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Postoperative Care Instructions for Sinus Lift Surgery

Introduction

Direct and indirect sinus lifting procedures are reliable methods for bone augmentation in the posterior maxilla when not enough bone is available for proper implant placement. Despite their predictability, these techniques come with potential intra- and post-operative complications. In direct sinus lifting, the most common complication is perforation of the Schneiderian membrane during osteotomy, occurring at an incidence rate of approximately 20%-25%. Aside from general oral surgery complications like swelling or hematoma, specific issues related to direct sinus lifting may arise, such as chronic rhinosinusitis, hemorrhage, or ostium blockage due to overfilling. These complications can compromise graft viability and implant success, causing discomfort for the patient.

Indirect sinus lifting, a less invasive approach, allows for transcrestal implant placement when there is sufficient residual bone height. However, it too carries its share of complications, including membrane perforation, benign paroxysmal positional vertigo, and implant displacement into the sinus cavity. 

Before undertaking any bone regenerative augmentation involving the maxillary sinus, a comprehensive medical history, along with a thorough radiographic and clinical examination, is crucial. It is recommended to choose the most appropriate technique on a case-by-case basis while keeping in mind our own surgical experience and skills as dental clinicians.

Postoperative Guidelines

These instructions should be given to the patient after bone grafting procedures for implant placement surgery.

The bone grafting material is usually a mixture of freeze-dried bone, synthetic bone, and the patient’s own bone. The patient should be informed that they may have two post-operative wounds: the donor site and the recipient site.

For a period of 4 weeks (or more if needed) after the surgery, the patient must not blow their nose or sneeze while holding it shut. 

Instruct your patient to avoid anything which might cause pressure in the nasal or oral cavity by:

  • Refraining from blowing their nose or sneezing while holding their nose.
  • Opening their mouth when sneezing.
  • Not using straws to consume drinks.
  • Avoiding scuba diving and air travel.
  • Avoiding bending over, carrying heavy objects, playing wind instruments, or blowing up balloons (i.e. anything that. can cause pressure in the nose or mouth).
  • Not smoking.

Prescribe decongestants and antibiotics to your patient as needed.

Oral Hygiene Measures

On the day of surgery, rinsing and spitting should be avoided as they can disrupt the newly formed blood clot and cause the surgical wounds to open. This may lead to a prolonged healing period and induce bleeding. Patients should be aware that they shouldn’t have a significant amount of blood in their mouth but it’s fine to swallow saliva if there’s a small amount of blood.

To avoid potential infection, it’s vital to maintain proper oral hygiene measures after sinus lifting surgery. It’s recommended to start rinsing the mouth with warm saltwater on the following 5 days. A half teaspoon of salt is dissolved in a glass of warm water, which the patient can use as a mouthwash 4–5 times daily after meals. 

For the first 2 days after the procedure, patients should refrain from brushing the teeth at or near the surgical site. It’s recommended to apply only gentle pressure when brushing.

In some cases, an antibiotic mouthwash may be prescribed; it shouldn’t be used more than twice daily (i.e. day and night) as it can lead to staining – and only after routine oral hygiene measures. Eating and drinking after using the mouthwash should be avoided.

Smoking

Smoking increases the risk of bone graft and sinus augmentation failure significantly. Patient who smoke must stop for a minimum of 2 weeks after surgery.

Wearing Dentures or Night Guards

Removable partial or complete dentures are not to be worn immediately after surgery. Patients should wait until their follow-up appointment for further instructions. When a removable partial denture is used, it shouldn’t touch the healing soft tissue, otherwise it can result in ulceration and breakdown of the sutured tissue and loss of bone graft.

Post-Surgical Complications

Unexpected post-surgical issues might manifest, so the patient should be informed to report any of the following conditions:

  • Sudden flowing of air or fluids between oral and nasal cavities.
  • Small pieces of graft material being expelled from the nose.
  • Congestion of sinus or nasal cavity.
  • Bleeding, pain or swelling within 3 days.
  • Vertigo and nausea caused by a rapid change in head position.

In Conclusion

Before making a decision to choose a particular sinus lifting approach, we need to consider various local and systemic factors, such as residual bone height, sinus morphology, sinus septa, anatomical position of the posterior superior alveolar artery, sinus pathologies, and the number of teeth to be restored.

It is important to conduct a comprehensive medical assessment in order to reduce the incidence of intra- and postoperative complications. This assessment should include a detailed medical history, coupled with meticulous clinical and radiographic evaluations. Symptoms of sinus-related conditions, such as compromised nasal breathing, retro-nasal secretions, headaches, or swelling of the eyelids, should be taken into consideration when taking the patient’s medical history. In cases where such symptoms are present, it is recommended to schedule a preoperative consultation with a specialist to facilitate a thorough assessment of potential sinus problems before proceeding with bone augmentation.

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