The Perfect Sinus Lift

The Perfect Sinus Lift - or at least my perception of it !!

Praia do Cabeço, Algarve — August 14, 2026

Sometimes, after many years of surgery, there are procedures that remind us why we still enjoy operating.

Yesterday, I performed what I would probably describe as the perfect lateral window sinus lift.

Not because it was particularly complex. Not because I used a new instrument or a sophisticated technique. Quite the opposite. It was memorable because the anatomy, visibility, surgical access and technique came together so perfectly that every step of the procedure became almost a demonstration of the biological principles behind sinus augmentation.

I only regretted one thing: there were not more people in the room to watch it. Arlette and Sofia were there with me, but this was one of those surgeries that would have been beautiful to teach.

Anatomy that allowed us to see everything

The case involved a posterior maxillary edentulous area in the first quadrant.

The anatomy was particularly favorable from a surgical perspective. Following the crestal incision and mesial and distal releasing incisions, we obtained excellent exposure of the lateral maxillary wall.

The CBCT showed a very characteristic residual bone pattern: reasonable bone height in the premolar region, progressively decreasing posteriorly until reaching the molar area, where very little residual vertical bone remained.

Once the flap was reflected, this anatomy could almost be read directly from the surgical field.

The lateral window

Using the piezoelectric instrument, I prepared the lateral window.

The osteotomy was exceptionally clean.

The remaining bony window was extremely thin, allowing it to be mobilized without placing unnecessary tension on the Schneiderian membrane.

From that moment onward, the procedure became remarkably simple.

For probably the first time in my experience, I was able to perform almost the entire initial sinus membrane elevation using essentially one sinus curette.

The access was so favorable that the instrument could move freely throughout the cavity. Anteriorly. Posteriorly. Superiorly. Inferiorly.

There was almost a 360-degree freedom of movement.

More importantly, through the instrument it was possible to feel extremely clearly the separation between the Schneiderian membrane and the underlying bone.

The membrane elevated beautifully.

Reaching the medial wall

Once the initial elevation had been completed, I introduced the larger, shell-shaped sinus curette.

Because visibility was exceptional, we rapidly reached the medial wall.

And this was perhaps the most beautiful part of the procedure.

The medial wall could be clearly visualized. The vascular anatomy could be appreciated. The entire regenerative compartment was visible.

It became almost a live demonstration of why lateral window sinus augmentation works biologically.

Once the Schneiderian membrane is adequately elevated, we create a protected and contained regenerative space surrounded by vascularized bony walls.

The blood supply is there.

The osteogenic surfaces are there.

The stability of the compartment is there.

When those conditions are respected, it becomes very easy to understand why this technique can result in such predictable formation of vital bone.

Creating the regenerative compartment

After completing the membrane elevation, I placed a collagen membrane between the elevated Schneiderian membrane and the grafted compartment.

This created an exceptionally well-defined and protected cavity.

The geometry of the space made graft placement extremely controlled. It was possible to distribute the biomaterial throughout the compartment—anteriorly, posteriorly, medially and superiorly—without excessive compression.

Once the cavity had been completely reconstructed, the original bony window could also be repositioned.

At that point, the regenerative compartment was complete.

Closure

The final step was one that I particularly enjoyed.

Two periosteal sutures were extended toward the palatal aspect, creating controlled compression of the connective tissues against the membrane covering the lateral window.

These were complemented with simple interrupted sutures.

The objective was not simply to approximate the wound margins.

It was to create stability and sealing of the entire regenerative complex.

The connective tissue was gently compressed against the lateral membrane, stabilizing everything underneath it.

The result was a completely protected grafted compartment with an excellent soft-tissue closure.

Postoperative control

The postoperative CBCT confirmed what we had observed clinically: the sinus cavity had been beautifully reconstructed and the graft was distributed exactly where we wanted it.

The patient received our usual postoperative pharmacological protocol, including azithromycin, together with etoricoxib and paracetamol for postoperative pain and inflammatory control.

Everything looked exactly as planned.

Why this case stayed with me

I have performed many sinus lifts over the years, and fortunately the overwhelming majority have progressed extremely well.

But occasionally there is a surgery where everything simply aligns.

The anatomy gives you access.

The instruments give you control.

The membrane responds exactly as expected.

The biology becomes visible.

And the surgical field almost teaches the procedure back to you.

Yesterday was one of those surgeries.

There was no spectacular trick and no revolutionary technique.

There was simply good anatomy, good visibility, respect for the tissues and a technique that has become completely familiar through repetition.

Perhaps that is ultimately what surgical experience gives us.

Not the ability to make difficult surgery look dramatic.

But the ability to make it look simple.

And yesterday, for a few moments, the lateral window sinus lift felt exactly like that.