8-Year Result of A Lateral Window Opening with a LS-reamer and a Semilunar Flap

Dr. Nam Yoon Kim 김남윤원장님

Dr. Nam Yoon Kim, DDS, MDS, PhD

Director of Global Academy of Osseointegration
Seoul, Korea

A 67-year-old female
No other specific medical condition
Panoramic view before surgery. Missing teeth on upper right area were noted. The residual bone of #15, #16, and #17 were 6mm, 2mm and 7mm respectively.

Occlusal view of right maxillary posterior area at the first visit. Attached gingiva was sufficient, and the alveolar ridge was quite thick for flapless implant placement.

A horizontal incision was made over the mucogingival junction. Periosteum was reflected using periosteal elevator and appropriate sight and access was gained.

A lateral hole was prepared using the 7.5mm widest LS-reamer with 2000 rpm. A thin bone disk and darkish-blue colored maxillary sinus membrane were clearly shown (Watch Mov 1.). The hole should have been made more anteriorly for the membrane anterior to the hole to be detached easily.

Using the #01 Elevator in the SLA kit, the membrane was carefully elevated on the mesial and distal sides of the window.
The tip of the elevator should contact the bone with low angle every time so as not to perforate the sinus membrane.

The membrane at the lateral wall of the sinus below the window hole was to be elevated with the right angle tip of #02 Elevator in the SLA kit.

The membrane from the floor of the sinus and medial wall to the posterior area could be detached with the 30 degree angle tip of #02 Elevator in the SLA kit.

The 30 degree angle tip of #02 Elevator in the SLA kit was used to elevate that area.

The #03 Elevator was designed to detach the membrane where the other elevator was hard to reach, especially at deep mesial or distal areas.

The #03 Elevator was designed to detach the membrane where the other elevator was hard to reach, especially at deep mesial or distal areas.

2cc of Calpore Ⓡ (40% beta-tricalcium phosphate and 60% hydroxyapatite) was grafted in the elevated space beneath the sinus membrane. The bone was pushed into the space with gentle pressure, starting from the posterior, then the anterior, and finally the middle area, to prevent void formation.

4.0x11.5mm CMI IS type implants (Neobiotech, Seoul, Korea) was placed at #15 area with optimal insertion torque.

5.0x11.5mm CMI IS implants were placed at the #16 and #17 area. Fixture direction pins were used to place parallel implants.

An explorer was used to check the level of the implants from the surrounding alveolar bone. The level should be 0.5-1mm subcrestal. The fixation situation of each implant was: D332 with 35 Ncm at #15, D200 with 30 Ncm at #16, and D320 with 30 Ncm at #17 area.

The implants right after placing at #15, 16, and 17 area, showing grafting materials in the sinus lateral hole.

Healing abutments were connected. Continuous locking suture was performed to close the horizontal incision area.

Panoramic view after implant placement showing graft materials as radiopaque mass around implants on the #16 and 17 area.

10 days later, good soft tissue healing was observed without too much pain and swelling.

Step by step procedure of the SLA technique with a semilunar incision and simultaneous implant placement.

Definitive prostheses were delivered 5 months after the surgery.

Periapical view after delivery of final prostheses, showing the marginal bone was well maintained around the implants.

2 years of follow-up panoramic view showing remodeling of the sinus floor.

Clinical buccal view at 8 year follow-up showing that the soft tissue around the implants is healthy and well maintained.

8 years of follow-up periapical radiograph showing the marginal bone is over growing.

A long horizontal incision was made for the SLA technique with a large LS-reamer and flapless implant placement in #15,16, and 17 area

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