Bone grafting and sinus lift before implantation

Bone grafting and a sinus lift are needed when the width or height of the jawbone is not enough to hold a dental implant securely. After a tooth is lost, the bone in that area gradually resorbs, and in the upper jaw, above the back teeth, the maxillary sinus slowly descends into the space, leaving less and less usable bone.

Why bone grafting and sinus lift are needed

Neither procedure is a complication or a sign that something went wrong: it is a planned stage of implantation that the surgeon foresees in advance from the 3D CT scan and explains to the patient before treatment begins. Most people do not discover a bone deficit on their own — it comes to light while preparing for implantation, when a tooth has been missing for a long time, after periodontitis or trauma, or when several teeth in the back of the jaw need restoring at once. Bone grafting and a sinus lift share one aim: to restore enough bone for the implant to be placed stably and to last, rather than fitting the implant around whatever bone is left.

Why bone disappears after tooth extraction

After a tooth is extracted, the bone tissue around the former socket gradually loses volume: the resorption process is most active in the first 6–12 months after tooth loss. Chronic periodontitis, tooth trauma, and a prolonged gap without a prosthetic speed up this loss — the longer the space stays empty, the less bone remains by the time the patient seeks implantation. In the upper jaw, another process adds to this: the maxillary sinus, located above the roots of the back teeth, gradually descends over time into the space freed up after molar loss, taking away part of the bone height available for an implant. Resorption can be partly prevented with immediate implantation — placing the implant in the same visit as the extraction. In some cases this preserves the bone from further thinning, but the surgeon assesses whether this approach is feasible individually, based on 3D CT data, not a visual examination. The longer a patient delays prosthetics or implantation after extraction, the greater the likelihood that bone grafting specifically will be needed later, rather than straightforward implantation without extra stages.

How to tell there isn't enough bone for implantation

A bone deficiency can be suspected visually from indirect signs: the tooth has been missing for a long time, the jaw area looks sunken, the gum over it is thin, and neighbouring teeth are gradually shifting into the empty space. But it's impossible to accurately determine the volume, height, and width of the bone from an examination or a panoramic image alone — this requires a 3D CT scan of both jaws, which shows the bone at every point individually. At Houston, this scan is taken at a separate centre Houston 3D on a Planmeca ProMax 3D machine, at a cost of UAH 1,290. After the CT scan, the surgeon assesses whether there's enough bone for standard implantation or whether grafting is needed, and to what extent. These questions are discussed at a consultation with the relevant specialist, costing UAH 690. It's not possible to determine on your own, from symptoms or sensations, whether there's enough bone: the absence of pain or discomfort in the future implant site tells you nothing about the bone volume under the gum, so an examination and scan are a mandatory step before a treatment plan can even be drawn up.

What is a sinus lift

Sinus lift is the lifting of the maxillary sinus floor and filling with bone graft substitute the space that has formed underneath it after bone loss in the upper jaw. The procedure only concerns the upper back teeth — premolars and molars, beneath whose roots the sinus is located; sinus lift isn't performed on the lower jaw, where other augmentation methods are used instead. During the operation, the surgeon carefully separates and lifts the sinus lining without damaging its integrity, and introduces material into the freed space, which over time turns into the patient's own bone. The procedure is performed under local anaesthetic. At Houston, sinus lift is a planned stage of implantation, calculated in advance, rather than a complication discovered along the way: the volume of missing bone is visible on 3D CT before the operation, and the patient is told about it in advance. The name of the procedure alarms some patients more than what it actually involves: in reality it's a localised procedure within the jaw that doesn't affect the sinus itself as an organ and doesn't affect breathing or the sinuses in general.

Closed and open sinus lift: which one, when

The choice between closed and open sinus lift depends on how many millimetres of bone are missing to the sinus floor, and is determined from 3D CT data — not during the operation itself and not "by eye" in the chair. Both options are performed under local anaesthetic at the clinic; the difference lies in the surgical access, the extent of the procedure, and when the implant can be placed after grafting. The patient does not choose the method themselves: the surgeon proposes an option based on the specific bone height at the future implant site, which is why a prior examination and scan precede any discussion of a surgery date. The detailed difference between the approaches is given below.

Other bone augmentation methods

Besides sinus lift, other methods are also used to restore bone volume, and the choice between them also depends on the shape of the defect seen on 3D CT:

• Guided bone regeneration (GBR) — the bone graft substitute is covered with a barrier membrane, which protects the area from soft tissue ingrowth and gives the material time to turn into bone.
• Bone block — a bone fragment is fixed in place at the defect site, when what's lacking is jaw width rather than height, and a solid block of material is needed rather than a granular one.
• Ridge splitting — the narrow ridge is carefully split and the resulting space is filled with graft material, allowing the implant to be placed immediately or with a short delay.

The surgeon determines exactly which method suits a specific case from 3D CT — the shape and extent of the defect is individual to each person, and there's no single solution for everyone. These methods are used on both the upper and lower jaw, whereas sinus lift is used only on the upper jaw, in the area above the roots of the back teeth.

How long the graft material takes to heal, and how long the whole path to a finished tooth takes

Graft material integrates into the patient's own bone over roughly 4–6 months — that's how long the body needs to turn the material into fully functional bone tissue capable of holding an implant. With a closed sinus lift and a small bone deficit, the implant is sometimes placed at the same time as the graft, in the same visit. With an open sinus lift and most other augmentation methods, the implant is placed as a separate stage, only after the material has fully integrated. Next comes the implant's own integration period, and only after that does prosthetics begin — making and fitting the crown. So the entire path from the first consultation to a finished tooth consists of several sequential stages: examination and CT, grafting if needed, a healing period, implant placement, another healing period, and prosthetics — and each stage begins only after the previous one is complete. The surgeon gives exact timings for a specific situation only after an examination and 3D CT; they aren't determined in advance. The duration of each stage is affected by individual healing characteristics, the volume of bone restored, and the patient's overall health, so for one patient the whole path may take noticeably less time than for another, even with a similar initial bone deficit.

The first few days after surgery: what's normal

For a few days after bone grafting and sinus lift, the following are considered normal:

• swelling of the facial soft tissue in the treated area, which gradually subsides;
• minor bruising, especially after an open sinus lift;
• moderate discomfort when opening the mouth and while chewing.

The operation itself is performed under local anaesthetic, so there's no pain during the procedure — discomfort and swelling appear only once the anaesthetic wears off. Smoking and uncontrolled diabetes impair healing and integration of the material, so it's worth telling the surgeon about these factors at the consultation, before surgery. If swelling increases after the third day, or a raised temperature or persistent, pronounced pain appears, you should contact the surgeon who performed the operation rather than wait for it to improve on its own. In the first few days, it's worth avoiding sharp pressure changes — flying, diving, blowing your nose hard — and physical exertion, as these can interfere with healing, especially after a sinus lift.

What determines the cost of bone grafting

There's no separate fixed price for sinus lift or bone grafting in the clinic's price list — the cost depends on the volume of graft material, the chosen method, and any accompanying procedures, and is quoted after an examination and 3D CT, not sight unseen. As a guide, related items that make up the overall treatment plan: consultation with the relevant specialist — UAH 690, CT scan of both jaws at Houston 3D — UAH 1,290, PRF plasma therapy, sometimes used to improve tissue healing — from UAH 2,850. The implantation itself, carried out after grafting and healing are complete, costs from UAH 18,000, and a Straumann NeoDent implant costs UAH 19,900. The surgeon quotes the final price for bone grafting only after seeing the volume and shape of the defect on the scan — this figure can't be determined by eye or from a photograph. This isn't an attempt to dodge the question: the actual volume of material, the method (closed or open sinus lift, GBR, bone block), and the need for additional procedures vary from patient to patient, so an honest answer on price is only possible once the surgeon has seen the specific picture on 3D CT.

When bone grafting can be avoided

In some cases, bone grafting can be avoided. Instead of augmentation, the surgeon may propose a shorter implant, a tilted implant that bypasses the sinus, or a protocol using several implants for the whole jaw, along the lines of All-on-4 or All-on-6, where the load is distributed to avoid areas with the least bone volume. Such solutions aren't always suitable — it all depends on how much bone remains and at exactly which point in the jaw, as well as the overall prosthetic plan. This can only be assessed with a 3D CT scan: it shows the actual bone height and width at the relevant site, not the approximate picture visible on a panoramic image or during a visual examination of the mouth. These alternatives aren't inherently worse or better than bone grafting — they're different engineering solutions to the same problem, and the right choice depends on the specific anatomy of the jaw, not on general advantages of one approach over another.

Why CT makes the final decision

3D CT is the only way to accurately see bone height and width, and the position of the sinus and nerves before treatment even begins. Based on this scan, the surgeon decides whether bone grafting is needed, what type and volume it should be, and, if required, builds a surgical guide for navigation-guided implantation, allowing the implant to be placed exactly where the plan specifies, rather than relying on the eye alone during surgery. At Houston, implantation carries a 100% guarantee, and part of this reliability comes precisely from the accuracy of CT-based planning, not just the surgeon's manual skill. More on the course of the operation and how to prepare for it — on the page oral surgery clinic. That's why the first step in any plan involving bone grafting or a sinus lift is not a discussion of price or a surgery date, but an examination and 3D CT: without them, no assessment of bone volume or treatment timeline can be accurate.

Frequently asked questions

Oleksandr Denysenko

Oral surgeon

4+ years of practice. Dental implantation, bone grafting, sinus lift, soft tissue grafting.

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