Reduction Crestal-Alveoloplasty with Sinus Graft

허영구 원장님 Dr. Heo

Author
Dr. Young-Ku Heo, DDS, MDS, PhD

Director of Global Academy of Osseointegration
Seoul, Korea



A 33-year-old, medically healthy patient
The treatment plan was as follows:
1) Left side sinus graft with lateral approach and an 8 month waiting period for healing
2) Sinus graft and implant placement: #26, 27
3) Implant placement: #22, 35, 37, 45, 46, 47
4) Implant placement after reduction of inferior part of the residual bone
5) Restore all teeth except #41,42,43.
슬라이드1
슬라이드2
On the occlusal view, rampant caries were observed.

슬라이드5
Lateral view of the right side in occlusion. Because of down growth of the maxillary posterior edentulous ridge (mostly from pneumatization of the maxillary sinus) and overgrowth of mandibular posterior edentulous area, inter-occlusal clearance was insufficient for any type of restorations in the maxilla and mandible. Reduction alveoloplasty of the maxilla was planned after sinus graft.

슬라이드6
A small vertical incision was made and the periosteum was raised so that the sinus lateral wall can be seen.

슬라이드3
Initial panoramic radiograph 4 years before starting the treatment. Many root rests were seen.

슬라이드4
Clinical photograph 4 years later. Dental caries on #13 and 23 were observed due to the patient’s poor oral hygiene.
Maxillary anterior teeth also had secondary caries underneath the crowns.


슬라이드7
The LS-reamer was used to make a lateral hole. The reamer should be tilted side to side for depth control while the operator should watch carefully the osteotomy site. When it gets closer to the sinus membrane, the color becomes bluish or dark.

슬라이드8
A lateral window was made in 30 seconds. In this case, the sinus membrane was exposed without a thin bony disk. If one wants to make a thin bony disk above the sinus membrane, he/ she should push the reamer a little harder during the drilling.

슬라이드10
Using the 90 angle part of the #02 elevator, the sinus membrane on the inferior part of the lateral wall was detached.

슬라이드11
The membrane over the sinus floor was detached with the 30 degree angle part of the #02 elevator.

슬라이드12
Two kinds of alloplastic graft materials (DM bone made of 2cc coral and 2cc Calpore) were added to the sinus graft (Left). The lateral window was covered with a resorbable collagen membrane (Lyoplant) (Right).

슬라이드13
Simple interrupted sutures were made along the vertical incision (Left). The incision site was completely healed in 10 days without pain and swelling (Right).

슬라이드14
A panoramic radiograph after the sinus graft. The remaining bone height was only 1mm. The lower part of the yellow line will be cut off after 8-9 months for creating interocclusal space.

슬라이드15
Occlusal view of left maxillary posterior area. Root rests were extracted 3 weeks previously.

슬라이드16
Panoramic radiograph after sinus graft and simultaneous implant placement. From only 1-2mm remaining bone 15 and 25 Ncm insertion torque for #26 and 27 implants, respectively, were obtained. Seven to eight months healing time was planned.

슬라이드17
A panoramic view seven months after the sinus graft on the left side.

슬라이드18
#26 and 27 was uncovered in seven months. Implant stabilities were measured with Ostell Mentor. ISQs were 73 and 71 for #26 and 27, respectively.

슬라이드19
One month after the 2nd surgery.

슬라이드20
A 3 unit-provisional restoration on implants #45, 46 and 47 was delivered to see how much inter-occlusal space was needed.

슬라이드21
9 months after the sinus graft in the left sinus. Some part of the alveolar ridge was removed to increase interocclusal space with bone rongeur.

슬라이드22
5.0X13mm long and wide implants were placed in the only grafted site. There was no original residual bone left.

슬라이드23
4 implants were placed successfully. The lateral wall where the bone graft was performed was completely filled with new bone-like material. The apical area of the #14 implant had severe concavity, so a bone graft was performed.

슬라이드24
A trephine drill was used to harvest some grafted bone in the 3rd molar area. Inset: Harvested bone with a trephine drill.
The bone density was D3~2.


슬라이드25
The one stage approach was applied. The implant fixation was charted as ‘D322 with 40 Ncm, D333 with 25 Ncm, D334 with 25 Ncm and D334 with 25 Ncm for implant #14, 15, 16, and 17, respectively.

슬라이드26
Panoramic view after the implants were placed in the right posterior maxilla 9 months after the graft. The crestal bone level was corrected, and the interocclusal space was secured.

슬라이드27
A histology of the biopsy shows favorable bony remodelling around the graft material.

슬라이드28
Buccal view of the right side. Favorable occlusal plane and interocclusal spaces were provided.

슬라이드29
Buccal view of the left molar area.

슬라이드32
Delivery of the restorations.

슬라이드33
2 year follow-up panoramic x-ray reveals well maintained marginal bone levels around implants. In the maxillary right posterior area, the implants have functioned well for 2 years in spite of grafted bone only.

슬라이드30
Final result of the treatment. It took about 14 months to finish.

슬라이드31
Delivery of the restorations.

Reduction alveoloplasty of the maxilla was planned after sinus graft.

44 Total Views 7 Views Today
0 Comments

Leave a reply

CONTACT US

We're not around right now. But you can send us an email and we'll get back to you, asap.

Sending

Copyright (c) GAO Forum. All Rights Reserved.

 

Forgot your details?