Jaime Lozada - One-stage sinus elevation with lateral approach

Sinus graft surgery can be performed as either a one-stage or a two-stage approach. 

With the single-stage surgery, the bone grafting and implant placement are performed in one surgery with the graft placed first, followed by implant placement. In the case of a two-stage surgery, the bone grafting is performed first and after bone healing, implant placement occurs at a second appointment some months later. 

The decisive factor in choosing a simultaneous approach (one-stage surgery) over a delayed approach (two-stage surgery) typically is based on two factors: 1.) the amount of remaining alveolar bone and 2.) the anticipated primary implant stability that could be obtained.

Generally, a two-step procedure is recommended in the presence of severe atrophy where minimal residual bone is available and, therefore, primary implant stability cannot be guaranteed. Also for patients with substantial vertical alveolar bone resorption, bone grafting of the residual ridge in combination with sinus grafting may be needed to provide sufficient bone for the placement of implants and be able to fabricate crowns with a normal occlusocervical dimension. 

Irrespective of the surgical approach or materials used for grafting the maxillary sinus, it is important for the surgeon to know the anatomy of the surgical field, be able to identify and evaluate the maxillary sinus membrane, understand the surgical management procedures, and be familiar with evidence-based data related to long-term results when performing a sinus graft procedure.