Bone Augmentation and Sinus Lift Before Implants
Why Bone Volume Determines Implant Success
A dental implant is an artificial tooth root made of titanium or ceramic, anchored directly in the jawbone. For this anchorage to hold long-term, the bone must offer sufficient height, width, and density. If that volume is lacking, a stable implant placement is not possible.
The issue is more common than most patients expect. According to the German Association of Dental Implantology (DGI), approximately 40 to 60 percent of all implant cases require concurrent or prior bone augmentation. The most frequent cause: after tooth loss, the body resorbs the jawbone that is no longer under functional load. This process begins within the first months after extraction and continues over years.
At Pul's Zahnmedizin in WiloHealthCube, Wilopark 15 in Dortmund Phoenix-West, we follow a clear principle: precise diagnostics first, an honest assessment of whether bone augmentation is necessary, and then treatment by the specialist — all at a single location.
How Jawbone Loss Occurs
The jawbone is not a static structure. It responds to mechanical loading. As long as a tooth transmits chewing forces into the bone, the bone remains stable. Once that stimulus disappears, disuse atrophy sets in.
Research shows that alveolar bone can lose up to 25 percent of its width in the first year after tooth extraction (source: Tan WL et al., Clinical Oral Implants Research, 2012). Over several years, the loss may progress to the point where implant placement is simply no longer feasible.
Additional causes of bone deficiency include:
- Periodontitis: Chronic inflammation of the supporting tissues progressively destroys the surrounding bone. In Germany, the 6th German Oral Health Study (DMS VI, 2025) reports that approximately 65 percent of younger seniors suffer from moderate to severe periodontitis.
- Prolonged edentulism: The longer a gap remains untreated, the more bone is lost.
- Anatomical factors: In the upper posterior jaw, the maxillary sinus often sits very close to the alveolar ridge. The natural bone height here is frequently insufficient for implant placement.
- Trauma or cysts: Accidents or pathological changes can leave localized bone defects.
DVT Diagnostics: The Jawbone in Three Dimensions
Whether bone augmentation is needed cannot be determined from a conventional X-ray. It requires a three-dimensional view of the jaw.
At Pul's Zahnmedizin, Dr. Pul creates a Digital Volume Tomography (DVT) scan — a low-radiation 3D image that maps the jawbone with millimeter precision. The DVT reveals:
- the exact bone height and width at the planned implant site
- the distance to anatomical structures such as the maxillary sinus or the inferior alveolar nerve
- bone density and existing defects
Based on this data, Dr. Pul determines the available bone volume and plans the optimal treatment approach together with the oral surgeon. Learn more about our digital diagnostics in our post on the fully digital workflow.
Bone Augmentation Procedures
Depending on the initial findings, different augmentation techniques are used. All surgical procedures at our practice are performed by a specialist oral surgeon who regularly practices at our clinic at Wilopark 15 in Dortmund. More about our surgical services on our oral surgery page.
Sinus Lift (Maxillary Sinus Floor Elevation)
The sinus lift is the most common augmentation procedure in the upper posterior jaw. It becomes necessary when the bone height between the alveolar ridge and the maxillary sinus floor is insufficient for implant placement. The German Society for Oral and Maxillofacial Surgery (DGMKG) describes the sinus lift as a standard procedure with a success rate exceeding 95 percent when properly indicated and executed.
During a sinus lift, the sinus membrane (Schneiderian membrane) is carefully elevated, and the resulting space is filled with bone graft material or autogenous bone. After a healing period of typically four to nine months, new bone has formed in which the implant can be securely anchored.
There are two variants:
- Lateral (external) sinus lift: Access through a lateral bone window. Suitable for larger bone deficits (residual bone height below 5 mm).
- Crestal (internal) sinus lift (osteotome technique): Access through the implant drill hole. Less invasive, but only feasible with minor bone deficits (residual bone height above 5 mm). In favorable cases, the implant can be placed in the same session.
Ridge Augmentation (Block Bone Grafting)
When the alveolar ridge lacks sufficient width or height, it can be rebuilt with grafted bone. Autogenous bone — often harvested from the mandibular angle or chin area — or a suitable bone substitute material is fixed to the defect site.
Bone Spreading and Bone Splitting
If the ridge is too narrow, the existing bone can be carefully expanded (bone spreading) or longitudinally split (bone splitting), and the resulting gap filled with augmentation material. These techniques are less invasive than block grafting.
Guided Bone Regeneration (GBR)
For smaller defects, a membrane is placed over the bone defect to prevent soft tissue from growing in, giving the bone space to regenerate. This technique is frequently combined with other augmentation methods.
The Treatment Process at Pul's Zahnmedizin
The advantage of our specialist center in Dortmund is particularly evident in bone augmentation cases: diagnostics, surgery, and prosthetic restoration all take place under one roof. For a comprehensive overview of the full implant journey, see our post on the three phases of implantology.
Phase 1: Diagnostics and Planning (Dr. Pul)
Dr. Pul creates the DVT scan, analyzes the available bone volume, and discusses the findings with you. Together, a decision is made on whether bone augmentation is needed and which procedure is appropriate.
Phase 2: Surgical Procedure (Specialist Oral Surgeon)
The bone augmentation or sinus lift is performed by the oral surgeon directly at our practice at Wilopark 15. The procedure takes place under local anesthesia or, if preferred, under sedation.
Phase 3: Healing Phase
Depending on the technique and individual healing, bone integration takes three to nine months. During this time, new load-bearing bone forms. Dr. Pul monitors the healing process with follow-up imaging.
Phase 4: Implant Placement and Prosthetic Restoration (Teamwork)
After successful bone healing, the oral surgeon places the implant. Once the implant has integrated, Dr. Pul completes the final crown, bridge, or prosthetic restoration. More about our dental implants in Dortmund.
What Patients Should Know
Bone augmentation extends the overall treatment timeline, but it is not a complication — it is a necessary investment in the long-term stability of your implant. Without adequate bone, an implant would fail prematurely.
The healing phase requires patience, but the results speak for themselves: implants placed in augmented bone show survival rates exceeding 95 percent at 10 years in long-term studies, comparable to implants placed in native bone (source: Al-Nawas B, DGI Implant Guidelines, 2024).
Frequently Asked Questions
What is a sinus lift and when is it necessary?
A sinus lift is a bone augmentation procedure for the upper posterior jaw. It becomes necessary when the bone height between the ridge and the maxillary sinus is insufficient for implant placement. At Pul's Zahnmedizin in Dortmund, a specialist oral surgeon performs the procedure directly in our practice.
Is bone augmentation painful?
The procedure itself is performed under local anesthesia and is well tolerated by most patients. In the days following, some swelling and mild tenderness may occur, which can be managed effectively with cooling and, if needed, pain medication.
How long does the process take from bone grafting to finished implant?
Depending on the technique and individual healing, bone integration takes three to nine months. After that, implant placement and healing follow (another two to four months), then the prosthetic restoration. The entire process can take six to twelve months.
Does health insurance cover bone augmentation?
Bone augmentation procedures associated with dental implants are generally not covered by German statutory health insurance (GKV). Costs depend on the scope of the procedure and are billed according to the German dental fee schedule (GOZ). We provide transparent cost information before treatment begins.
Can every patient receive bone augmentation?
Most patients are suitable candidates for bone augmentation. However, certain contraindications exist, including severe systemic conditions, specific medications (e.g., bisphosphonates), or uncontrolled metabolic disorders. During your individual consultation, we clarify whether the procedure is appropriate for you.
Our Location in Dortmund
Pul's Zahnmedizin is located in WiloHealthCube at Wilopark 15 in Dortmund Phoenix-West. As a specialist center, we bring together general dentistry, oral surgery, and further specialties under one roof. For patients who require bone augmentation, this means no switching between practices for diagnostics, surgery, and prosthetics.
For patients from Dortmund, the Ruhr area, and the wider region, we offer seamless implant care at a single location.
The opening at Wilopark 15 in Dortmund Phoenix-West is planned for 2027.