Is a sinus lift possible with sinusitis?
With an active infection, the sinus lift is usually postponed until the sinus has healed; after that it is possible for most patients. A sinus lift raises the membrane at the sinus floor and places bone graft material beneath it, so a healthy sinus is a precondition. What a sinus lift is and how it is done is explained in our guide sinus lift before dental implants; this page is about the sinuses.
The consensus statement by Testori and colleagues (2012), drawn up by dentists, ENT surgeons and microbiologists, classes an inflammatory or infectious process in the sinus as a contraindication that has to be treated before a sinus lift. If there is enough bone below the sinus, the membrane is not touched and the question does not arise.
What is sinusitis, and when does it count as chronic?
According to the NHS, sinusitis is swelling of the sinuses, usually caused by a virus; it is common after a cold or flu and usually clears up on its own within 4 weeks. Typical symptoms are pain, swelling and tenderness around the cheeks, eyes or forehead, a blocked or runny nose, a reduced sense of smell and green or yellow mucus. Cleveland Clinic divides sinusitis by duration: acute (less than four weeks), subacute (four to 12 weeks), chronic (at least 12 weeks) and recurrent acute (four or more episodes a year). The Mayo Clinic defines chronic sinusitis as lasting 12 weeks or longer even with treatment and names a deviated septum, nasal polyps, fungal infection and regular exposure to cigarette smoke among the factors involved.
One point matters particularly for implant planning: the Mayo Clinic also lists dental infection as a risk factor, so inflamed upper back teeth are taken into account when the procedure is planned.
How is the sinus assessed before a sinus lift?
The sinus is assessed from your medical history, a clinical examination and a cone-beam CT (CBCT) scan, supplemented by an ENT examination if needed. Testori and colleagues recommend a careful history and a three-dimensional scan to identify the anatomy of the sinus and any existing disease. Pignataro and colleagues (2008) report that a conventional X-ray shows disease of the sinus lining reliably in only 73 percent of cases and that the drainage area of the sinus (the ostiomeatal complex) should also be imaged.
Prepare the following information for the examination:
- how often you had sinusitis in the last year and when the last episode was
- whether your nose is permanently blocked, runs on one side, or your sense of smell is reduced
- previous nose or sinus operations
- nasal sprays and other medicines
- smoking
Patients travelling from abroad should bring any ENT reports and existing scans; which documents are useful is listed in documents for dental treatment in Türkiye. What the scan shows is explained in CBCT scan before dental implants.
What does a thickened sinus lining on the CBCT scan mean?
A thickened lining is a common finding and on its own not an obstacle, but it has to be interpreted. In the literature review by Costa and colleagues (2018), the proportion of thickened linings in eleven studies with 1,792 patients before a sinus lift ranged from 25.5 to 93.1 percent, with a mean of around 55 percent. There is no consensus on the thickness from which disease is diagnosed, and most studies did not compare the images with symptoms. The authors recommend a clinical assessment with nasal endoscopy when the thickening is combined with a blocked sinus outflow. Pignataro and colleagues note that mild inflammation of the lining alone is not an absolute contraindication; the meaning of a finding emerges together with your symptoms.
When is an ENT examination needed?
An ENT examination is recommended when the history or the CBCT scan points to impaired ventilation or drainage of the sinus. Pignataro and colleagues propose an examination with nasal endoscopy and divide the findings into two groups:
| Treatable before the sinus lift | Possible permanent obstacle |
|---|---|
| Acute viral or bacterial sinusitis | Permanent damage to the lining after surgery or radiotherapy |
| Recurrent or chronic sinusitis due to an anatomical drainage problem | Chronic sinusitis with congenital disorders of mucus clearance |
| Nasal polyps | Polyps together with asthma and aspirin intolerance |
| Limited anatomical obstacles such as a deviated septum | Immune disorders and granulomatous diseases |
| Removable benign cysts | Tumours of the sinus |
| A connection between mouth and sinus (must be closed first) |
According to the authors, treatable findings are first managed with medication or, more often, endoscopic surgery, and the sinus lift follows. For patients travelling from abroad it makes sense to complete this assessment at home before the trip, so the stay does not have to be postponed. If a permanent obstacle remains, our guide dental implants without a sinus lift describes the alternatives.
Why is the procedure postponed with acute sinusitis?
With acute sinusitis the lining is inflamed and swollen; the procedure is postponed until the symptoms have fully settled. According to Pignataro and colleagues, diseases of the nose and sinuses and impaired ventilation increase the risk of complications afterwards, above all sinusitis.
The NHS describes referral to an ENT specialist if sinusitis is still present after 3 months of treatment, keeps coming back, or affects only one side of the face. If you notice pain in the cheek or forehead, a blocked nose, yellow-green discharge or a fever shortly before your trip, please let us know on WhatsApp before you leave. Whether the procedure can go ahead is then decided after the examination.
How common is sinusitis after a sinus lift?
After a sinus lift, sinusitis occurs in roughly 2 to 13 percent of patients depending on the source. In the systematic review by Asmael and colleagues (2018), the rate in eight studies ranged from 2.12 to 12.7 percent, with a mean of 5.4 percent. Testori and colleagues give 2 to 5.6 percent for infections after the procedure, without distinguishing sinusitis from infection of the graft.
According to Asmael, the risk is higher in people with previous sinus disease; smoking and the size of the lifted area also played a part. On smoking, see smoking and dental implants.
Which symptoms after the procedure point to sinusitis?
Cambridge University Hospitals describes the sinuses feeling “full” or “blocked” for some weeks, and according to Testori, swelling, bruising and mild to moderate discomfort usually settle within three weeks; symptoms that last longer or get worse need to be assessed.
The consensus statement names sudden severe pain as a warning sign, along with the following symptoms lasting longer than three weeks:
- tenderness and pain in the area
- a blocked nose
- pus from the nose or down the throat
- an open wound, pus or a discharging opening in the mouth
Headache, fever and a bad smell were also reported in the studies reviewed by Asmael. If you are already home, a dentist or ENT specialist near you is the first contact for such symptoms; also send us a message with photos (see aftercare and follow-up). According to a 2023 article in the British Dental Journal, there should be no sinus symptoms before your return flight, because pressure changes in the aircraft can put a sinus lift at risk.
How do we assess the sinus before a sinus lift at Rönesans?
For patients who may need a sinus lift, we assess the sinus as well as the bone height on the CBCT scan at our clinic in Serdivan. Describe your history of sinusitis, nasal symptoms and medicines at the examination. If the scan shows a finding, our dentists discuss the case together and clarify with you whether an ENT assessment makes sense and when the sinus lift can take place.
We carry out sinus lifts and bone grafting at the clinic, under general anaesthetic if needed, following a written sterilisation and hygiene protocol. Before treatment begins you receive a written treatment and cost plan; on departure you receive copies of your treatment summary and X-rays for your dentist and doctor at home. If you notice signs of sinusitis shortly before the procedure, message us on WhatsApp at +90 532 363 49 54.