Sinus Bone Grafting with Simultaneous Implant Placement in Case of Residual Bone Height Less Than 4mm Using TSIII SA Implant
By Yong-Jin Kim, Young-Jin Park, Kyung-Tae Park
Sinus bone grafting and implant placement are predictable treatment options for pneumatized maxillary sinus and severely resorbed maxillary posterior reconstruction. A minimum of 4~5 mm of residual bone height is traditionally recommended for the one-stage surgical procedure of sinus bone grafting and implant placement to ensure initial stability from preexisting residual bone. I would like to report the survival rates of the TSIII SA implants simultaneously placed into grafted maxillary sinus where the residual alveolar bone height was less than 4mm.
Materials & Methods:
- From Jan. 2010 through Sep. 2012
- Average follow-up : 15.8 7.1 months after the implant placement (Min. 188 day~Max. 1,003 day)
- Implant / Bone graft material : TSIII SA / OssteOss
- Site : Posterior maxillary bone deficiency / Residual alveolar bone height 1~4 mm
- Medical History : Those with controlled medical conditions
Perforation size < 5mm Fig 1-2 Bovine collagen membrane (Lyoplant , B.Braun Surgical GmbH, Germany) was used.
Perforation size > 5mm Fig 3-4 Bovine collagen membrane (Lyoplant , B.Braun Surgical GmbH ,Germany) was fixed to sinus medial wall with titanium pin (TruTACK , ACE Surgical Supply, USA) to obtain membrane security.
Time Schedule for Second Surgery and Prosthodontic Treatment
2nd stage surgery was performed about 5.57 months (Min. 112 ~ Max. 409day) after implant placement. Marginal bone level, implant mobility, and presence of fistula were examined. Final impression was taken 1 or 2 weeks after 2nd stage surgery.
In other words, final prosthetic performed about 6.23 months (Min. 139 ~ Max. 423 day) after implant placement. All patients were treated with a fixed implant-supported prosthesis for final restoration. The final tightening torque of abutment was 30Ncm. The screw-retained porcelain fused metal or gold crown was fabricated for definitive restorations.
Sinus bone grafting with simultaneous implant placement can be used to treat the atrophic maxilla in patients irrespective of residual bone when careful surgical methods and taper designed implants are used. Immediate sinus bone grafting with simultaneous implant placement can reduce the number of surgeries and overall treatment time. Membrane perforation did not have an adverse effect on implant success if the membrane was properly repaired.
In this study, even a short period of time, but the cumulative survival rates were 99.4% with an average follow-up of 15.8 7.1 months. So, it is concluded that sinus bone grafting with simultaneous implant placement in case of residual bone height less than 4mm could be considered as a predictable procedure.