Sinus Lift

When a sinus lift may be considered

• Upper back teeth have been lost, and the bone below the sinus is too shallow for an implant of the planned length. The hospital leaflet notes that many people who have lost their upper back teeth do not have enough bone for implants¹.
• An implant at the back of the upper jaw is the option you prefer, after the alternatives have been explained.

When another step comes first

• Sinus problems. Sinusitis, a blocked nose or previous sinus surgery are assessed first. An active sinus infection is treated before the operation. If symptoms or the scan call for it, an ear, nose and throat assessment is requested.
• Infection in the mouth and untreated gum disease. These are treated first.
• Uncontrolled medical conditions. If your blood sugar is not under control, or a new symptom needs to be investigated first, surgery is postponed.

What is associated with higher risk

• Smoking. The hospital leaflet says that the risk of the graft failing is higher in some people, especially in smokers¹. Smoking is also associated with poorer wound healing.
• Bone-strengthening medicines (such as bisphosphonates or denosumab), diabetes, a history of gum disease, and radiotherapy to the head and neck. Each needs a careful look at your medical history, and sometimes planning with your own doctors. What studies report for each is set out on the bone grafting page. Tell us about every medicine you take, including any blood thinner. Do not stop your blood thinner unless your dentist or doctor tells you to². Do not stop any other medicine without asking the doctor who prescribed it.

Suitability is decided by an examination, a 3D scan and your medical history. An assessment made from photographs or X-rays you send is preliminary, not a treatment plan.

Before a sinus lift is planned, the dentist examines your mouth and takes your medical history. A 3D scan (cone beam CT) shows how much bone is left below the sinus and the shape of the sinus floor. It can also show some signs of sinus disease, such as a thickened lining. Recommendations on 3D scans in implant dentistry say a scan could be justified for diagnosis and planning before surgery³. The dose of a 3D scan is generally higher than that of ordinary dental X-rays and lower than that of a medical CT scan⁴. It also varies widely between machines and settings. Ask for a copy of the scan; it is part of your record.

The teeth next to the sinus are checked as well. Sinus symptoms and toothache can overlap: toothache can be one of the symptoms of sinusitis⁵. A review looked at sinus infections from teeth that spread beyond the sinus. The most common source was infection at the root tips of upper molars⁶. Such a tooth is treated before a sinus lift.

We also ask about sinusitis, a blocked nose, previous sinus surgery and conditions that stop the sinus draining. With your permission, we write to your own doctor if needed. The plan is given in writing, with the approach, the graft material, the reasoning and the alternatives.

There are two main approaches. Which one suits you depends mainly on how much bone is left below the sinus.

Through a window in the side of the jaw

This is the lateral, or external, approach. A small window is opened in the side wall of the jaw, on the cheek side. The sinus lining is lifted, graft material is packed beneath it, and a covering membrane may be placed. Where there is no usable bone, the hospital leaflet says the implant is not normally placed until the bone has healed¹. That means a second operation. Where some bone is left, the implant can be placed in the same operation.

Through the hole prepared for the implant

This is the internal, or crestal, approach. In the technique the leaflet describes, the floor of the sinus is gently tapped upwards through the implant site, and graft material may be added. The implant is usually placed at the same time. The leaflet describes it for cases where only about 3 millimetres of extra bone height is needed¹. Ask which technique and instruments your dentist would use.

The study figures on this page for implant loss and for tears in the lining come from side-window sinus lifts. They do not describe the approach through the implant site.

Graft materials

Graft material can be your own bone, or it can be prepared from a human donor or an animal source (cattle or pigs). It can also be fully synthetic. The graft creates a scaffold for your own bone to grow into¹. If your own bone is used, ask where it will be taken from. If it is taken from a second site, a second wound is opened, with its own pain and swelling. Covering membranes can also be of animal origin. For some patients this is decisive, for religious or personal reasons. Before you consent, you are told which graft and which membrane will be used and where they come from.

A review of sinus floor augmentation found no significant difference⁷ in implant loss between your own bone and bone substitutes. It does not show that every material works equally well. If a material is presented to you as "the best", ask for the reasoning on your own scan.

A sinus lift without graft material has also been reported. A review of 16 articles reported implant survival at 48 to 60 months of follow-up. It was 96 per cent without graft material⁸ and 99.6 per cent with a biomaterial, counted per implant. These are published figures, not our own. The review's published summary reports no direct statistical comparison of these two rates; we could not read the full text. So neither approach can be counted as a proven advantage.

Instruments

The window can be cut with rotating instruments or with an ultrasonic (piezoelectric) device. A review of 69 studies of mixed design reported tears in 24 per cent with rotating instruments and 8 per cent with the ultrasonic device⁹. Its authors note that studies without a comparison group were included. A review of four randomised trials found fewer tears with the ultrasonic device, but the difference was not significant¹⁰. The evidence was too weak to confirm it. So it is not established that one instrument causes fewer tears than the other. The ultrasonic device added an average of 3.43 minutes to surgery.

A sinus lift is usually done under local anaesthetic, with you awake. The hospital leaflet says sedation or general anaesthesia is used only when surgery will be difficult or when multiple procedures are required¹. It also says the procedure may take 45 minutes to two hours¹, depending on its complexity. Conscious sedation can be added if you want it and it suits you. Whether it suits you is assessed first from your medical history and medicines. Your written plan names the place where any sedation is given.

If you have sedation, note that a UK national standard covers conscious sedation in dentistry. For adults, it says that every form of sedation other than inhalation sedation requires an escort¹¹. It also says that if an escort cannot be assured, treatment under sedation must not be provided. Ask us before you book whether the method planned for you needs an escort, and how this works if you are travelling alone. More is on the conscious sedation page.

The number of visits, the gaps between them and the waiting periods are given in your written plan; they vary from patient to patient.

Whether the implant goes in during the sinus lift or in a later operation depends mainly on how much bone is left below the sinus. It also depends on how firmly the implant holds when it is placed. A review of sinus floor augmentation found no significant difference⁷ in implant loss between same-session and later placement. That does not show the two routes are equivalent for every patient.

How long the graft needs before an implant, or before the teeth are fitted, varies. The hospital leaflet gives its own patients a figure for the side-window sinus lift. It says the graft can take 4 to 9 months¹ to join with the patient's own bone before implants are placed. The time depends on the amount of bone needed and the graft material used, it adds. Another passage gives four to 12 months¹ for bone to grow into the graft. From the sinus lift to the finished teeth, it gives six to 12 months, sometimes longer¹. These figures describe that hospital's practice. They are not a rule, and they are not our timetable. Your own waiting time is set after the examination and given in your written plan. Ask how it compares with these figures, and why. Do not ask for it to be shortened to fit travel plans.

How many visits

Implant treatment usually needs at least two visits to Antalya, because a healing period separates the surgery from the final crown or bridge. A staged sinus lift adds a step. The sinus lift comes first, the implant follows once the bone has formed, and the crown or bridge once the implant has healed. Your plan states how many visits you need, what is done on each, how many days each one takes and when you can fly. Have it in writing before you book travel.

The examination in Antalya may change the plan made from your X-rays. A sinus lift may turn out to be unnecessary, or a staged one may be needed instead of a same-session one. Ask before you travel what you would pay in that case.

When you can fly

A 2023 narrative review suggests waiting at least two, and ideally six, weeks¹² after a sinus lift before flying. After an implant alone, it suggests at least 72 hours. These intervals assume no pain, swelling or bleeding at the treated site. The authors say the research is limited and comes mostly from military aviation. They call these intervals a starting point for the dentist's decision. Treat them as the start of a conversation with the dentist who treated you, not as clearance. Ask before you book how long you will stay in Turkey after the operation, and who decides when you can fly.

Between visits, at home

Talk to your own dentist before you go. The Dutch dental association suggests discussing your plan with your own dentist¹³ before treatment abroad. It also suggests asking whether you can go to them if something goes wrong. Ask now whether they will see you between the visits and afterwards. If you do not have a regular dentist, find one near your home before you travel. A check with a dentist near your home between the stages can be written into your plan. If so, ask for the records of the first visit before you fly home. Some dentists may not want to take on treatment that is in progress. So the plan also says where to turn if a problem arises in between.

Risks

The figures in this section come from published studies and from one hospital leaflet, not from our own records. The leaflet does not say where its figures come from, or whether they count patients or operations.

• A tear in the sinus lining. This is the main risk during the operation. A review of 10 studies looked at side-window sinus lifts with graft material. The average tear rate was 29.42 per cent¹⁴. The earlier studies it cites report 16 to 56 per cent. The hospital leaflet gives a 19 per cent chance with the side-window approach and 3.8 per cent through the implant site¹. It does not say where these figures come from. A tear is usually repaired in the same session. If the repair is not reliable, the procedure may be stopped and done again once the lining has healed. The leaflet says that healing usually takes a few months. In the review, implant survival was 97.1 per cent after a repaired tear and 97.7 per cent with no tear; the difference was not significant. Some of its studies describe problems after surgery, such as sinusitis. The review does not compare these problems between torn and intact linings, so it does not show that a tear has no drawbacks.
• Infection. Infection can develop in the graft or the sinus. The leaflet gives a 2.9 per cent chance with the side-window approach and 0.8 per cent through the implant site¹. A longer-term infection may mean the graft has to be removed.
• Sinusitis. Inflammation of the sinus can follow the operation. We have found no sourced figure for how often it happens after a sinus lift.
• The graft not taking. Stitches can open and the graft can become exposed; the leaflet gives 3 per cent for graft exposure¹. Part or all of the graft may be lost, or too little bone may form for an implant. The leaflet gives 1.9 per cent for no graft remaining after a side-window sinus lift, and 1 per cent for too little bone.
• Numbness. The cheek, upper gums and teeth on the treated side may feel numb after surgery. The leaflet says this is usually temporary but, very rarely, can be permanent¹.
• An opening between the mouth and the sinus. The leaflet lists this among the rare but serious problems.
• Other effects. Swelling, bruising and pain are expected in the first days, and a nosebleed can happen. Your sinus may feel full or blocked for some weeks¹. The leaflet lists vertigo, a spinning kind of dizziness, as rare and temporary¹. Tell us if it happens.
• A limit on flying. A 2023 narrative review suggests waiting at least two, and ideally six, weeks¹² after a sinus lift before flying. That assumes no pain, swelling or bleeding at the treated site. This affects how long you stay in Turkey after the operation.

Benefits

• The aim is to gain the bone an implant needs at the back of the upper jaw. The implant can then be placed at the planned length. Sometimes the bone gained is not enough, and a further procedure or a different plan is needed.
• Implant loss after sinus floor augmentation has been reported as low. In 11 prospective studies with at least five years of follow-up, annual loss was 0.43 per cent per implant⁷. In these studies the remaining bone height was 6 millimetres or less, and the side-window technique was used.

These rates come from published studies, not from our own records. They are outcomes observed in studies, not promises, and they are averages of studies from different countries and different groups of patients. What happens in your case depends on your bone, your sinus, your habits and your care.

A sinus lift is not the only way to replace upper back teeth. Your dentist should discuss each option with you, including leaving the gap.

• A shorter implant. This needs enough bone without a sinus lift. The hospital leaflet says the risk of implant failure increases as the implant length decreases¹. It calls the success rates good, but says complications are potentially more likely than with longer implants placed after a sinus lift. Several short implants might be an alternative, it adds. A Cochrane review looked at the shrunken (resorbed) lower jaw. There, short implants appear to be a better option¹⁵ than building the bone up in height. That finding concerns the lower jaw, not the upper jaw.
• Fewer implants, placed further forward or at an angle. Implants placed in front of the sinus, or angled alongside it, can avoid a sinus lift. Grafting may still be needed around the other implants, the leaflet notes. More of the chewing force then goes through fewer implants¹. It says this can potentially lead to more frequent problems with the implants and with the bridge or denture. In a jaw with no teeth, this is the idea behind the designs on the All-on-6 page.
• Zygomatic implants. When the upper jaw has very little bone, long implants anchored in the cheekbone may be considered. A Cochrane review describes the procedure as technically demanding¹⁶ and notes that it may be associated with serious complications. Of the problems in the tissues around these implants, inflammation of the sinus is the one reported most often¹⁷. The hospital leaflet says the surgery is more complicated than ordinary implant placement, and not all surgeons can provide it¹. See full-mouth dental implants.
• A bridge on your own teeth. A conventional bridge needs the neighbouring teeth to be reduced to hold it. An adhesive bridge is bonded to a neighbouring tooth and needs very little or no grinding. A bridge usually replaces only one or two teeth¹. The options are compared on the dental implants page.
• A removable denture. It needs no surgery.
• Leaving the gap. If you have enough working teeth, the hospital leaflet notes that it might be better to accept the gap¹.

Before you decide, you can ask a dentist near your home for an independent opinion. Ask whether you need a sinus lift and what they think of your plan. Having the treatment with a dentist where you live remains an option. You can say no, or ask to stop, at any stage, including after the examination in Antalya.

What is usual

The hospital leaflet describes normal healing after a sinus lift. Swelling is at its worst after two days¹, and bruising over the cheek can spread to the lower jaw. It says patients can expect to feel back to normal after two to three weeks. Pain is usually controlled with simple painkillers such as ibuprofen and paracetamol (called acetaminophen in some countries). If you take a blood thinner or other regular medicines, ask your dentist or pharmacist which painkiller to use. Your sinus may feel full or blocked for some weeks, and a nosebleed can happen.

Protecting the sinus

• Do not blow your nose. The hospital leaflet advises not blowing your nose for two weeks¹ after the operation. Follow your own written instructions for how long.
• The leaflet lists bony material that may have been dislodged after sneezing or blowing your nose¹ as a reason to contact the surgeon. Ask whether your written instructions add other rules, for example on sneezing or drinking through a straw.
• Take the medicines you are prescribed. The leaflet lists antibiotics and decongestants¹ among the medicines that may be prescribed after the operation.
• Choose soft, lukewarm food, and avoid chewing on the area. Keep brushing; clean the area gently, the way your dentist shows you.
• Smoking is associated with poorer healing. At the least, do not smoke during the healing period.
• If you had sedation, do not drive or operate machinery for as long as the sedation team tells you. Before you leave the clinic, you and your escort should have written aftercare instructions and know how to reach the clinic, including out of hours.

Later reviews

When the crown or bridge is fitted, an X-ray and pocket measurements around the implant are taken as a baseline¹⁸. Later changes are judged against that record. Much of your later care will be with a dentist near your home. Take your baseline X-ray and measurements home with you, and agree before you travel who will see you for reviews.

After surgery, or at any time later, contact us if any of the following happens. The hospital leaflet gives similar reasons to contact the surgeon¹.

• Swelling or pain that gets worse after the second day, or pain that does not ease over time
• Bleeding that does not stop, or bright red bleeding that keeps flowing
• A high temperature, or feeling generally unwell
• A bad smell or pus from the area, stitches opening, or graft material showing through the gum
• You think graft material has come loose after sneezing or blowing your nose
• Discharge from the nose, a blocked nose or pain over the cheek on the treated side that does not settle
• Liquid coming out of your nose when you drink, or air passing between your mouth and nose
• Numbness of the cheek, gum or lip that lasts longer than you were told to expect

Before you fly home. Have the area checked before your flight, and take written instructions for your stitches, your medicines and your reviews. If any of these signs starts while you are still in Turkey, tell us before you travel.

Once you are home. Contact us through the route written in your plan. See a dentist near you as well if pain or swelling keeps increasing or bleeding does not stop. Do the same for signs of infection, lasting numbness or discharge from the nose. Do not wait for our reply. If your plan names a dentist near your home, contact them as well.

Emergencies. The signs below need urgent medical help¹⁹. Do not wait for our reply. Go to the nearest emergency department or call the emergency number where you are (112 if you are in Turkey).

• It is hard to breathe, speak or swallow
• There is a lot of swelling in your mouth, or it is hard to open your mouth
• Your eye is swollen or painful, or your eyesight changes suddenly
• Your neck is swollen²⁰

Once you are home, the first person to see a problem may be a dentist or a doctor near you. Plan for that before you travel.

• Sinus symptoms on the treated side. See a dentist first, with your records, and contact us through the route in your plan. Scottish guidance for dentists says that when sinusitis is suspected, a dental cause should be ruled out first²¹. If you are very unwell, or painkillers do not help or the symptoms get worse, ask for an urgent appointment with a doctor⁵. Tell the doctor about your sinus lift and show them your records.
• A graft that does not take. Part or all of the graft may be lost. Once the area has healed, the sinus lift can be repeated, or the plan changed to an option that needs less bone. That may mean another visit to Antalya.
• An implant that fails. Further surgery, another graft or a different restoration may be needed, and that may also mean another visit.
• Who pays. Our written remake terms state who pays for further treatment and travel (see "Is the work guaranteed?" below).

Health service and insurance where you live

What a health service or an insurer covers after treatment abroad differs from country to country. Before you travel, ask the health service or your insurer where you live what they would cover. Ask in particular about care at home if the graft or the implant has a problem. Ask your travel insurer too, in writing and before you book, whether anything linked to planned treatment abroad is covered.

These are the questions we suggest you ask before a sinus lift abroad, each with our answer. Where our answer is a commitment rather than something you can check today, it says so. Ask us each of them, and ask for the answers in writing. Our full list of questions to ask before treatment abroad is on our page about dental treatment abroad.

Who will treat me, and how can I check their registration?

We name the dentist who will carry out the sinus lift, in writing, before you commit. In Turkey a dentist in private practice must register with the provincial or regional dental chamber²² within a month of starting. Without it, they cannot practise privately. The Turkish Dental Association's website offers a search of registered dentists by name and province²³. Ask us for the treating dentist's registration details.

How often do you do this, and what are your complication rates?

Ask how many times the procedure has been carried out, and what its success, complication and infection rates are. The figures on this page come from published reviews and one hospital leaflet, not from our own patient records. We publish no sinus-lift figures of our own yet, so ask us for them. Ask how many sinus lifts, tears and infections there were, how complications were defined and over what period. Ask which approach the dentist would use for you, and how often they use it.

Is the clinic licensed and regulated?

In Turkey a dental clinic cannot open without a licence or treat patients without an operating permit. It is inspected at least once a year²⁴. To treat international patients, a facility also needs an authorisation certificate from the Ministry of Health²⁵. The Ministry publishes a register of authorised facilities²⁶ that you can check yourself. We give you our authorisation details before you commit. A licence or authorisation is a legal minimum, not a statement about the result of your treatment.

Will I get the plan in writing?

Yes. You should be assessed by a qualified dentist before you are given a treatment plan and a cost estimate. Your written plan states whether you need a sinus lift and why, and the approach. It says whether the implant goes in at the same time, and gives the alternatives. It names the graft material and membrane and where they come from. It also states what the plan covers and does not cover, and how many visits are needed. A plan made from photographs or X-rays you send is preliminary. It is confirmed after the examination and 3D scan, and we tell you before anything in it changes. You can say no, or ask to stop, at any stage, including after the examination. Ask before you travel what you would pay if the examination shows that the plan does not suit you.

Is the work guaranteed?

Ask whether the work is guaranteed and for how long. Ask too whether further treatment is included if there are complications, and who pays for extra flights, the hotel and remedial work. Before you commit, we give you our complication route and remake terms in writing. They state what is covered, for how long and what is excluded. They also say what happens if the lining tears and the operation has to be stopped, or if the graft does not take. They state what you must do to keep the cover, such as attending reviews, and who pays for further treatment and travel. Read that document before you decide, rather than relying on the word "guarantee" on any web page.

Is there insurance if something goes wrong?

In Turkey a facility treating international patients must take out complication insurance for surgical and interventional procedures carried out in an operating theatre²⁵. That does not by itself tell you whether your sinus lift is covered, so ask which procedures in your plan fall under it. Ask us too, in writing, whether the clinic or the treating dentist holds insurance for complications or errors, and what it covers. Travel insurance and cover where you live are under "Health service and insurance where you live" above.

Who do I contact after treatment?

Your written plan names the contact route for questions and problems once you are home, and your review interval. For the emergency signs listed under "When to seek help" above, get emergency care where you are first. For other problems, follow the steps given there under "Once you are home".

What records will I take home?

In Turkey you are entitled to an itemised bill, and on request to free copies of the records of materials, tests and imaging²⁵. You may also examine your file and take a copy²⁷. Before you fly home, ask for your record in a form a dentist near your home can use. It should say which approach was used and whether the lining tore. It should list the graft material and membrane, with their brand names and batch numbers, and the implant system if an implant was placed. It should also include your X-rays and scan. A dentist or doctor near your home needs it to look after the area.

What if I am unhappy, and where can I complain?

We give you our written complaints procedure before treatment. A complaint goes to the clinic first; private dental polyclinics, centres and hospitals in Turkey must have a patient rights unit²⁴. If the clinic does not resolve it, you can apply in writing to the provincial health directorate's Patient Rights Board²⁷. The Board decides within thirty days, but it does not assess allegations of medical error. The dental chamber can also open disciplinary proceedings²² against a dentist. Turkey's patient rights regulation also keeps your right to apply, to complain and to take legal action²⁷.

Will the team speak English?

Ask whether the team speaks your language and, if not, whether a translator is provided. We confirm in writing, before you commit, who will explain the plan, the consent form and the aftercare instructions to you in English.

Warning signs, including for us

Think twice before booking any treatment abroad if you notice any of these signs. They are a hard sell, a lack of information, pressure to make a quick decision, no discussion of possible complications, and no mention of aftercare. Apply these signs to us too. If you feel pushed to decide quickly, wait.

No prices are shown on this page. The main factors in a plan are these:

• The approach, and whether the implant goes in at the same time
• The type and amount of graft material
• Whether a membrane is used
• Sedation
• The number of visits and the review programme

The plan also states what will be done if the lining tears and the operation is stopped, or if the graft does not take. Ask in writing what your plan includes, and who pays for further treatment and extra travel if there is a complication. The Dutch dental association advises counting all the costs, travel and accommodation included¹³. For you, that means your travel for every visit, the longer stay before you can fly, and reviews with a dentist near your home.