Bone grafting & sinus lift

Grafting work is usually a step towards implant treatment rather than a treatment people come looking for. If it has been mentioned to you, or you've been told implants aren't possible, it's worth a conversation.

What it involves

A sinus lift is a type of bone graft procedure. Bone grafting is any procedure to increase the volume of bone in an area, normally so that an implant can be placed.

A sinus lift is a particular graft, done in the upper jaw towards the back, used to regenerate bone height to compensate for loss over time. There are various types, both in the technique involved and in the graft material used — synthetic bone graft, human donor bone, or animal bone graft material. Predominantly we use a synthetic material; in certain circumstances human donor bone is preferred, normally determined by the size and shape of the defect being filled.

Whether it's right for you

A dental implant is a screw placed directly into the bone, so there has to be enough bone volume and quality to take the right sized implant for the tooth or teeth being replaced. A small lower front tooth needs a narrower implant than a back molar chewing tooth would. There also needs to be enough bone around the implant itself for long-term stability.

Bone volume may be insufficient for several reasons. A previous abscess or infection around the natural tooth will have eaten away at the bone. Previous gum disease causes the bone to shrink around the tooth and makes it loose. Where teeth were removed a long time ago, the bone shrinks away through lack of stimulation.

That last point matters particularly with an upper back tooth, where the air cavity within the bone — the sinus cavity — expands once the teeth are removed. The result can be a lack of height, and sometimes a lack of width, of bone.

How the treatment runs

Where possible, grafting and implant placement are done at the same appointment, sinus lifts included. It reduces the number of invasive appointments and often does not increase the overall length of treatment.

Where there is a significant lack of bone, the grafting has to be done as a separate stage first, which adds appointments and time. Depending on the size of the defect, that can mean an extra healing period of up to six months before the implants are placed.

How much it adds to the cost depends on the amount of grafting required and the technique used. Sometimes it adds no overall length to the treatment and the additional cost is very minimal; sometimes it is included within the cost of treatment already quoted. For much more extensive grafting, you are given an itemised treatment plan for each stage before treatment begins.

Recovery

It varies significantly with the area being grafted and the volume of graft needed.

A small bone graft placed around an implant at the time of surgery often has no impact on healing either way. Likewise, when a tooth is removed a bone graft is sometimes placed directly into the socket to help maintain bone volume, and that adds no discomfort to the procedure.

In bigger cases, where there is more significant grafting across multiple sites, there is likely to be increased swelling, discomfort and bruising afterwards.

What can go wrong

As with any surgical procedure there is no 100% guarantee, so it is important to mitigate the risk where possible. That may involve pre-operative and post-operative antibiotics and antiseptic mouthwashes, to maintain excellent hygiene and increase the success of the graft.

It is also important to note that bone grafting in smokers, and in patients with uncontrolled diabetes, is much less successful.

Grafting can sometimes fail. In rare cases it may need topping up with an additional graft when the implant is placed. If need be, the initial graft material can be removed and the area left to heal before attempting treatment again or looking at alternative options.

Choosing between your options

It is not always necessary to graft bone. Grafting can be avoided in certain cases by using shorter implants, or by positioning the implant at a slightly different angulation.

In All-on-4 treatment the implants can be angled to avoid areas where bone is lacking — as with zygomatic implants into the cheekbone, or by angulating implants in front of the sinus cavity into better areas of solid healthy bone.

One of the benefits of All-on-4 is that grafting can often be avoided entirely, even where there has been bone loss around the existing teeth. Removing the failing teeth gives more freedom to place implants where the bone quality is good, to compensate for where it isn't. It is normally a graftless procedure.

What happens at your consultation

The first appointment is a conversation, not a sales pitch. We listen to what's bothering you, examine thoroughly, and explain what your options actually are — the pros and cons of each — including the option of doing nothing for now.

After that assessment you get a total cost for the treatment, in writing. Clear pricing up front matters to us: you should know what is involved and what it costs before you decide anything, and it is very rare for that figure to change once treatment is underway.

Then take it away and think about it. There is no deadline and nobody will chase you.

Who you'll be seeing

The same surgeon, the whole way through. Dr Brad carries out your consultation, your treatment and every review afterwards — you won't be handed between clinicians, and you won't have to explain your history twice.

Every treatment plan is built around the individual patient rather than pulled off a shelf, and that runs across the whole team — before, during and after treatment.

Dr Brad qualified at University of Birmingham in 2005, has placed implants since 2007, and holds an MSc in Restorative & Aesthetic Dentistry (2015). He is registered with the General Dental Council, number 85988.

If you've been putting this off

Most people who come to us have been thinking about it for a long time — sometimes years. That is normal here, and nobody will make you feel awkward about it.

It starts before you even get here. When you ring, you will speak to our reception team or to Dr Brad's treatment coordinator, all of whom know the implant process well. They will take the time to understand where you are up to and how you are feeling about it, rather than just putting a date in a diary.

If nerves are the thing holding you back, sedation is worth asking about. The options range from simple oral sedation — a tablet taken beforehand, purely to calm you — through to IV sedation, carried out by a dedicated medical doctor who comes in to assist. For longer and more complex cases Dr Brad will recommend it as a matter of course. With IV sedation you would need someone to bring you in, take you home afterwards and stay with you for a few hours.

Take the appointments at your pace. Ask the same question twice if you want to. If you would rather just find out what is possible and go away and think, that is a perfectly good reason to come in.

What it costs

You are given a total cost for your treatment after your consultation, set out in writing, so you know the full figure rather than a starting price that grows.

Payment is normally spread across the appointments involved, and you will get a breakdown of those appointments, the intervals between them and the cost of each. Longer-term finance through an external provider is also available — we can talk that through at your consultation.