Everything about closed sinus lift (surgery and post-operative care) Closed sinus lift surgery is a minimally invasive surgery. But unlike the open method, this technique does not allow volume increase in a large part of the bone. Closed sinus lift surgery is performed by creating a small opening in the implant placement area. The mucosa of the sinus floor is moved and then a substance that stimulates the patient's bone growth is introduced. The injected substance gradually activates and integrates with the tissue. After a few months, a solid bone mass is formed. The advantage of closed sinus lift surgery is that tissue reinforcement and implant placement can be combined in one operation. > **English text:** > > "Compared to an open sinus lift procedure, a closed one is a less traumatic surgery with a lower risk of complications and a shorter rehabilitation period. If all doctor's advice is followed, the risk of complications is minimal." > > **Persian translation**: > > "Compared to open sinus lift surgery, closed sinus lift is a less invasive surgery that is associated with a lower risk of complications and a shorter recovery period. If all the doctor's recommendations are followed correctly, the risk of complications will be minimized." > > Quoted from the axiomadental site When is closed sinus lift surgery performed? - **Video of performing sinus lift and three units of upper jaw implants and four units of lower jaw implants** Closed sinus lift surgery is usually performed when the residual bone height in the posterior maxilla has decreased, but is still sufficient to provide primary implant stability. This surgery is performed when the height of the remaining alveolar bone is between 6 and 8 mm and it is possible to place the implant simultaneously with the sinus lift method. A closed sinus lift is used in cases of moderate bone loss. Closed or closed sinus lift diagnosis cases According to all the necessary conditions for closed sinus lift surgery, lift surgery is performed in the following cases: - Atrophic changes in bone tissue for various reasons - Anatomical features when the floor of the sinus is in a low position and the roots of the molars enter its cavity. - Changes related to the aging of the patient - Disorders of bone tissue structure in the sinus area - Previous implant failure > In patients who cannot have a sinus lift, the use of (short base implant) can be a suitable alternative. There are several reasons why there is not enough bone in the upper jaw. One of the cases is the loss or extraction of the back teeth of the upper jaw. On the other hand, poor oral health with conditions such as gum disease causes bone loss as well as gum tissue, in addition, bacteria that cause tooth decay also increase bone loss. If you've been missing teeth for a long time and then decided to replace them, your body may have naturally started reabsorbing bone because it thinks it's no longer needed. Bone loss occurs when the jaw is no longer able to withstand chewing pressure due to tooth loss in certain areas. Without tooth roots to deeply stimulate the bone, this leads to bone loss as the body breaks it down into minerals for other uses. This is why closed sinus lift surgery is necessary in cases where placing dental implants in the upper jaw is not possible without a maxillary bone graft. Prohibitions of closed sinus lift surgery Dentists are not allowed to perform closed sinus lift surgery if a person has any of the following diseases: - Blood clotting disorders - Immune system diseases and weak immune system - Presence of disease or cancer in the head and neck area - Sinus polyps and cysts - Ear, nose and throat diseases - Presence of decayed teeth, pulpitis, etc. - Mental disorders - Cancer - Poor oral hygiene - Disorders of tissue regeneration - Diabetes - Cardiovascular diseases - Addiction to drugs or alcohol - In case of sinus polyps, chronic rhinitis and maxillary sinusitis Procedure for closed sinus lift surgery Examination and evaluation of bone tissue volume is performed by the dentist during the initial visit. Radiography and CT scan methods are used to determine tissue volume. In cases where a slight increase in bone height is required, the closed sinus lift method is used. For surgery, general anesthesia is applied and then the gum is opened in the desired area. The space where the dental implant is placed is prepared so that 1 to 2 mm of bone remains between the sinus floor. > Sometimes after a closed sinus lift, it will be necessary to implant an implant (ramus bone graft) in the lower jaw as a complementary technique to achieve an optimal result. After this preparation, the closed sinus lift is placed in this prepared gap and the remaining 1 to 2 mm wall is slowly lifted into the sinus. Depending on the amount of bone that is going to be created in the sinus floor, in some cases it may be necessary to use bone graft (bone powder) before placing the dental implant. After this stage, the dental implant is placed in this cavity and the healing process begins. Immediately after the operation, antibiotics, pain relievers, mouthwash and decongestants (to keep the sinuses clean and dry) are prescribed. The healing process is completed on average after 4 to 6 months and the prosthetic part of the implant is made. Recovery period after closed sinus lift It takes about 7 days for the patient to recover after the operation. Full recovery takes 14 days. Do not eat or drink for 2 hours after the first day. After 8-9 hours, it is necessary to drink a lot of water and eat soft and warm food. On the second day, it is necessary to follow hygiene tips by using a soft toothbrush. Avoid applying pressure on the operation site and stitches. Avoid physical activity, travel or long walks. > If a closed sinus lift is performed to strengthen the upper jaw bone, finally, advanced methods such as (complete upper jaw implant) can be used to implant teeth and achieve desirable results. Take the medicines prescribed by the surgeon. During the recovery period (first month), diving or air travel is not recommended. Do not eat hard food and avoid drinking with a straw. Smoking, drinking alcohol and eating very hot food are not recommended. Advantages and disadvantages of closed sinus lift When there is not enough bone height in the upper jaw area for a dental implant and there is less bone loss, the best method is a closed sinus lift. #### (advantages): - **Less invasive:** This is less invasive than the open sinus lift. Most patients do not realize that they have had a closed sinus lift even when dental implants are placed at the same time. - **Less surgery time:** This method requires less time for surgery than other methods and is done quickly. - **Less overall side effects**: Closed sinus lift technique has much less risks of side effects. This is because this technique is very minimally invasive, much simpler and requires less surgery. **simultaneous implant planting**: At the same time as closed sinus lift surgery, the titanium base of the implant is placed in the jaw bone during the same session and the overall treatment time is reduced. - **less incisions**: The absence of extensive incisions means that soft tissue is better preserved, which can lead to faster healing and less discomfort. - **Less infection**: In this method, there is less disturbance in the sinus cavity, and this causes a reduction in infection after the operation. - **Faster recovery**: Closed sinus lift surgery has a faster recovery than the open method, and the patient returns to normal and daily activities sooner. - **reduction of treatment costs**: little or no bone graft material is needed, so the cost is also reduced. #### (disadvantages): - **Limited vision:** The surgeon does not have a direct view of the site and this makes the work more sensitive. - **Limitation in bone volume increase:** It is not possible to increase bone height excessively. - **Possible displacement of the implant:** In cases where proper fixation is not performed, the implant may be displaced. - **Limited uses:** It can only be done in special conditions and mild bone loss. - **Longer treatment time in some protocols:** Sometimes there is a need for more treatment follow-ups. - **Limitations in specific patients:** Patients with very large or damaged sinuses are not suitable options for this procedure. - **Possibility of minor side effects:** such as pain, inflammation or mild swelling in some patients. - **Probability of bone graft failure:** Although low, the graft may not be done well. > English text: > > "Closed sinus lift or cross lift. It is considered less invasive and is used to minimally increase bone volume. Closed surgery avoids large incisions and reduces recovery time." > > Farsi translation: > "Closed sinus lift or cross lift is known as a minimally invasive method and is used to minimally increase bone volume. In closed surgery, large incisions are avoided, which reduces the recovery time. > > Quoted from k31.ru Cost of surgery The cost of sinus lift surgery depends on the type of procedure chosen. In addition, the sinuses should be examined to identify and treat sinus diseases, which will minimize the risk of complications. The final cost includes the cost of surgery, anesthesia, application and removal of stitches and examination by a doctor. The cost of the Bio Oss material and the Bio Guide membrane should also be considered. The amount of material and membrane does not affect the cost. The costs vary between 3 and 12 million. Post-surgery care Compared to the open sinus lift method, the closed sinus lift method is a less risky surgery with less risk of complications and a shorter recovery period. If you follow all the doctor's recommendations, the risk of complications will be minimized. Doing the following will help you recover faster: Do not eat anything for two hours after surgery. - Some bleeding or redness in the saliva for 24 hours is normal. Excessive bleeding (your mouth quickly fills with blood) can be controlled by holding a sterile gauze pad for 30 minutes. Press as little as needed. use If necessary, change the sterile gauze every 30 minutes. If excessive bleeding continues, please see a dentist. - Drink plenty of fluids. Avoid eating liquids and hot foods. Soft foods and liquids should be consumed on the day of surgery. Do not eat solid foods for a few days. - Don't fin for at least 7 days, because this will damage the sinus by applying pressure. If you have to sneeze, try to cover your mouth. - In some cases, the dentist may prescribe nasal decongestants such as decongestant tablets or nasal spray to keep the airways dry. - Take the antibiotics prescribed by your doctor, even if you feel well. They protect the surgical site from infection. It is also recommended to consume 1 or 2 servings of yogurt or a probiotic tablet daily to reduce digestive complications (such as diarrhea). - Do not drink liquids with a straw. This creates suction that dislodges the healing clot at the surgical site. - Do not smoke, as smoking reduces blood flow, contaminates the healing wound and often leads to infection. - Clean the teeth with a soft toothbrush and take care of the operation site. - Avoid long trips or flights, drinking alcohol and vigorous physical activities for 2-3 weeks. > One of the advantages of using a closed sinus lift is that you can use (types of dental implants) afterwards according to the condition of the patient's jaw and bones. **final word** Closed sinus lift surgery is performed with the aim of increasing bone volume in the area of the upper jaw and close to the paranasal sinuses. In people who are unable to do implants due to bone loss, the dentist uses this surgery to increase the durability and stability of the implant base. Closed sinus lift surgery is less invasive than open sinus lift surgery. The recovery period is shorter, and in the same session, the dentist is able to place the titanium base in the patient's jaw, and the recovery period is shorter. Closed sinus lift is used when there is moderate bone loss. This surgery is less expensive than open lift surgery.