact, I am one of the few in the world to be trained by the inventor of this procedure.  Hilt Tatum first performed this procedure 36 years ago!

The procedure is exclusively used to build bone height in the back part of the upper jaw for dental implants.  When teeth are lost, the sinus bone expands making the bone small for implants of adequate length.

Although the sinus bone graft is common and is necessary in many situations, this video describes three ways to possibly avoid it all together!  These really do work!

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Burbank, California
http://www.burbankdentalimplants.com

74 thoughts on “3 Ways To Avoid a Sinus Lift Bone Graft for Dental Implants – Burbank Dentist Explains

  1. i had a bridge for 35 years and finally the periodontist removed it and found out that tremendous bone loss on the tooth that connected to the bridge. periodontist recommended sinus lift..however, i do not want to have that. Is there an alternative to sinus lift and have dental implants? periodontist told me only sinus lift is possible to proceed for bone graft procedure to do implant. i do not want to go through sinus lift. im looking for alternative to dental implant since i implantation is not possible.

    1. A sinus lift his a very predictable procedure that has been done since approximately 1974. I have done this procedure 100s is not thousands of times. If you are missing all of your upper teeth A zygomatic implant can be placed if you really wants to avoid a sinus graft.

  2. Hi I had an right upper Bone graft on 16 and 17 with a sinus lift. I had an implant put in 14 and 36. All in the one procedure. Everything went well I believe, and pain and swelling settled after a week. But now at the 2 week mark my right side face where I had the bone graft etc has started to swell again? To the point where I can’t smile properly as the swelling limits it. My Surgeon says this is normal as I had a lot of work going on there and put me back on Antibiotics for a week. The first round of antibiotics gave me my first ever bout or Oral Thrush which hasn’t been enjoyable and it almost cleared up. However I envisage I will get again as I am now on more pre cautionary antibiotics.? Questions is it normal to have swelling come back, I don’t have much pain or throbbing pain just dull ache as it still tender, just more sinus pain, headaches behind my eye ever since?

    1. It sounds like you got infected which could have occurred due to swelling. Swelling is best controlled with a low dose steroid given “before” the procedure. At this point the second round of antibiotics is important and you may want to switch family’s altogether. You can read more about antibiotics by clicking on this. I would also go ahead and take a probiotic also to help with your gastrointestinal system. Make sure you see your dentist very frequently… at least weekly until this resolves which I’m sure it will

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

  3. Has been six months since had tooth 13 and 14 extracted am told bone is good and I can have dental implants done I have good oral health is six months the appropriate time span I have been trying to decide how to proceed

  4. Hello,

    What about a sinus lift with implants on #2 and 4 and a tooth in the middle which would be a bridge with two implants. On previous post I see that you recommended Implants separate, do you also recommend with 3 teeth in a row 3 implants or a 3 piece bridge implant. This would not be connected to any healthy teeth. Also I’m 41 years old and don’t want to end up with another sinus lift and more implants 20 years from now. How long should they typically last? My sister has dentures and her Implants are failing due to more bone loss in her upper tooth area after about 12 years. That typical?

    1. This post should help answer your question. I would suggest connecting dental implants in the soft upper jaw bone and always having more than less implants in the upper jaw. Also on the upper jaw larger and longer is the way to go in addition to having additional implants.

  5. Assalamualaikum Dr Amin,

    If I opt not to have a dental implant, and as such not have a bone graft and sinus lift, will this cause complications in the future? ( leave that one missing tooth in my upper jaw as is, that is)

    Thank you very much.

    1. Of course replacing teeth is considered optional but you will notice that your other teeth will begin to shift and The bone in that area will also shrink because of disuse atrophy –losing one tooth often leads to a domino effect of losing others.

  6. Hello Doctor,

    Can you please advise as to the absolute minimum height one must have for an implant (#3 tooth). My dentist insists I need an osteotome sinus lift but I am very resistant. I have a 4-tooth bridge (2-3-4-5) that had to be removed due to a longstanding fracture of the #3 tooth, which was extracted and a cadaver graft done at the time of the extraction.. The #4 tooth had been the only missing tooth until that time. What remains are the anchor teeth – #5 good condition – #2 decayed and hanging on by a thread, or else I would just opt to have a replacement bridge made with just those teeth but it is not advisable. I believe I had 7 mm of height in the #3 tooth, the worst one, several months after the cadaver graft. I really feel I would just like to take a chance with the implants, without the sinus lift, which I really don’t want. Can you give me an opinion of the likelihood of having success with this 7mm height, if I try the implants without the sinus lift. Interestingly, the #4 missing tooth, for which the bridge was constructed, has enough height but is narrow. Thank you for any ray of hope in this situation.

    1. you’re asking for trouble if you’re only have about amount of bone. The internal osteotome sinus lift when done by experienced provider is a very standard procedure. You can learn more about it in this video

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

  7. Hello dr. Amin,
    I’ll be having a dental trip in ten days for implant procedure
    As my dentist here in Ottawa suggested and the implant dentist did to, most probably I will need a sinus lift.
    My trip will last two weeks. So I’ll be flying back about 12-14 days after the surgery. Flight itself is not short – ~12 hours in the air. Would this be a problem? And in general, what should be the appropriate time after such surgery to fly?

    1. This should not be a problem. Pain in the air pressurized cabin can come from a bad tooth abscess that has no place to vent. If you are having a lateral window sinus or even an internal sinus lift flying for any duration at anytime should not be a problem.

      I would suggest you see your dentist for a follow up though within the first week for sure. Especially if it is a lateral window approach. I typically will see a patient at one week post surgery and one month post surgery. Those are really the critical times.

      Good luck, be safe and happy new year.

      1. Hello dr. Amin,
        Luckily, everything with sinus lift went OK and these days the dentist is about to put the tooth. Hope it will go well, as well. Thank you again for your advice and support.
        However, not everything is going well with my wife implant experience, which becomes the reason to write you again and ask for second opinion. She had second time bone draft until this time and the other day she got two neighboring implants in. The problem to my understanding has come after removing the stiches. Then it seems that the gum shrank and exposed the membrane and even a portion of one of implants. I know it is hard to judge from few words of not very competent in dentistry person as I am, but I’d be very grateful if give me some comment.

  8. i finally got my tooth #4 extracted
    the periodontist did a graft
    and said that i will probably need a sinus lift
    could he have done the sinus lift right after the extraction of the tooth to avoid re opening the gum to do the sinus lift later and i would not have to pay for the graft and also the sinus lift?….

    1. it is usually better to do it the way that you’re having it done. Tooth number for is often in the location where the sinuses slanting and not complete flat. An internal sinus lift may help rather than a complete lateral window procedure.

      Good luck

  9. o need advise and info for my dental health . It has impacted my physical health in jepordy . I have lost ALL MY TEETH . I have full dentures that just wont allow me to eat properly . I am told i need extensive bone grafting . Then implants can then be used to give me back a healthy life . Unfortunatly i am not rich mor have insurance . But im a bit suicidal over what my life has become . Are there foundations that do good works for folks like me ?

    1. Most of my patients in the year 2015 that have lost all of their teeth do not require bone grafting. This is been a paradigm shift in the way I have treated patients over the last 15 years. This is mostly due to technological advancements in virtual surgery 3-D planning and 3-D CAD/CAM fabricated full Bridges. Read a little bit more about a Prettau dental implant bridge. It is not the bridge that reduces the cost and reduces bone grafting but rather the technique employed by the dental implant surgeon.

      Happy Thanksgiving

      Very respectfully,

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

  10. Dear Dr. Amin,
    Follow my last questions on Nov. 3, 2015
    Would you make a comment on my concern the tooth-implant connection bridge to compare the implant only bridge?
    We want to keep the health nature tooth #2 as part of 5 teeth (tooth-implant) bridge (#2–#6, #3 and #6 implant and #4,#5 missing). Do you consider it will as good as the only implant bridge by extract the good health #2 for a implant bridge?

    We need your opinion as soon as possible.

    Thank you very much.

    1. Connecting a tooth to a dental implant is almost never a good idea. This was tried extensively in the 1970s and 1980s and had a very high failure rate. A tooth and a dental implant move microscopically at differently when you bite. Because of this, the natural tooth would always fail causing a recurrent cavity under the crown portion of the bridge. Even things like telescoping crowns were tried and may work for a few years but you’re only delaying the inevitable.

      I would only suggest connecting dental implants to dental implants. Sometimes implants should be connected for other reasons while sometimes they should stay as individuals. This post may help you. It describes connecting dental implants together versus keeping them apart.

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

  11. URGENT—-TOTALLY CONFUSED- LOOSING MY MIND with all the contradictions.
    Hi Doctor, I live in south east Florida.
    I was impressed by your knowledge on this website and sure hope that I will be able to get your reply before I make the wrong decision.
    My tooth #4 has been bothering me for months. Cold/hot don’t bother me…sometimes, yes only sometimes chewing hurts a bit, sometimes it burns and sometimes it sores.
    I can go for days with mild discomfort or other days, there is a pain that I have to control with ibuprofen. I am concerned that I will wake up at an inconvenient time with an excruciating pain and also have do dedicated dentist/periodontist to go to.
    I MUST RATIONALIZE MY CONDITION AND CHOSE THE BEST TREAMENT PLAN– PLEASE HELP ME!
    I got two 3d cone beam scans. Not one of the several dentists/periodontists that I saw can see anything ‘’for sure’’ on the scans. The suspect that I have a cracked tooth 90%….or that I don’t have a cracked toot 90%….and tell me that we will know for sure only when the tooth will be extracted.
    I have a pocket 7 deep in some area around that tooth. I asked if there was a possibility that it was an infection and some of the professionals said yes and prescribed amoxicillin and penicillin and others said absolutely no. I did take one a full script of amoxicillin and it did not help.
    Tooth #3 and #5 have a crown. One dentist said that I should do a bridge, which would be completed within 2 weeks and no graft. Simple and fast and safe he said. When I asked why he would not do a graft, he justified his theory by saying that he would cement the PERMANENT bridge with temporary cement for 6 months and re-send the bridge to the lab before final placement if it needed adjustment after the gum would have shrunk.
    The close up single X-ray of that tooth shows that the bone is quite close to the sinus. One periodontist suggested to do the graft but avoid the sinus lift by putting the abutment a bit crooked away from the sinus. He said that they often do it that way in that practice and it turns out fine.
    I took alendronate for over 10 years and stopped one month ago. My blood level of bisphosphonates is 142. I brought to the attention of the periodontist that I had read that it should be 150. He did not seem to be concerned and said that those researches where not 100% conclusive. He also said that if it made me feel better I could wait 3 more months before starting the treatment but that I might lose some bone during that period.
    Well,… that tooth bothers me or sometimes hurts and takes my quality of life away. I am always afraid to chew on it and am favoring the other side of my mouth when I chew…so guess what?….the other side is starting to hurt. It is weird…it is like I now have a pain traveling in my mouth from side to side and sometimes even bottom.
    The price of: extraction, graft, abutment and porcelain/ceramic crowns varies from $2,500 in a modest, low key practice to $9,800 in a fancy practice ….where I live. I am not sure the price will necessarily deliver more quality and I am on a budget.
    I must take a decision before Tuesday when I will go to hopefully what will be my last interview with a dentist who had been doing implants for a very long time.
    Many dentists that I interviewed had a citation form the Dental Board (many years ago). Can I trust them anyway?
    PLEASE HELP ME see through this?
    Thank you in advance,

    1. You can always try doing just an initial root canal and a temporary crown on the tooth or just a temporary crown only. This will allow you to see how the tooth does over the first few weeks and determine whether or not a fracture is truly present without pulling the tooth.

      Your ctx number is ideally over 150 but fortunately most problems happen in the lower jaw rather than your upper tooth.

      You just need to find an excellent dentist and there truly is no right answer 100% of the time unfortunately. Good luck

      1. hi dr amen i have tooth number 3 root canal 20 years a go every thing was ok till recently i went to students college they have told me the tooth have infection and the crown have small cracked vcfrom the back i went to specialist he said we have to extract the tooth and sinus lift about 3000 thousands dollar now do you thing if i change the crown i might pass thanks i live in Michigan so please I appreciate your help.

        1. Dental schools are honest. Trying to crown a tooth that is planned for an extraction is not going to help. Sorry
          🙁

  12. My wife has dental bridge on her right upper 5 teeth (#2-#6), #2 is in good condition (wisdom tooth already removed), #3 had root amputation, #4and #5 are missing, #6 recently has fracture and need to be extracted. Base on the missing teeth have been lost more than year, the implant dentist think it is very difficult to rebuild up the needed bone for implant. Our dentists gave us three options: (1) partial removable denture of #4, #5 and with implant #6; (2) remove #2, #3 and #6 with layer window sinus augmentation on #2#3 done, then implant #2#3#6; (3) remove #2#3 and #6 with bone replacement graft for ridge preservation, then implant teeth with vertical sinus augmentation on #2 and #3. Options 2 and 3 will install a 5 teeth bridge.
    My wife is a 65 years old breast cancer survivor. She has osteoporosis treated with Fosamax, Boniva and now Prolia. Last year she was found having osteonecrosis on her torus palatinus (had been treated and removed).
    Here are the questions I need your help. (1) On her health history, does it safe for her to implant any tooth, and even worse with sinus augmentation? If the answer is yes, which our dentists’ option is the best for her, or have you any recommendation? (2) We want to keep the health tooth #2. Does it is a good ideal? If it is, can we have only implant #3 and #6, but have #2 to include in bridge. (The periodontist thinks it will not work due to consider the tooth-implant connection having a difference in mobility, but the general dentist does not sure for it.)? Or leaving #2 along, can we just have 4 teeth bridge (#3-#6)? (Our dentists think it will not last as long as including #2 as implant. On your expertise, Can you estimate how longer it could be?) (3) On her case, have any way to avoid sinus lift bone graft or what is the best way to do. Your answers and recommendation would be appreciated. Thanks

    1. Hi Chen,

      I believe I answered her questions already on another post if you’re the same person. I do not suggest connecting dental implants to teeth. This was done back in the 1970s and 1980s and almost always failed. The tooth moves differently than the implant so ridge would become detached and decay on the natural tooth leaving the dental implant intact.

      More importantly your wife’s health and the fact that she’s been taking bisphosphonates such as Fosamax, Boniva and now a monoclonal antibody call Prolia. There is a condition called osteonecrosis of the jaw that can occur and patients who have taken these medications were she can lose her entire jaw from having a simple tooth extraction or dental implant. This mostly occurs in the lower jaw fortunately and it sounds like you’re wife needs treatment on the upper jaw. I have written a post on this particular topic. Your implant dentist needs to consult with you physician after doing some blood testing to see what the risk factors are for developing such a condition. There are test called serum CTX, NTX and bone specific alkaline phosphatase which allows your dentist to determine stability for your wife to make bone and break down bone which is a normal process that we all go through every day. Osteoporosis reduces that ability as more bone is being taken away and is being formed. Sorry for the complexity of my answer but I figured you need to know this.

      The fact that she has had what was called osteonecrosis on her palatal tori, I would consider her case for high risk and perhaps look at other options or explore a drug holiday from the current medications.

      From a dental standpoint, never under design the upper jaw. When it is under designed with too few implants or skipping on a bone graft, you will likely have long-term problems with failure and bone loss.

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

  13. I am hearing impaired and I would have loved to understand the video…
    It would have been so beneficial to me to be able to read what the Dr. had to say..
    The video should have had the CC option…
    Thank you,
    Felice Diamond

    1. Thank you for letting me know. How do I do this? is this a setting within YouTube or does it have to be recorded originally like this?

  14. I need a sinus lift on both sides. I am missing three teeth on the right and two on the left. The last molar on both sides is intact. Can a sinus lift be performed on both sides at the same time ? I want to be knocked out and I want to get it over with and I m afraid that if I do one side I wont do the other because this is the least favorite thing in the world to me.

    1. yes, you can be sedated for this procedure. In fact I encourage it because there are so many other benefits such as faster healing, the ability to draw blood to use for enhancing you’re healing with platelet concentrates. I routinely do both sides at the same time under IV sedation. If done correctly, and you are healthy overall, this can be very smooth procedure.

      Dr. Amin

  15. I am waiting for my #3 crown on implant to be placed prior to having 2 decaying teeth – 14 & 15 removed. They allow me to chew my food and do not hurt has they have both had root canals. Trying to make best decision about 14& 15. Apparently there is approximately 7-8 MM there so a potential bone graft can be done and a short implant say 7 mm could be placed. I was told that if the implant becomes fully integrated that should be strong enough to support replacement crowns- 14& 15. I am in my 70’s so they don’t have to last 30-40 years. Also is it possible to place bone graft material when teeth are pulled or do I need to wait (potential decay infection left from bad 14& 15? Any recommendation would be appreciated . Thanks

    1. Hello David,

      The upper back teeth have the highest failure rate for dental implants. This is because the bone is very soft like a sponge. Not only is it soft like a sponge, but it has to undergo a tremendous amount of bite force even at your young age!

      Using short implants for upper back teeth is a bad idea. The only way this could work is if they had a massive diameter of 7 mm or greater and they were connected. Having an internal sinus lift to gain height would be your best option. It is minimally invasive, virtually painless, very effective and not too costly. The last thing you want to do is have these fail and just a few years due to bone loss such as peri-implantitis from an overloaded bite.

      Sometimes socket bone grafting at the time of extraction helps but that will depend on a case by case basis. I would suggest you see somebody very experienced since this is an area of high failure. 7 mm in length is not enough.

      Good luck,

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

  16. I tried all I could to avoid a sinus lift and bone graft. Unfortunately my last dentist gave me an implant and didn’t give me any prophelactic antibiotics and I developed an infection which destroyed what little bone I had left. I’ve now moved to another dentist who has stricter antibiotic protocols and had a sinus lift and bone graft a couple of days ago. Can you tell me when is it most likely for someone to develop an infection or for it to fail? I want to have an idea of when I might be able to breathe a sigh of relief and I haven’t found any of these procedures pleasant and I am aware that sorting it out if it does get infected will require yet another procedure which would be my 5th in this area of my mouth this year!

    1. Hi Jane,

      As of 2015 I have practice sinus grafting for the last 16 years. This is a very predictable procedure in my hands.

      Typically 3-4 weeks after the procedure you should be in the clear. I hope you have better luck.

      Here’s a post on antibiotics that might help you understand more about antibiotics and dental implant/bone grafting.

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

  17. I tried all I could to avoid a sinus lift and bone graft. Unfortunately my last dentist gave me an implant and didn’t give me any prophelactic antibiotics and I developed an infection which destroyed what little bone I had left.
    I’ve now moved to another dentist who has stricter antibiotic protocols and had a sinus lift and bone graft a couple of days ago.
    Can you tell me when is it most likely for someone to develop an infection or for it to fail? I want to have an idea of when I might be able to breathe a sigh of relief and I haven’t found any of these procedures pleasant and I am aware that sorting it out if it does get infected will require yet another procedure which would be my 5th in his area this year!

  18. I have had teeth 15 and 14 removed. Still have the wisdom tooth on that side. Directly below 14 & 15 is a permanent bridge tooth spanning two crowned teeth that have both had root canals. If I choose not to have implants for 14 & 15, is there a problem with the bottom teeth growing or shifting? I am 64 yrs. old.

    I have had bone grafts under 14 & 15 when they were removed, but the dentist says I now need a sinus lift graft prior to replacing 14 & 15 with implants.

    thank you

    1. Hello Chris,

      Replacing the upper molars is one of the most complex areas of the mouth to complete. This is because the bone is soft, are bite is strong in this area and the sinuses expands leaving minimal room for dental implants.

      It is not uncommon to require 2 bone grafts in order to have enough bone to place implants. This depends on your genetic position of your sinus. Oftentimes a socket bone preservation graft is needed at the time of extraction and a lateral window or internal sinus lift is needed at the time of dental implant insertion. Again this depends on how much bone you have currently and how much bone you need. Watch this video that I made it that helps explain the inside of the sinus on the upper molar #14 your describing. It also applies to the molar behind on #15.

      If you decided not to replace your teeth, your other teeth will likely shift over time. You also place more forces on all of your other teeth which may lead to more teeth being extracted. Our bite requires balanced support in the front and back for longevity.

      Respectfully,

      Ramsey Amin DDS

  19. Can you have a sinus lift on just one side of your face. I really need it one both sides of my face but I can’t afford it at this time. Will it effect my sinuses by only doing one side.

    1. Having a sinus lift bone graft on one side is absolutely 100% okay. You only need to graft the area that bone is missing. Sometimes it is both sides and sometimes it is only one side. Some people believe that their breathing can be affected but that is generally not true.

      sinus graft //breathing

      Ramsey Amin DDS

  20. Dear Doctor,

    My #3 tooth need to be extracted and do an implant. The surgery doctor suggests a sinus lift procedure. I showed my x-ray to another doctor. The doctor said sinus lift is not necessary for me though it always helps implanting. So my question is in which situation we can avoid sinus lift and when we have to have it. It seems I have some bone loss.

    Many thanks,

    Sue

    1. Hello Sue,

      Remember it is always better to have more bone than less bone. This is the support that holds the implant in and will determine the longevity of your dental implant. If it is questionable whether you have enough bone we don’t have enough bone, I would err on the side of having the sinus lift.

      10 mm would be the minimal height of your own natural bone to have an implant in this area. If you have a less than that, a sinus elevation graft should be done. This is especially important if the implant is a smaller diameter implant which does not have a lot of surface area to begin with. Ideally the upper molar has a diameter of 5 mm or greater which can make up for surface area where the implant contacts the bone. A large and long implant is the best for the upper molars. This is an area that undergoes a lot of bite force and has the softest bone in the entire mouth….. This is a bad combination.

      I would suggest you see somebody extremely skilled and experienced in this procedure so that you have the best chance of long-term success.

      look at these posts to help you

      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 Amin DDS

  21. Hello Dr. Amin. I’ve had been wearing full upper dentures for 40 yrs and would like to get dental implants. Do you think it’s a good idea? What are your recommendations on the placement of implants?

    1. Hi Brenda,
      I see that you have posted a question on a blog post for avoiding a sinus bone graft…. Is that the reason for your apprehension?

      There is a good chance that you will need a sinus bone graft if you have been wearing dentures for 40 years. Likely you have moderate to severe bone loss. The most important thing for your dental implant reconstruction is that you have adequate bone to support implants for the long-term.

      I have patients all the time who have dentures replaced completely with fixed dental implants such as a Prettau dental implant bridge or a number of other options. My recommendations would be for you to see an expert in dental implants and have a 3-D CBCT scan done in order to evaluate your bone density, bone mass and skeletal relationship of your upper jaw to your lower jaw. Also to be taken into consideration is your facial appearance and the ability of your teeth to support your lips and face.

      My guess is that your lower denture is the biggest issue and that your upper is not so bad from a standpoint of your feelings.

      Let me know what I can do to help…. I am assuming you live in a different part of the world.
      These web links may help:
      BONE LOSS
      Prettau Dental Implant Bridge
      Is Old Age a Problem With Dental Implants?

      Very Respectfully,

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

  22. Hi Dr. Amin,
    Firstly, great article and I thank you sincerely for sharing your professional experience and advice with not only your colleagues but for us- the patient.
    I am 37 and recently (Dec. 18th 2014) had an extraction of molar 15 which has left me feeling uneasy and concerned for the future integrity of my jawbone (relating to resorption) and the rest of my teeth. This is my first extraction and from what has been reviewed no other is required. I am now looking at dental implant (going with CeraRoot) to help reduce/slow down bone resorption. I still have molar 16 (wisdom tooth). In your video you mentioned a window of time around 3 to 6 months following the extraction to avoid a sinus lift and or sinus augmentation- I would very much like to avoid these procedures. Have you found this window of time consistent?- I appreciate that each person’s body is different and in so the circumstances can be different.

    All the best.

    1. Hi Clint,

      Thank you for your very kind and flattering words. There much appreciated.

      The biggest determining factor is going to be your anatomy. Some people have a sinus that hangs much lower than others. You can blame your parents… LOL

      Should you need to have a sinus lift bone graft, keep in mind this is a very predictable procedure and performed by a skilled practitioner. The sinus lift bone graft has been done since 1974 and is documented worldwide with great success.

      The window of time from 3-6 months is pretty consistent overall but anatomy can be widely variable. Tooth #15 tends to have a higher sinus then the molar right in front of it which is tooth #14.

      checkout this video on the internal sinus lift… I think it is extremely helpful in getting you to understand what goes on for this procedure
      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

      1. Hello again, Dr. Amin

        I greatly appreciate the prompt reply.

        Well I had my consultation with a periodontist (one that uses Ceraroot) and as it would turn out (I believe) I must be one of those with naturally lower hanging sinus cavities. I plan on getting a second opinion before moving forward with the procedure. The Dr. suggested that I wait a few more months before surgery to allow the site to adequately heal from the extraction.

        Do you have much data relating to the longer-term reliability of equine bone? – this is his recommended source.

        The video you suggested was very helpful to me- as it has increased my awareness of protocol and practice.

        Gratefully,
        Clint

  23. Hi Dr. what is the minimum amount of bone a dentist can create with a closed sinus lift bone graft procedure? my natural bone height is currently 6.25mm left after a root canal upper molar tooth was extracted 5 years ago …I just hope there is hope that I don’t have to go down an open sinus surgical procedure.

    1. Hi Sonia,

      Watch this video in the link below. It goes through all the details of the closed internal sinus procedure. I think it will really help you understand.

      It ultimately depends on the skill of your dentist that is performing this technique. There is nothing to fear about the open sinus lift surgery. It is a procedure that has been done since 1974!!

      Upper Molar/Internal Sinus Lift 3-D Scan Real Time Dental Implant Before and After Planning Video

      How to Choose an Implant Dentist

      Very Respectfully,

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

  24. hi Dr. I have an missing upper molar. i have had a CTscan and it shows I have 6.25mm of bone height. I want to avoid open sinus lift surgery – is there HOPE for me to have a successful closed sinus lift? i believe closed sinus lifts are less invasive is that correct?

  25. Hello, I had a root canal done on #14, (I believe) about 15 years ago and replaced the silver crown with a porcelain one about 6 years ago. The porcelain eventually fell out in 2010 because there was not enough tooth to hold it on, because I was living overseas for the next 3 years, I decided to wait to have the tooth extracted when I had an implant done back stateside 2014.
    My dentist said he could do the implant when he extracted the tooth, which he preceded to do this past Friday. After extraction, he said the bone kept chipping away and would not hold the implant and he wanted to proceed with a bridge in 3 weeks. My teeth, with the exception of said extracted one, are relatively perfect healthy straight teeth and I do not want to file down two virgin teeth for a bridge. I 6 days later, I have seen a periodontist who suggests CT Scan in 5 months to see if bone graft alone can be done or a sinus lift w/ bone graft must be done. Sorry for the very long story to get to this question, but is it too late to do anything now and do I need to wait 5 months even with the open hole of the missing tooth? Is there nothing that could be done now to save money and time?
    v/r

    1. Hello Mandi,

      I would not have a bridge if your teeth on either side or perfect. Why grind down perfectly healthy teeth to replace one of them. You have a 1 tooth problem… Don’t give it a 3 tooth solution.

      Bone can be easily rebuilt in the area since the tooth was recently extracted. Having an internal sinus lift or even a lateral window sinus lifts is really not a big deal. In the whole scheme of things it will be a short-term sacrifice for a long term benefit. Once you grind down the teeth for a bridge, this is irreversible and you are forever committed to crowns on those 2 teeth. You will pay a lot more to have these teeth treated and retreated over the span of your life that it would be to have the implant and bone graft done just once.

      You may need to see another dentist who is more skilled in implant replacement before you commit yourself to a bridge.

      Sinus Lift Bone Graft

      Ramsey Amin, DDS – Sinus Lift Bone Graft Case Example For One Dental Implant

      Understanding Sinus Bone Lifting Done Simultaneously with Dental Implants

      Very Respectfully,

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

  26. I had a sinus lift Oct, 2013. Dr extracted 2 teeth and did bone implant. The bone grew and hardened well. Two implants were put in with plans for a bridge between the implants since I had lost 1 tooth. In May, 2013 I woke up one morning and my cheek caved in. Implants were done on upper top right back teeth. What caused my cheek to cave in and what must I do?

    1. Hello Judy,

      What you described is completely unusual. I would suggest you see your dentist for an evaluation. The bone of the upper and lower jaws cannot just cave-in overnight.

      A sinus bone graft whether it be internal or a lateral window procedure cannot cause what you described.

      Sinus Lift Bone Graft

      Very Respectfully,

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

  27. I had a sinus lift Oct, 2013. Dr extracted 2 teeth and did bone implant. The bone grew and hardened well. Two implants were put in with plans for a bridge between the implants. He extracted only 2 teeth since I lost a tooth about 5 years before. In May 2013 I woke up one morning and my cheek caved in. Implants were done on upper top right back teeth. What caused my cheek to cave in and what must I do?

    1. Hello Judy,

      What you described is completely unusual. I would suggest you see your dentist for an evaluation. The bone of the upper and lower jaws cannot just cave-in overnight.

      A sinus bone graft whether it be internal or a lateral window procedure cannot cause what you described.

      Very Respectfully,

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

  28. I had a sinus lift bone graft done three weeks ago (upper right #’s2-5). This was done subsequent to a failed (accident) implant of 20 years ejected.
    Since the procedure I have had a chronic sinus infection and graft material (particulate) has been falling into my mouth. I have been on ampicillin for these three weeks to which the infection is somewhat less but not resolved.
    What would you recommend for resolution of the infection and do you think this bone graft has a chance of success?

    1. Hi Larre,

      Sinus bone grafts are extremely predictable and typically an uncomplicated dental procedure. I perform this procedure several times a week. The first thing I would do is to have a 3-D scan taken. This will allow your dentist to visualize if the particulate bone graft material has penetrated the sinus membrane. If there is a significant amount of membrane tear, and you continue to be infected, then you may consider removing all the graft material and allowing the area to heal for several months. After several months the membrane will reestablish itself and the procedure can be repeated with likely minimal problems. I would also suggest you have a culture and sensitivity of any pus that may be coming out so that the antibiotic being used is definitely killing the bacteria in your sinus.

      Complications can and do happen, but it is all about managing it. I’m sure your dentist will do a great job and have you fixed up in no time… Have faith and hang in there!!

      If there are some membrane tears, I would suggest patching them closed with platelet rich fibrin PRF at the time of graft removal

      Sinus Lift Bone Graft

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

      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

  29. my dentist extracted #14 (my first ever…) due to extensive infection in the root. this happened about 2 weeks ago.

    he wants to do a cantileaver bridge using 13 (has an existing crown – don’t think that there was a root canal done on this tooth) and 12 (which has some discoloration but has not presented any issues)
    i asked about an implant which seems more stable esp for the molar that does most of my chewing… and helps me keep #12 and #13 intact.
    he showed me that the sinus is very close and that there is some bone loss where the tooth was extracted.

    I see him tomorrow to revise my overall treatment plan and i think he was going to begin the process for the cantileavered bridge. i have strong doubts against this direction without medical evidence. It doesn’t seem like the best long term route.

    I love to eat too much – at 62, I’ve recently had my first and second root canals, my first tooth pulled #14 (outside of my far back molars) and hope to keep my orig teeth for the duration… as much as possible. #15 is in tact, but he says that I will lose it – the xray shows some bone loss and some possible infection – but I do not feel that this tooth is at all a problem.

    He wanted to pull it when he pulled #14, but I wouldn’t let him. I said when it becomes a problem we can always pull it, but now it’s not a problem.

    Any clarity on the best strategy to proceed with would be so helpful. i watched your video with the 3 ways to avoid doing a sinus lift with an implant. I wish i lived closer as they seemed like reasonable solutions.

    1. Hi Bev,

      I would not make a cantilevered bridge in your particular situation. Cantilevered Bridges only work well in the front of the mouth or when anchored by 5-6 dental implants. Using 1 natural tooth to hang another natural tooth off in the back of the mouth, is almost never a good idea. I would suggest you have a sinus bone graft done to build vertical height for a proper size and length dental implant. Your dentist is probably right about tooth #15. Keep in mind most people can’t feel major problems with her teeth until it is too late.

      Your likely going to need a sinus bone graft and two dental implants for teeth #14 and 15. I would suggest that these 2 dental implants are connected for long-term strength and durability

      Connected Dental Implant Teeth or Separate Crowns …What is Best? Dentist –Ramsey Amin, DDS Explains

      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

  30. Can a fixed bridge be done using the canine or even lateral tooth as the abutment tooth in the front and an implant as an abutment in the back? I am missing most of my back teeth and the teeth that I do have need to be extracted. I was considering the all on four but it’s not what I really want. I would prefer to have four bridges and use what I have left to save on the cost.

    1. Hi Tami,

      Using a tooth connected to a natural tooth is not a new idea. It used to be done in the 1970’s and 80’s. The natural tooth almost always has problems because the implant does not flex with your bite while the tooth does. Your canine is likely to break or decay under the bridge. It is only done in extreme situations in contemporary practice.

      Sorry to be the bearer of bad news!

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

  31. I was in a car accident 2 months ago. The accident caused my number 15 and 17 teeth ruptured to the gum level. So my dentist had to remove those two teeth. In addition number 16 was also removed since there is no support after 17 is removed. When I asked whether I have to have implant for number 15 she said since majority of the chewing is done by molar 14, an implant for 15 may not be needed. What do you think? Thanks for the help.

    1. Hi Hanxu,

      Yes, the upper first molar does most of the chewing. Depending on your bite, you may be able to get away without replacing the second molar #15.

      Keep in mind that if you don’t replace it soon, you are likely to have the following occur.

      Expansion of your sinus cavity
      Alveolar bone loss
      Shifting of other teeth especially #18

      If 18 is well supported by 14 you may be ok. Have your dentist check you out closely.

      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, California

  32. I have been wearing an upper partial for at least 7 years and is now considering dental implants on an overdenture.Been evaluated by a local Peridontics for implant placement and he informed me that all of my bone has been desolved in the sinus area, but he want to avoid sinus argumentation and place 5 implant in the upper anterior area with nothing in the back upper right or left near the sinus.For some reason, I don’t feel comfortable avoiding the sinus lift since it seems like it will give me better long term support if implants were placed there as well as the upper anterior.

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About Ramsey A. Amin, DDS

Dr. Ramsey Amin has extensive experience in surgical and restorative implant dentistry. As one of only less than 400 Diplomates of the American Board of Oral Implantology/ Implant Dentistry (ABOI/ID) he is considered an expert, and board-certified in dental implants. He is a former instructor at the UCLA School of Dentistry.