Sinus Lift-Before-Extraction Approach: Our Experience With a Strategic Approach to Implant Site Development

Objectives: To present a sinus lift-before-extraction staged approach for maxillary sinus augmentation in patients with posterior maxillary teeth of poor or hopeless prognosis. In this protocol, lateral sinus augmentation is performed before tooth extraction and implant placement to increase available bone height for subsequent rehabilitation. Method and materials: This retrospective case series included 16 posterior maxillary sites in 13 patients treated over an eight-year period. All cases required lateral window sinus augmentation in regions with compromised teeth planned for future extraction and implant-supported rehabilitation. Preoperative cone-beam computed tomography demonstrated a mean residual bone height of 4 mm. Following augmentation, the non-restorable teeth were temporarily retained during healing to support provisional restorations and maintain function and esthetics. Tooth extraction and implant placement were then performed as a second-stage procedure. Results: Between 2014 and 2022, sinus augmentation was performed as the initial stage in 13 patients (43-69 years). Healing was uneventful, and morbidity was minimal. At the second stage, the compromised teeth were extracted, and 39 implants were placed in the augmented sites. All implants achieved osseointegration and were restored with fixed implant-supported prostheses. The mean follow-up was 60 months. Patient-reported satisfaction was favorable. Conclusion: A sinus lift-before-extraction staged approach appears to be a feasible approach with favorable clinical, radiographic, and patient-reported outcomes in selected posterior maxillary sites associated with hopeless teeth. Temporarily retaining the teeth during healing may help preserve interim function and esthetics while enabling implant placement after augmentation.