Simultaneous implant placement with bilateral sinus floor augmentation in atrophic ridge of maxilla.
By Du-Eun Park
Introduction:
After the extraction of maxillary posterior tooth, the extraction area undergoes wound healing process which generally creates an unfavorable esthetic and morphological soft and hard-tissue complex. Especially periodontally compromised tooth causes large amount of alveolar bone resorption and sinus pneumatization. Conventionally, placement and integration of endosseous implants in patient with such atrophic ridges requires augmentation of the maxillary sinus floor.
Sinus augmentation is classified according to residual alveolar bone height. When the residual bone height is less than 3 mm, 2-step lateral approach is recommended. But data published since 1998 have shown that using an appropriate implant design and an optimal surgical technique, sinus floor augmentation with simultaneous implant placement can be performed in cases of 1 to 2 mm of residual alveolar bone height with predictable results during a follow-up >10 years.
Materials & Methods:
Age/Sex: 66 / F
Chief complaint: severe chronic periodontitis.
Treatment: #17, 24, 31, 32, 41, 42, 46 teeth were extracted. Severe bone loss was observed 6 months after extraction.
Fig.1 Pre-operative panoramic radiograph Fig.2 Six months follow up after multiple extraction and #36,37 implant placement
In mandibular area, implants were placed at #32, 42, 36, 37, 46, 47 extraction site.
In presurgical computed tomographic scan images, residual bone height was about 1.0~2.0 mm. First stage implant surgery was performed using TSIII (#15,17,24,26) with sinus augmentation. Lateral approach for the open-window method using osstem LAS kit and for sinus lifting with placement of Xenoplast was carried out. Second stage surgery was performed after 4 months of healing. There were no surgical complications such as sinus membrane perforation and achieving adequate initial implant stability(30N) and maintaining parallelism are major concerns in implant placement.
Fig.3 Panoramic radiograph after implant placement
Results:
Although residual bone height below 2mm, initial implant stability and parallelism are achieved. There were no surgical complications such as infection or sinus mem-brane perforation. Patient were satisfied with the clinical outcome.
Conclusion:
LAS kit for the sinus floor elevation makes lateral window formation safe and easy. Simultaneous implant placement was predictable procedures available for placing dental implants in the severely atrophic posterior maxilla.
In this case, Osstem TSIII implant system was successfully integrated with graft material in radiograph.
