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In the back part of the upper jaw, there is a large sinus (air space which is connected to the nasal (nose) space. Commonly, the floor of the sinus is very low, and close to the mouth, thus not leaving enough vertical height of bone into which dental implants can be placed to an adequate depth.
As a result, to place implants in this area it is often necessary to perform a procedure called an Open Sinus Lift, the purpose of which is to cause the growth of more bone in the bottom of the sinus, resulting in more vertical depth of bone into which implants can be placed.
Several techniques are available for this purpose, and the appropriate technique is selected in accordance with the details of the situation at hand.
In the case presented here, the patient did not wish to have this procedure done. The four back teeth, with a hopeless prognosis because of advanced periodontal disease, were removed, and we placed only two implants using the available bone just up to the floor of the sinus to make the most of what was available; however, it would have been preferable to add one or two more implants further back for more support if the patient was willing to undergo the treatment.
 
 

 

Here are the four back teeth before being removed. As a result of severe periodontal disease, there was insufficient bone to continue holding them, and they were extremely loose.

 

Two implants exploit to the maximum degree possible the available existing bone. It was not possible to place more implants further back without a sinus lift procedure, which, as mentioned, the patient was unwilling to do.

In the next case, we can see how implants can be placed into an area where a low sinus floor does not provide adequate vertical depth of bone through the use of a sinus lift procedure, thus providing more support and a much better long term prognosis for the implants.Open Sinus Lift