Four perforation checks
We check all four: Valsalva (pinching the nose and exhaling), bubbles, saline leakage, and membrane elasticity. If even one is ambiguous, we treat it as a perforation and move on to the next step.
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GWONSEON SINUS LIFT
Sinus Lift Implants Why We Finish the Same Day Even if the Membrane Tears
The two things people worry about most in a sinus lift are membrane perforation and sinusitis. We first tell you what is done if they occur.
Why Diagnosis Matters
What are the risks in a sinus lift?
The representative complications of a sinus lift are perforation, in which the sinus membrane tears during surgery, and sinusitis before and after surgery. Membrane perforation is not uncommon, so what decides the result is not whether it is avoided but whether it is caught and repaired. At Yeonhap Dental Clinic, we check for perforation with four methods (Valsalva, bubbles, saline leakage, membrane elasticity), and if the judgment is ambiguous, we treat it as a perforation and switch to the lateral approach on the same day. If sinusitis is present, we postpone the sinus lift, re-check with CBCT 3 months after extraction, and then proceed.
Consultation Checklist
What we check at your first consultation
At the first consultation, we use 3D CT to look at the five items below and estimate the risks of perforation and sinusitis in advance.
- Thickness of the sinus membrane. If it is too thin or too thick, the risk of perforation increases
- Shape of the sinus floor. If there are root impressions or a septum, the membrane tears more easily
- Signs of inflammation inside the sinus. If there is clouding, treatment comes before a sinus lift
- History of sinusitis, nasal congestion or runny nose, and any history of ENT treatment
- When the upper molar was extracted and whether 3 months have passed since extraction
Treatment Options
This is how we check and deal with a membrane perforation
In the crestal approach, instead of tapping with instruments, we spread the force across the whole membrane with water pressure to reduce perforation. Perforation can still occur, so we carry out all four checks without exception, and if one is confirmed, we cover it on the spot with a collagen membrane and switch to the lateral approach to repair it.
If perforated, switch to the lateral approach on the same day
If a perforation is confirmed, we make a window in the cheek-side bone, cover the membrane with a collagen membrane while looking at it directly, and if initial stability is secured, complete the bone graft and placement on the same day. If it is not secured, we do the sinus lift first.
When sinusitis is present
We do not perform a sinus lift while infection is present. We re-check with CBCT 3 months after extraction; if it is still present, we re-evaluate after 1 week of antibiotics; if there is no improvement, we irrigate the inflamed area through a lateral approach, check the remaining inflammation and the condition of the membrane, and if we can proceed, continue directly with the sinus lift.
Planning Points
This is how the timeline differs depending on perforation and inflammation
The time until the final prosthesis is expected to be about 4-5 months or 6-7 months, depending on the remaining bone and the condition of fixation and healing. We do not decide the timeline based only on whether a perforation was repaired, and if sinusitis is present, we begin with the re-evaluation 3 months after extraction.
Sinusitis: re-check 3 months after extraction
If inflammation remains on CBCT 3 months after extraction, we re-evaluate after 1 week of antibiotics. If there is no improvement, we irrigate the inflamed area through a lateral approach, check the remaining inflammation and the condition of the membrane, and if we can proceed, continue directly with the sinus lift.
The timeline after a perforation is repaired
If it was repaired with a collagen membrane and the bone graft and placement were completed on the same day, the perforation does not necessarily lengthen the timeline. The timing of the final prosthesis is decided according to the remaining bone and the condition of fixation and healing.
Before Visit
Helpful details before your visit
If you know the items below before you come, we can tell you the perforation and sinusitis risks and the schedule at the first consultation.
- Whether you have ever been diagnosed with sinusitis or received ENT treatment
- Whether you have recently had nasal congestion, a runny nose, or facial pressure
- When the upper molar was extracted and whether there was inflammation at the root tip at the time
- The area and symptoms that bother you most right now
Why our standard for perforation is “never miss one,” not “never cause one”
Sinus membrane perforation is the most common complication of sinus lift and is reported in 7-56% of cases in the literature. In the lateral approach, the survival rate of implants placed after a perforation was repaired with a collagen membrane was 97.68%, and no significant difference was observed compared with 98.88% when the membrane was intact (7 studies, 3,604 implants, Díaz-Olivares 2021). In another meta-analysis that also pooled lateral approach studies, no significant difference was observed between repaired perforation sites at 97.1% and sites without perforation at 97.7% (7 studies, Schiavo-Di Flaviano 2024). Septa and smoking were associated with a greater likelihood of perforation (odds ratios of 3.56 and 2.57, respectively; meta-analysis, Liu 2026). For this reason, Yeonhap Dental Clinic's standard for perforation is not “never cause one” but “never miss one.” The real problem is when bone graft material is placed without knowing about a perforation and flows into the sinus. At Yeonhap Dental Clinic, if even one of the four checks (Valsalva, bubbles, saline leakage, membrane elasticity) is ambiguous, we treat it as a perforation, cover it with a collagen membrane on the spot, switch to the lateral approach to repair it, and if initial stability is secured, complete the placement the same day. If it is not secured, we do the sinus lift first. References: Díaz-Olivares 2021, implant survival after repair of membrane perforation in lateral approach sinus lift of 97.68% versus 98.88% with an intact membrane, no significant difference observed; 7 studies, 3,604 implants · Schiavo-Di Flaviano 2024, meta-analysis of the effect of membrane perforation on implant survival in the lateral approach (97.1% after repair versus 97.7%; no significant difference observed) · Liu 2026, meta-analysis of the incidence of membrane perforation in sinus lift and related factors (septum and smoking, odds ratios 3.56 and 2.57) Treatment results may vary depending on each person's oral condition.
Related links
Implant with sinus lift
Sinus Lift Implants in Suwon: Three Key Points
Sinus Lift Implants in Tap-dong: When Is a Sinus Lift Not Needed?
Sinus Lift: Yeonhap Dental Clinic's 3 Clinical Standards
When Sinusitis Does Not Settle and You Want an Implant
Sinus Lift: The Limits of the Crestal Approach and How to Overcome Them
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Frequently Asked Questions
- Q. If the sinus membrane is perforated, does the implant fail?
- A perforation by itself is not a failure. In the literature, perforation is reported in 7-56% of cases, and when it was covered with a collagen membrane as soon as it was identified and the bone graft and placement were completed, no significant difference in survival rate was observed (lateral approach studies). The problem is when bone graft material is placed without knowing about a perforation, so Yeonhap Dental Clinic treats any case as a perforation if even one of the four checks is ambiguous.
- Q. How many days do nosebleeds or nasal congestion last after sinus lift implant surgery?
- A heavy feeling on the nasal side or a small nosebleed for 2-3 days after surgery is common and mostly subsides within a week. For two weeks, you need to avoid blowing your nose hard, using a straw, and flying. If your nasal discharge smells or you have a fever even after a week, you must contact us right away.
- Q. If I have sinusitis, do I need to get ENT treatment before the implant?
- We do not perform a sinus lift while infection is present. We re-check with CBCT 3 months after extraction; if it is still present, we re-evaluate after 1 week of antibiotics, and if there is no improvement, we irrigate the inflamed area through a lateral approach, check the remaining inflammation and the condition of the membrane, and if we can proceed, continue directly with the sinus lift. If you are receiving ENT treatment for chronic sinusitis, we start after that treatment is finished.
- Q. If a sinus lift implant fails, can it be done again?
- Yes. The standard is to remove the failed implant and place again after 3 months, and we avoid placing again right away. At re-placement, a bone graft is done together depending on the condition of the bone, and if sinusitis was the cause, we resolve the inflammation first.