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The surgeon can refuse the patient in sinus elevator, if he has health problems. Conventionally, contraindications to surgery are divided into two groups: absolute and relative.
Absolute contraindications
These include conditions that make it difficult to carry out surgical manipulations or repeatedly reduce the chances of implant engraftment. Surgery is not possible in:
- mental disorders,
- severe heart disease,
- cancer,
- tuberculosis,
- blood clotting disorders,
- autoimmune diseases (lupus erythematosus, rheumatoid arthritis, multiple sclerosis),
- pregnancy.
Relative contraindications
They can be easily eliminated or corrected by the time of implant placement. The decision to operate is made by the surgeon after a thorough diagnosis of the patient and consultation with subspecialty doctors.
Relative contraindications include:
- diabetes mellitus (the operation will be done after the endocrinologist selects the correct treatment),
- angina pectoris (the intervention is performed in remission),
- rhinitis, acute or chronic sinusitis (the patient will be referred to an ENT specialist for treatment),
- cysts, purulent processes in the oral cavity, tooth decay and gum disease (treated by a general dentist).
With caution, surgical intervention is performed on smokers, as they have worse healing of tissues. The risk of implant rejection is reduced if the patient stops smoking at least 2 weeks before surgery.
A contraindication to closed sinus elevator is a bone height of less than 5-6 mm.
How safe is a sinus elevator
Any surgical procedure is a health risk. A common complication of a sinus elevator is rupture of the maxillary sinus walls. The doctor can damage them while moving the bottom of the sinus upward. If this happens, the surgeon sutures the tear and completes the sinus elevator surgery. But if the tear is too large, the procedure has to be interrupted. It is attempted again six months later, when the sinus wall has healed.
Other complications:
- infection of the bone substitute,
- bleeding,
- exacerbation of chronic inflammation of the maxillary sinus.
The risks of complications are higher in smokers, diabetics, and patients with immune disorders.
Alternatives
An alternative to sinus elevator is the placement of removable prostheses (burettes or plates) or basal implantation. Unlike classical implants, basal implants bypass the maxillary sinuses. They are placed in the deep layers of the jaw, which do not resorb over time. Therefore, the procedure is performed without prior bone augmentation. The only disadvantage of basal implantation is that it is used only in the absence of 3 or more consecutive teeth.