Management of Combined Ridge Defect and Osteotome Sinus Floor Elevation With Simultaneous Implant Placement—A 36-Month Follow-Up Case Report
This report demonstrated the management of combined ridge defect and maxillary sinus pneumatization with simultaneous implant placement. One case with vertical and horizontal ridge deficiency and sinus pneumatization in the maxillary premolar area was indicated for ridge augmentation and sinus elevation before implant placement. Implant osteotomy was enlarged using a ridge expansion osteotome to 1 mm short of the sinus floor; sinus elevation was performed using sinus lift osteotomes; the implant was placed; bone graft and resorbable membrane were used to augment the remaining defect. The second stage was done after 6 months, followed by final restoration. The patient was reevaluated for 36 months following the final prosthesis. The surgical site healed without complication following implant placement. During the second stage, the implant was completely surrounded by bone, with bone covering the buccal aspect of the cover screw. The X-ray showed a 5 mm apical shift of the sinus floor at 6 months post surgery. At 12 months post loading, crestal bone loss to the level of the first thread was noted; no changes were observed at the sinus or surrounding teeth. Pocket depth ranged from 3–4 mm. No further bone loss or soft tissue contour change was noted at 18, 24, 30, and 36 months post loading. The combination of these three techniques with simultaneous implant placement as described in this report seems to be successful. Further research is needed to evaluate whether the combination of these techniques with simultaneous implant placement offers similar results when compared with the stage approach.Abstract
Figure 1. Initial periapical radiograph of the case showing the vertical ridge defect and sinus pneumatization. Figure 2. The combined ridge defect after surgical exposure. Figure 3. Ridge expansion osteotomes were used to enlarge the osteotomy. Figure 4. A 2.5 mm sinus lift osteotome was used for sinus floor infracture.
Figure 5. Implant site after completion of the osteotomy. Figure 6. After implant placement. Figure 7. Bone graft was used to cover the exposed threads and fill the defect. Figure 8. Resorbable collagen membrane was trimmed and adapted to the surgical site.
Figure 9. Immediate postsurgical photograph. Figure 10. Immediate postsurgical radiograph: Note the amount of sinus floor elevation obtained by this technique. Figure 11. At the second stage: The implant was completely surrounded by bone with bone covering the buccal aspect of the cover screw.
Figure 12. Radiograph taken after placing the healing abutment: note the apical shift of the sinus floor. Figure 13. Radiograph showing the implant and surrounding bone at 12 months post loading. Figure 14. Clinical photograph showing the implant at 36 months post loading. Figure 15. Radiograph showing the implant and surrounding bone at 36 months post loading.
Contributor Notes
Ali Saad Thafeed AlGhamdi, BDS, MS, is head of the Periodontic Division, and assistant professor and chairman in the Department of Oral Basic and Clinical Sciences, at King Abdulaziz University, Jeddah, Saudi Arabia. Address correspondence to Mr AlGhamdi at Department of Oral Basic and Clinical Sciences, Faculty of Dentistry, PO Box 109725, Jeddah 21351, Saudi Arabia. (e-mail: dr_thafeed@hotmail.com)