Are implants without a sinus lift possible in the back of the upper jaw?
Yes, for many patients implants without a sinus lift are possible; it depends on how much bone is left below the sinus, how many teeth are missing and whether the upper jaw is toothless. After the upper back teeth are lost, the bone thins and the sinus can expand downwards, so the height for a standard-length implant is often missing. The American Academy of Periodontology (AAP) describes the back of the upper jaw as hard to treat with implants because it often lacks enough bone, the remaining bone is frequently of poor quality and the sinus is close by. Why that is, and how a sinus lift works, is explained in our guide sinus lift before dental implants.
As alternatives to a sinus lift, the sources describe three implant solutions in particular:
- Short implants: an implant that fits into the remaining bone.
- Tilted (angled) implants: the implant is placed at an angle in the bone in front of the sinus, mainly for fixed teeth on a whole jaw.
- Zygomatic implants: long implants anchored in the cheekbone, for a severely shrunken toothless upper jaw.
There is also tooth replacement without implants: a bridge or a removable denture.
What are short implants, and who are they for?
Short implants are short enough to fit into the bone below the sinus floor; they come into question when only a few millimetres are missing. The definition differs between sources:
- Toledano and colleagues (2022) count implants of 6 millimetres or less as short and 8 millimetres or more as standard.
- Mester and colleagues (2023) define implants under 8 millimetres as short.
- In the trials of the Cochrane review (2014), implants of 5 to 8.5 millimetres were placed in patients with 4 to 9 millimetres of remaining bone.
Short implants do not always fit. If the remaining bone is below these values or the jaw is too narrow, another route is needed. Height and width are measured to the millimetre on a cone-beam CT (CBCT) scan.
How do short implants compare with a sinus lift?
Systematic reviews show similar survival rates for short implants and for standard implants with a sinus lift, but the long-term evidence is limited.
| Review | Scope | Main result |
|---|---|---|
| Cochrane, Esposito et al. (2014) | 4 randomised trials, 102 participants, 4 to 9 mm of bone | One year after loading no clear difference in implant or prosthesis failures; significantly more complications after a sinus lift |
| Toledano et al. (2022) | 14 randomised trials, 901 implants | Similar survival rates; more bone loss at the implant after a sinus lift with a standard implant |
| Mester et al. (2023) | 5 randomised trials with at least five years of follow-up | Five-year survival 95.78 percent (short) versus 99.5 percent (standard), not significant; fewer biological complications with short implants |
| Alemán et al. (2025) | 7 randomised trials with at least five years | No significant difference; high risk of bias in most trials, so no firm verdict |
According to Cochrane, complications after a sinus lift included sinusitis, infection and bleeding. Toledano and colleagues report fewer symptoms after surgery with short implants. Mester and colleagues note that standard implants did numerically slightly better after five years and call for longer studies.
How do tilted implants help?
Tilted implants are placed at an angle into the bone in front of the sinus; this allows a longer implant to be used without touching the sinus. The approach is used mainly for fixed teeth on four or six implants. According to the systematic review by Menini and colleagues (2012), the sinus often prevents long implants in the shrunken back of the upper jaw; tilted long implants in the existing bone were proposed to achieve good primary stability and avoid bone grafting.
The review analysed 1,623 implants in 324 patients with immediately loaded full-arch restorations in the upper jaw. In the first year, 2.19 percent of the tilted and 1.89 percent of the straight implants were lost, with no significant difference; bone loss at the implant did not differ significantly either. The authors stress that randomised trials were lacking and the data covered only one year. Why the back implants are tilted in a four-implant plan is explained in our guide four or six implants; the treatment itself is described on our full-arch implants page.
What are zygomatic implants?
Zygomatic implants are long implants that, when very little bone remains in the upper jaw, are anchored not in the jaw but in the cheekbone (zygoma); they are regarded as an alternative to large bone grafts in a toothless, severely shrunken upper jaw. According to the systematic review for the 2023 ITI Consensus Workshop (Kämmerer and colleagues), they were originally developed for patients after tumour surgery and later also used to avoid large bone grafts.
The ITI consensus statement summarises:
- In 24 studies with 918 patients, the survival rate was at least 90.3 percent; losses occurred mostly in the first six months.
- The most common complication is sinusitis: 9.5 percent with the original technique, 4.4 percent with anatomically guided techniques.
- Temporary numbness of the cheek, connections between the mouth and the sinus, and gum recession or overgrowth at the implant were also reported.
The review advises against zygomatic implants in heavy smokers and with untreated sinusitis, and recommends examining the sinus beforehand. Whether zygomatic implants are an option for you is assessed at the examination.
What options are there without implants?
Missing teeth can also be replaced without implants, with a fixed bridge or a removable denture. Neither needs a sinus lift, but each has its own requirements:
- Bridge: healthy teeth are needed on both sides of the gap to carry the bridge; they are usually prepared for this. See our guide dental implant or bridge.
- Removable denture: when several or all teeth are missing, a removable denture can be made. The differences from implants are explained in our guide dentures or implants.
How is the right solution decided?
The choice between a sinus lift, a short implant, a tilted implant or tooth replacement without implants is made after the examination and the CBCT scan. The following are usually discussed:
- height and width of the remaining bone below the sinus
- whether one tooth, several teeth or the whole jaw is missing
- the condition of the sinus and any previous sinus problems
- smoking and general health
- your expectations about the number of operations and the length of treatment
Averages from studies do not replace an individual decision. The Cochrane comparisons, for example, include only patients with 4 to 9 millimetres of bone; with less bone the results may differ.
What does this mean for treatment in Türkiye?
For international patients, the decision mainly affects the number of stays. A sinus lift with later implant placement can mean an additional stay; short or tilted implants are placed in the same session as other implants, so two stays usually remain. Every option needs the implant’s healing time before the final teeth are fitted on the second stay.
For a preliminary assessment you can send us photos and any existing X-rays, such as a panoramic X-ray or a CBCT scan from home, on WhatsApp. Whether a sinus lift can be avoided can often be estimated from these, but is confirmed only after the examination on site. How we organise a stay is described on our page dental treatment in Türkiye.
How do we assess alternatives to a sinus lift at Rönesans?
Whether a sinus lift is needed in the back of the upper jaw is judged at our clinic in Serdivan from the height and width of the bone on the CBCT scan. Our dentists compare the options together; if a sinus lift is needed, we carry it out at the clinic, under general anaesthesia if required. Whether short or zygomatic implants are suitable in your case is assessed at the examination.
For a toothless jaw we provide fixed teeth on four or six implants. Whether the implant positions are transferred with a surgical guide is decided by your dentist after the examination and CBCT scan. Crowns and dentures are made with CAD/CAM at our partner laboratory, and an intraoral scanner is available for impressions. Before treatment starts you receive a written treatment and cost plan with the procedures for each tooth, and you can reach us in English or German on WhatsApp at +90 532 363 49 54.