Sinus Lift Instruments: Sinus Elevators, Membrane Elevators and Kits

In the posterior maxilla, there is often not enough bone height for an implant after tooth loss. The maxillary sinus expands and the ridge resorbs. In sinus floor elevation, or sinus lift for short, the Schneiderian membrane is detached from the floor of the maxillary sinus and lifted, creating space underneath for bone graft material. The procedure demands delicate instruments, because the membrane is thin and tears easily. This guide gives an overview of sinus lift instruments, explains the difference between a sinus elevator and a membrane elevator and shows which instruments are needed for the lateral and the crestal approach.

Key points at a glance

• In the lateral sinus lift, a bony window is created in the lateral sinus wall. Through this window the membrane is detached with sinus elevators.
• In the crestal (transalveolar) sinus lift, the sinus floor is raised through the implant site, classically with osteotomes according to Summers.
• Sinus elevators (sinus curettes) have blunt, rounded working ends with different angulations for the floor and walls of the sinus.
• Membrane elevators have a wider, thin-tapering blade and lift the membrane over a large area.
• The most important complication is perforation of the Schneiderian membrane. Sharp edges have no place near the membrane.

Lateral or crestal?

The lateral approach (also called external sinus lift or window technique) was introduced by Tatum in the late 1970s and published by Boyne and James in 1980. It is considered the most frequently described technique and is indicated above all when residual bone height is low. The crestal approach with osteotomes goes back to Summers (1994). It is less invasive but requires a certain residual bone height, since the sinus floor is raised through the implant site. How much residual bone is needed for which procedure and for simultaneous implant placement is assessed differently depending on the case and the literature. The clinician decides on the basis of three-dimensional imaging.

Instruments for the lateral sinus lift

1. Incision and flap

After a crestal incision, usually with a releasing incision, a mucoperiosteal flap is raised down to the bone. You will need a scalpel, for example a scalpel handle No. 3 with scale, and a periosteal elevator. The types of periosteal elevators are explained in our guide periosteal elevators. Retractors hold the flap back during the procedure.

2. Preparing the bony window

The window in the buccal sinus wall is created with a round bur, a diamond instrument or piezosurgery. The aim is to remove bone layer by layer until the membrane shows through bluish, without injuring it. Special burs are available for this purpose, such as the sinus lift bur for the lateral approach.

3. Detaching the membrane with sinus elevators

Once the window is prepared, the most delicate step begins. Sinus elevators are used to detach the Schneiderian membrane from the bone, first at the window margin, then on the floor and finally on the medial wall. The working ends are blunt, rounded and angled differently so that all areas of the sinus can be reached without piercing the membrane. The instrument always stays in contact with the bone. In our shop you will find a range of numbered sinus elevators, for example sinus elevator 1, sinus elevator 2 or maxillary sinus elevator 3.

4. Lifting with membrane elevators

Membrane elevators have a wider, thin-tapering blade. They distribute pressure over a larger area and lift the already detached membrane evenly instead of loading it at a single point. Examples are the membrane sinus elevator 1 and the membrane elevator 2.

5. Grafting and closure

Bone or bone substitute material is placed in the created space and gently condensed, for example with a bone graft packer. The window is then usually covered with a membrane and the flap is sutured. For suturing you need a needle holder, forceps and suture scissors.

Instruments for the crestal sinus lift

In the crestal approach, the implant site is prepared to just below the sinus floor. The remaining bone is then pushed cranially step by step with osteotomes, lifting the membrane together with the bone. Osteotomes are cylindrical or conical pluggers in graduated diameters that are tapped lightly with a mallet. Alternatively, hydraulic, balloon or piezosurgical techniques are used. Sinus elevators and membrane elevators are usually not needed in the crestal approach, or only as a supplement.

Overview: sinus lift instruments

Sets or individual instruments?

If you perform lateral sinus lifts regularly, a coordinated set is worthwhile. It contains matched instruments for the procedure and can be reprocessed in an orderly way. In our shop you can get the sinus lift kit for the lateral approach and the lateral sinus lift kit. Individual elevators are useful to supplement an existing set or to replace a worn instrument.

Care and inspection

The working ends of sinus and membrane elevators must be smooth and free of burrs. After every reprocessing cycle, check under good lighting whether edges are damaged or bent. Even small burrs can injure the membrane. Cleaning, disinfection and steam sterilisation follow the manufacturer's reprocessing instructions. Tips on storage in cassettes can be found in our guide instrument cassettes and sieve trays.

Frequently asked questions

What is the difference between a sinus elevator and a membrane elevator?

The sinus elevator has a blunt, rounded, angled working end and detaches the membrane from the bone. The membrane elevator has a wider, thin-tapering blade and lifts the already detached membrane over a large area.

Which instruments are needed for a crestal sinus lift?

Apart from the implant drill set, mainly osteotomes in graduated diameters and a surgical mallet. Alternatively, hydraulic or piezosurgical systems are used.

How can membrane perforation be avoided?

Through careful window preparation, blunt and burr-free instruments and constant bone contact. The membrane is detached step by step starting from the window margin.

Can sinus lift instruments be autoclaved?

Instruments made of surgical stainless steel are steam-sterilised after cleaning and disinfection. Follow the reprocessing instructions.

Conclusion

A sinus lift requires only a few, but precise instruments: a periosteal elevator for the flap, a bur or piezo for the window, sinus elevators to detach and membrane elevators to lift the Schneiderian membrane. You will find all instruments in the category implantology and further surgical instruments under oral surgery.