Category Archives: Sinus Lifts


Which one is better??? Zygomatic dental implants or a sinus lift bone graft?  I would like to start by saying that both are excellent options.  Both have long-term data to support their use and I do both procedures very routinely.

Often I will recommend one over the other or give you the option to choose what is right for you.  There are times where both options are not good!

Try-in for upper and lower bridge. Upper implants are zygomatic placed by Ramsey Amin DDS

x-ray taken at time of zygomatic implant placement. The left sinus is a bit cloudy because it is taken on the day of surgery. This will clear up in just a few days since sinus passages are clear.

Both of these procedures only apply to the upper jaw.  Specifically they apply to the back teeth of the upper jaw.  In the back part of the upper jaw where your molars are, that bone is remarkably soft and it is generally hollow.  It is hollow because the maxillary sinus drapes down into this area.  The combination of hollow and soft does not make for strong and secure dental implants.  Something has to be done to augment it so that back teeth implants can be placed.

I often tell patient that if your sinuses are hollow on 3-D scan and we need back teeth implants than either way I need to go into your sinus somehow.  Either it has to be grafted in the sinus to rebuild bone  …then… have dental implants or we have to go *through* the sinus (or very close to it) to place zygomatic implants in the cheekbone. 

Unless there is an option to bypass/avoid the sinus with a tilted dental implant concept, then there is no way to avoid the sinus.

Please keep in mind that the distance from the cheekbone to the sinus is very similar.  It is not that much further up.  The outer wall of the sinus is the zygomatic cheek bone of the skull.  They are connected!

3-D image of zygomatic implants placed into the cheekbones on a severe bone loss patient

Final x-ray with upper and lower solid zirconia Bridges on 12 implants. There are 24 teeth supported by these 12 implants. The sinus was avoided

surgical entry point for zygomatic implants. Please note that it is not much higher than sinus lift bone grafting through lateral window approach

entry points for lateral window sinus grafting. Please note that it is not much lower than zygomatic position.

To properly restore your mouth you must have molars.  Without back teeth, everything in the front will fail prematurely and nothing will work right.  The bite must be level and stable.

The zygomatic implant is typically only used when you are replacing a full set of upper teeth.  This allows all of the teeth to be connected in an arch form called “cross arch splinting”.  This gives strength and rigidity to the system where each implant is strengthened by another implant.

A sinus lift bone graft can be used when you are replacing just one side of your teeth and not the other.  It can also be used to replace both sides of your back upper molars and bicuspids.

Sometimes I only use one zygomatic implant per side and sometimes I will use two per side (quad zygoma).  Sometimes I will only put zygomatic implant on the left or on the right and bypass the sinus on the opposite side.  It is not necessary for implants to be placed in a symmetrical nature because our bodies are not symmetrical.

The following table describes some of the differences and similarities between the two:

Sinus lift Zygomatic Dental Implant
Typically takes 8-18 months to complete Completed in a single visit – 1 day
Requires bone graft from human, cow, self or synthetic. Requires no bone graft
Not possible to have fixed teeth on surgery day Fixed temporaries on same day of surgery
Must have clear sinuses to perform Must have clear sinuses to perform
Pain and bruising –usually mild Pain and bruising –usually mild
In office procedure under IV sedation In office procedure under IV sedation
Antibiotics required Antibiotics required
Can be used to anchor teeth on one side or both sides, keeping some existing teeth Can only be used when all upper teeth are being replaced
Implants are regular length Implants are extended length
Patient must wait for healing You can leave with immediate loaded functioning fixed teeth on the same day of the surgery.
Very risky to use a temporary denture over the top while it is healing – best if no denture is worn for 1-4 weeks or not at all Upper denture is eliminated on the day of surgery for most patients. 
No option for immediate teeth Immediate teeth very likely
Sinus Lift cost  – generally more than zygomatic because of numerous appointments and graft materials Zygomatic generally less costly than sinus lift
Numerous appointments Single appointment
Bridge can be made thinner on inside The final bridge on the tongue side of the molars sometimes needs to be made a bit thicker
Must be done in the sinus Zygomatic implant can be placed partially in and partially out of the sinus
Multiple implants necessary per side Generally only one implant needed per side
3-D scan necessary for diagnosis 3-D scan necessary for diagnosis
Can be used for All on 4, 5,6,7,8 etc Can be used for All on 4, 5,6,7,8 etc
Existing bone is very soft Zygomatic cheek bone is generally harder
Procedure dates back to 1974 Procedure dates back to 1988
Can be used to replace one tooth Cannot be used to replace one tooth.

2 implants lateral window sinus lift

postoperative 3-D scan cross-section of sinus lift also showing zygomatic bone.

3 implants through lateral window sinus graft for 3 tooth bridge

internal (small) sinus lifting for too wide body dental implants molar replacement

Both zygomatic dental implants and sinus lifts bone grafts should not be done if your sinus is not healthy or it is plugged shut.  The sinus is supposed to drain into your nose and other sinuses. If that area is blocked the procedure should be delayed until that blockage is cleared.  Sometimes clearing that blockage only requires some nasal sprays/steroids and other times and requires surgery by an ear nose and throat doctor.  Many smokers have thickened sinus membranes that are not healthy.

The zygomatic dental implant really opens the door for having immediate teeth on the upper jaw on the same day of removal of your existing teeth (PRETTAU dental implant bridge is one example)  This is a big deal for those patients that I am having to remove all of their teeth both upper and lower on the same day and provide them with new teeth and implants within 24 hours.  For a lot of people wearing a denture for a year is not an option.

Whether you are in the public eye, a stay-at-home mom, retired or a busy professional many people cannot tolerate a denture and need same day teeth.  The sinus lifts graft does not allow for this to happen.  Occasionally I have a patient that is okay wearing no teeth at all for 6-18 months and that really allows all options to be carried out.  There is no age restriction for either procedure although I would suggest you are 20 or older.

Both options are very stable long-term and neither option has a high risk for chronic sinus issues after the procedure.

Both of these procedures should be completed by a very skilled and experienced implant surgeon.  I would not consider these procedures for a novice!  They require a very in-depth knowledge of the anatomy.  Offices that do these procedures should do them under a hospital-like, aseptic surgical operatory to prevent infections.

I hope the detailed descriptions help you to make an informed decision.

Your comments are welcome.

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

Upper Molars with Sinus Bone Graft and Lower Single Implants -Ramsey Amin DDS Reviews

VM (5)
VM (4)
VM (3)
VM (1)

This is a nice example of basic treatment with dental implants that was well engineered. What you are looking at here are four dental implant molars that I placed in virtual 3-D. The implants are actually surgically placed in the bone but what I did was ‘overlay’ the implants that are actually there with the computerized virtual dental implants. This is done so that the exact position can be seen more easily and you can learn more from this article.


Before treatment…. patient already has one implant

Notice that all of the implant sizes maximize the available bone volume… The implants are not too small and they are not too large… Both of these can create problems. Also notice that each implant has plenty of bone on the outer wall which will support these implants for a long time and will greatly reduce the chance of ever having bone loss/peri-implantitis.

On the upper right notice there are two dental implants. A sinus bone graft was done in order to create enough height of bone to place these implants. The implants are placed against the medial wall for best trajectory but also avoiding the contents of the nose. Previously she was missing the second molar and the first molar had to be extracted due to periodontal bone loss.

Genetically, her sinuses hang down fairly low which would not allow implants of larger diameter and length to be placed. This is very important for the upper jaw in the back of the mouth. I also suggest that these implants be connected especially if the last two teeth are dental implants. You can clearly see the sinus bone graft over the top of the implants.


Teeth not on 3 of the implants yet. One of the implants in the upper was placed in eastern europe 20 years ago.

The lower molar dental implants are single tooth dental implants. The one on the left side of the screen is smaller and longer while the one on the right side of the screen is wider and shorter. Even though they are the same lower first molar the anatomy, each area is slightly different. Every tooth is planned in a unique manner.

This patient happens to be the wife of a dentist that I treated. I actually treat many doctors and dentists…. Even we need tooth replacements too!!

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

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

In the short video you will be able to get a sample of the awesome power of 3D planning for a dental implant and simultaneous internal sinus lift bone graft. You will see all the details that go into planning for a single tooth dental implant that happens to be more complex in nature.  If you have lost an upper molar, this video will be very helpful for you to understand and actually see the relationship of the sinus to the teeth. I show the plan workup through my eyes then I show you the immediate result.  This really helps to understand the process of a single tooth dental implant to replace an upper molar where the sinus is very low.

Internal sinus lift dental implant x-rayThe bone graft used here was a combination of platelet rich fibrin (PRF) cow bone and human bone.  A computer generated guide was not used on this case. As of 2014 I believe that virtual planning should be done for all dental implants.  This technology is way too powerful to skip or just use regular x-rays.  It allows for both the patient and the Dr. to understand your unique situation and adds a tremendous degree of accuracy and safety to your dental implant procedure.

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

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

In this video, I described what is PRP and PRF and how to concentrate growth factors, stem cells and molecular enhancers made from your own blood to be used in dental implant and bone grafting procedures. PRP, PRF, PDGF, BMP, and others, are all abbreviations for wonderful enhancers of dental implant bone grafts.

I make it from simply drawing a few test tubes of your own blood from your arm and concentrating your natural growth factors made from your own immune system. I have been using this technique since about 2003 and it always helps to reduce pain and make your bone and gums heal faster and stronger with less complications.

PRP/PRF is also helpful in reducing infections and helping blood to clot in a bone graft and makes the bone graft material handling hold together. It is extremely beneficial and safe because it is made from your own blood. It has been very well studied and documented for many years . Most of my patients that have very large sinus bone grafts usually only need Advil or Tylenol afterwards if they have had PRP/PRF/PDGF/BMP. There are other medical specialties that use this technology including vetrinarians.

it works very well and treating peri-implantitis also.

Watch this video to learn a lot more and feel free to ask questions of course.

PRP = platelet rich plasma
PRF =platelet rich fibrin
PDGF =platelet derived growth factor
BMP =bone morphogenic protein

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

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.


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

What is Sinus Expansion? Do I Need a Sinus Lift? Sinus is Big and Close…Burbank Dental Implant Expert Reviews

Your sinuses are big hollow holes above your upper teeth.  The roots of your upper back teeth are really close to your sinus. In order to have dental implants in that area, sometimes a sinus lift bone graft is necessary to treat the expanded sinus.  Whether you live in Burbank ,Glendale or Los Angeles, all of our sinuses pretty much expand when teeth are lost.

When you lose your teeth, your sinus expands.  This destroys the bone needed to have dental implants. When these upper teeth are removed, there is often just a paper thin wall of bone separating the maxillary sinus and the mouth.

Sinus              Sinus7                    Sinus8
Normal                     Moderate expansion        Severe Expansion

When all teeth are present, the sinus is protected from expansion which is really bone loss. The presence of teeth keeps the maxillary sinus in place. The expanding sinus destroys surrounding bone.


Most of the sinus lift bone grafts I do in my Burbank, California office are to add back the lost bone height from the expansion of the sinus.  If you are missing teeth on both sides, then usually the bone loss happens on both sides too. Dental implants prevent bone loss.


You can prevent the need for a sinus lift bone graft by either placing your implant on the same day the tooth is extracted (immediate implant) or by placing the dental implants within a few months of losing the tooth or teeth.

There are two main ways you can add bone to an expanded sinus: (follow links for details)

            Internal Sinus Lift

            Lateral Window Sinus Graft

In cases where the sinus has greatly expanded, your body may form or accentuate “septae” in your sinuses.  Septae are like “cross bar stabilizers in the sinus when the sinus is big and expanded.  Sinuses with septae should be grafted by a very experienced implant surgeon to reduce the chance of  the sinus membrane ripping (perforation.)

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

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

This is a very unique case where a large sinus bone graft had to be performed for just one dental implant. This example below was done at my office in Burbank.

The sinus was so expanded from bone loss that an “internal sinus bone graft” would not work.  There was not enough pre-existing bone to do that technique which reduces cost and time.

On a side note, many patients mistake the word “graph” with “graft.”  “Graft” is the proper term for “grafting” bone or tissue such as gums or skin.

Here is how he started with one missing tooth and no bone in the area.  This is a hollow sinus in the area of the upper left first molar #14:


This is what the sinus looks like from the inside from the CT scan. Double click to enlarge the image.


My virtual surgical planning software allows me to do surgery on the computer before the real dental implant or bone grafting procedure.

The purple object is the dental implant plan and the red drawing is how much bone is missing.  That is a lot of missing bone!

Here is the x-ray after the bone graft.  The implant is 16mm long and there is still bone beyond it.  I was able to build about an inch and a half of bone for this patient!

It was allowed to heal for 4 months.


When you look closely at the implant near the top, you can see that the bone is dense near the neck.  Now he can put the tooth on the implant!


Can you see the bone growth?  Feel free to comment below.  No need to sign up!

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

Burbank Sinus Lift Bone Graft for Dental Implants Case Example -Ramsey Amin,DDS

This is a fantastic sinus lift bone graft for dental implants case that I completed yesterday in my Burbank private practice.

This patient was missing three teeth in the upper right area. These are the three main teeth that allow you to chew.

Because the teeth were missing for so long, the bone shrank, and his sinus cavity expanded.  That happens to all of us if we extract and upper tooth and don’t replace it in a very timely manner.

The bottom x-ray shows the hollow sinus cavity.  His bone was only about 2-3 mm tall.  After I did the bone graft, the bone was about 18mm tall…that is more than an inch of new bone growth!

Before and after sinus 
The red outline shows how tall the bone is in each image

When doing the graft, I mixed in some of his own blood that I drew from his arm to concentrate bone growth factors, stem cells and platelets. This is called "PRP."

Here is a skull showing the how close the sinuses are to the upper teeth:Max sinus

I was very pleased with the result of his sinus lift bone graft.  The three dental implants are firmly anchored.  I did this procedure while he slept under intravenous sedation in the office. I have been doing this type of bone graft for the last eleven years on a very routine basis.

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

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

how to avoid a sinus lift bone graph

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