Class III M Fixation with Sinus Crestal Elevation and GBR with a Ti mesh

Dr. Nam Yoon Kim 김남윤원장님

Author
Dr. Nam Yoon Kim, DDS, MDS, PhD

Director of Global Academy of Osseointegration
Seoul, Korea



A 58-year-old male good general health despite 20 years of smoking.
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Pre-op panorama: Bilateral partial edentulism on the maxilla. Both posterior regions require sinus augmentation for implant placement. Severe bone loss and PDL space widening around the maxillary left 2nd premolar (#25). The extraction socket of the 2nd molar (#27) is not completely healed.
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Soft tissue healing three weeks post-extraction.

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Bony defects at the extraction sites of 2nd premolar and 2nd molar.

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Crestal approach for sinus lifting and grafting with the SCA reamer.

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Crestal approach for sinus lifting and grafting with the SCA reamer.

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Crestal approach for sinus lifting and grafting with the SCA reamer.

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Three implants placed at the sites of #25, 26, 27. The threads of the #25, 27 implants are exposed due to the size of the bony defect.

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FDBA graft packed over the implants and defects.

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A titanium membrane was placed over the graft. Titanium membranes are preferred to resorbable membranes in terms of space maintenance.

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A titanium membrane was placed over the graft. Titanium membranes are preferred to resorbable membranes in terms of space maintenance.

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Interrupted suture with supramid 4-0.

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Post-op panorama. Note two additional implants were placed in the maxillary right posterior edentulous region.

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The initial stability for #25 was low (approx. 5 Ncm), compared to 20 Ncm for #26 and 35 Ncm for #27 respectively.

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Soft tissue healing at 2nd surgery.

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Removal of titanium membrane after 10 weeks.

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Note the excellent bone formation underneath the titanium membrane.

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The implants are uncovered by removing the excess bone formed on top of the implants.

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Unique flap design to maximize the keratinized gingiva.

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The final prosthesis on maxillary right posterior region is delivered. The final prosthesis on the left side will be fabricated after the grafted bone matures.

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Soft tissue is healed around healing abutment after 2nd surgery.

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Monolithic zirconia restorations are fabricated for final prosthesis.

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Stock abutments are milled to fabricate cement-retained prosthesis.

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The final prosthesis (splinted monolithic zirconia crowns) is delivered after contact and occlusal adjustments.

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The final prosthesis (splinted monolithic zirconia crowns) is delivered after contact and occlusal adjustments.

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Occlusal access holes (for SCRP prosthesis) are prepared at the fossa areas.

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The fit of the prosthesis is verified on periapical x-ray.

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After final cementation with permanent resin cement and removal of the excess cement by removing the whole prosthesis.

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Lateral view: The final prosthesis in occlusion.

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Periapical x-ray of the final prosthesis.

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Pre-op panorama: Partial edentulism on maxillary right posterior region. The height of the remaining alveolar ridge at the 1st molar site is 4-6mm.

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Panoramic x-ray immediately after sinus grafting procedure.

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3-year follow-up panorama.

Bilateral partial edentulism on the maxilla. Both posterior regions require sinus augmentation for implant placement. 

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