Dec 17, 2020

Immediate Placement with the Crestal Sinus Elevation in Limited Available Bone Height

Situation

A 49-year-old femaleNo significant medical history and occasional daytime clenching. #25 and 26 were extracted due to endodontic failures caused by fractured endo files. Immediate implant placement was planned for both sites. The heights of the residual bone were 7mm for #25, 3-4mm for #26 and 2-3mm at #27. Sinus graft was performed by crestal approach for all sites.

Immediately after extractions. For #26, osteotomy was used, and aimed at the center of septum.

The height of the residual bone was expected to be 3-4mm on the radiographs. The S-reamer of 3.6mm diameter with 3mm stopper was used to drill through the septum.

The intact sinus membrane is visible through the osteotomy opening.

Sinus membrane at the buccal part of sinus floor is lifted with an SLA #01 elevator.

After the elevation of the sinus membrane, 1cc of alloplast biomaterials, CalporeⓇ (60% beta-tricalcium phosphate and 40% hydroxyapatite) was packed below the elevated sinus membrane.

An implant fixture (Neobiotech IS II 5.0X8mm) is placed after the bone packing. High final insertion torque (about 30 Ncm) was obtained from the fixation at the crestal cortical bone only.

Immediately after implant placements. Note the gaps between implants and the extraction socket walls.

Cover screws were tightened to prevent the bone particles from entering the connection part of the implants. 0.5 cc of RegenOss™ (FDBA) was used to fill the gaps around implants.

After the bone packing, the cover screws were removed and wide healing abutments were connected to seal the opening of the extraction sockets. The use of wide healing abutments will prevent the loss of bone grafts, and make suture unnecessary.