What is a crestal sinus lift, and how does it differ from the lateral window?
The crestal sinus lift (also called the internal, transcrestal or osteotome sinus lift) raises the sinus floor from the inside, through the channel drilled for the implant anyway, so no side window is needed. Cambridge University Hospitals calls it the “internal approach”: the bone is prepared for the implant, the sinus floor is gently tapped upwards, graft material is pushed in through the channel if needed, and the implant is placed in the same session.
The approach through the side window is described in our guide lateral window sinus lift. What a sinus lift is in general, how healing proceeds and what to avoid afterwards is covered in sinus lift before dental implants. This page is about the crestal procedure itself.
How is the crestal sinus lift done step by step?
The sources describe this sequence:
- Anaesthesia: the area is numbed with local anaesthetic.
- Preparing the channel: the gum is opened at the implant position and the channel is drilled in the bone to just below the sinus floor.
- Lifting the sinus floor: rod-shaped instruments (osteotomes) are tapped lightly with a small surgical mallet and push the sinus floor upwards; the membrane rises with the bone. According to the systematic review by Farina and colleagues (2023), some techniques use special drills, screw-type osteotomes or electric mallets instead of the hand mallet.
- Material if needed: according to Cambridge, bone graft material can be pushed under the membrane through the same channel.
- Implant: the implant is placed in the channel and the gum is closed.
Who is the crestal sinus lift suitable for, and how much bone is needed?
The crestal sinus lift is suitable when some bone remains below the sinus and only a few millimetres of extra height are needed. The sources give these reference values:
- Cambridge University Hospitals: the internal approach is chosen when about 3 millimetres of extra height are enough.
- Antonaya-Mira and colleagues (2012): in the eleven studies of the meta-analysis, residual bone height before the procedure was between 4.1 and 8.8 millimetres.
- Farina and colleagues (2023, re-analysis of a randomised trial): with 4 millimetres of residual bone or more, the crestal approach was quicker, less demanding and caused less discomfort, and the authors recommend it for these cases. With less than 4 millimetres, patients treated crestally had more pain on the day of surgery and the day after.
- Farina and colleagues (2023, review): a network meta-analysis found the crestal approach superior to the lateral one at 4 to 8 millimetres of residual bone.
The distance between the ridge and the sinus floor is measured to the millimetre on a cone-beam CT (CBCT) scan; why this scan is needed is explained in CBCT scan before dental implants.
How much height can be gained crestally?
The height gain in a crestal sinus lift is usually limited to a few millimetres. In the meta-analysis by Antonaya-Mira it ranged from 2.07 to 4.62 millimetres depending on the study. If more height is needed, the lateral approach comes into question.
The gain depends on material and technique: Farina and colleagues report values of around 6 to 7.5 millimetres after six months in individual studies using graft material. Such figures are study averages, not a personal target.
What do you feel during a crestal sinus lift?
The area is numb and pain is not intended, but the tapping with the small mallet can be felt as a vibration in the head, which some people find unpleasant.
- In a study cited by Farina, 12 of 15 people treated with osteotomes found the procedure unpleasant, but not on the side treated with drills; after one month and after one year, most preferred the drill technique.
- The 2014 Cochrane review notes that participants preferred rotary instruments to the mallet in crestal procedures, but rates this evidence as low quality.
If the tapping worries you, mention it beforehand. What you feel during implant placement in general is described in do dental implants hurt.
Can dizziness occur after a crestal sinus lift?
Rarely, benign paroxysmal positional vertigo (BPPV) can occur after a crestal sinus lift: brief spells of dizziness with certain head movements. Cambridge University Hospitals lists vertigo as a rare, temporary risk. According to the review by Giannini and colleagues (2015), it is rare after the osteotome technique and is linked to the vibration of the mallet blows.
In a study cited by Farina, it occurred in 3 of 98 people (3.1 percent) treated with the mallet and in none treated with screw-type osteotomes; one case resolved on its own within the first week.
The Mayo Clinic describes BPPV as rarely serious: crystals in the inner ear can move out of place into a semicircular canal, making it sensitive to head movements; episodes are brought on by tipping the head, lying down or turning over in bed and usually last under a minute, and a healthcare professional can treat it during an office visit. According to East Kent Hospitals, a repositioning manoeuvre (the Epley manoeuvre) clears the symptoms in about 8 out of 10 cases at the first attempt. Because dizziness can have other causes, report it to your dentist after the procedure; if it starts only once you are home, your GP or an ENT specialist is the right contact, and we welcome a short message on WhatsApp.
How do the crestal and lateral sinus lifts compare?
The crestal approach gains less height but is shorter and causes less discomfort afterwards. The table summarises the figures from the sources:
| Feature | Crestal (internal) approach | Lateral window (external) approach |
|---|---|---|
| Access | Through the implant channel | Window in the side wall of the bone |
| Height gain | Cambridge: when about 3 mm are enough; meta-analysis 2.07–4.62 mm | When considerably more height is needed |
| Membrane tear (Cambridge) | 3.8 percent | 19 percent |
| Infection (Cambridge) | 0.8 percent | 2.9 percent |
| Duration of the lift (randomised trial in Farina) | 32 minutes | 54.5 minutes |
| Discomfort afterwards (same trial) | Swelling, bruising and runny nose less frequent | More frequent |
| Implant | In the same session | In the same session or after the graft has matured |
The 2014 Cochrane review found only one trial comparing both approaches directly and showed no difference in implant or prosthesis failures. When an implant can be placed in the same session as a sinus lift is explained in sinus lift and implant in one session.
What does a crestal sinus lift mean for your trip to Türkiye?
Because the implant is usually placed in the same session, it usually stays at the two trips of an implant treatment: sinus lift and implant in the first, the teeth in the second, so one stay fewer than with the two-stage lateral approach. The rules for the sinus also apply after a crestal lift, for example no nose-blowing in the first weeks; they are listed in our sinus lift guide, together with the advice on flying. How many days to plan for the first stay is set after the examination and CBCT scan; book your return flight only then.
How do we assess suitability for a crestal sinus lift at Rönesans?
The first criterion is the residual bone height below the sinus, which we measure on the CBCT scan at our clinic in Serdivan. We carry out sinus lifts and bone grafting at the clinic, under general anaesthetic if needed; whether the crestal approach is enough for you or the lateral one is needed is assessed at the examination.
Since the implant is usually placed in the same session as a crestal sinus lift, you receive your implant card with the manufacturer’s official label for each implant after the procedure. During healing, a temporary tooth is fitted depending on your case. Before treatment begins you receive a written treatment and cost plan; transfer from Istanbul and accommodation in Sapanca are included in the treatment price. We answer questions in English on WhatsApp at +90 532 363 49 54; the treatment is presented on our dental implants page.