Complicated Implant Surgery


Implant operation is a very simple minor surgical procedure when the jaw bone and surrounding gingiva is sufficient. Teeth which are supported by implants having sufficient width and height, correct angle and position may have a very long lifetime. Usually finding the sufficient bone is impossible when the teeth were lost a long time ago or due to a trauma or gingiva problems. In these circumstances increasing the bone volume of the related area by using additional surgical procedures is necessary. Those procedures are commonly called augmentation (grafting procedure, bone graft procedure). Different materials and technics can be used for different type of bone deficiency in every region.

1-)Sinus Lifting: This is one of the most applicable procedures. There are two big cavities which are called maxillary sinus located in our maxilla at right and left sides. Frequently molar teeth and sometimes premolar teeth can be in a close relationship with sinus. After tooth extraction bone resorption may occur inside the sinus. Bone level of the patient should be examined from an x-ray at the sinus cavity level. When the bone height is not sufficient sinus lifting procedure is performed.

In open sinus lifting procedure, we reach the membraneous structure which is called sinus membrane that surrounds inside the sinus cavity, by opening a window inside the sinus. Subsequently sinus membrane is raised gently by stripping it from the inner walls of sinus. Increasing the bone volume is provided by placing bone graft into the cavity between the membrane and bone.

If the quantity of bone is sufficient enough to provide an early period support to the implant then implant operation can be done at the same stage. If the quantity of bone is very limited like 1-2 mm, previously graft operation is performed and implant is applied 4-6 months later for healing of the graft.

Recently sinus lifting operation is a very common and successful procedure. Protection of the integrity of sinus membrane is critically important. Tearing of the sinus membrane is called perforation. Perforation may lead spreading of previously placed bone graft into the sinus. If there is a perforation  then it should be repaired. If the perforation is too big for  repairment, sinus should be closed without grafting and the procedure should be repeated 3 months later for the healing of the sinus membrane.

Facial swelling and pain, bruises especially located under the eyes may be observed after sinus lifting. Those kind of disturbances will completely disappear between 7-10 days. There is a rare risk of sinusitis development inside the sinus at the post operative period as in every surgical operation. When sinusitis occurs, the most effective treatment is cleaning the graft and infected material from inside the sinus.

In closed lifting procedure when the quantity of the bone is on the limits approximately 6-7 mm, during preparation of the implant socket, 1-2 mm quantity of bone is left between the sinus cavity and implant socket. Later on, the left bone part became removable by stretching it with hitting movements into the sinus using devices called osteotome. After placing the implant a tent form is obtained and increase of bone volume is provided by bone regeneration in this cavity. When compared to open lifting procedure, bleeding, pain and swelling occurs less due to raising less gingiva in closed lifting procedure. Provided amount of bone is also very low, only a few mm bone is acquired.