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Newsletter Articles

Case Study 10 Post-Extraction Delayed Implants and Bone Added Osteotome Sinus Floor Elevation

Post-Extraction Delayed Implants:

Post-extraction methods may utilize the pre-existing socket to good advantage. Wilson and Weber have described the waiting time between extraction and fixture insertion, classifying the sites as: immediate, recent, delayed and mature. The most popular methods have been delayed fixture insertion. A protracted waiting time between the dental extraction and the fixture insertion allows for the socket healing and a good soft tissue recovery. Accordingly, the surgical procedure would be easier. For this reason, we utilize most frequently post-extractive methods with limited time. Early post-extractive delayed methods, usually performed 45-90 days post-extraction, allow for soft tissue recovery, preventing for the most part the feared process of resorption at the bone ridge level, even if the re-ossification inside the socket is lacking.

Bone Added Osteotome Sinus Floor elevation:

An inadequate bucco-lingual and apico-occlusal dimension of the crestal bone under the maxillary sinus is a frequent anatomical restriction for the prosthetic rehabilitation of the posterior region of the upper jaw. The loss of teeth, together with a marginal and cortical resorption, produces a reduction in the alveolar bone height: as a matter of fact, after every extraction, the periosteum of the Schneider's membrane shows an increasing osteoclastic activity and there's a resorption of alveolar bone following the loss of marginal bone. As a direct consequence of this process, the distance between the highest point of the ridge and the sinus floor decreases and is not suitable for the insertion of implants.

Various techniques have been proposed in order to accomplish the necessary bony dimension for the insertion of implants: 1) The Guided Bone Regeneration (GBR) of the crestal bone, that is not always successful and 2) the elevation of sinus membrane by the lateral approach introduced by Tatum. For many years the surgical technique used for this operation involved a lateral approach that caused quite a trauma to the patient and required certain technical skills from the surgeon because of its difficulties. In 1994 Summers introduced a new technique with a crestal approach, reducing the problems linked to the surgical procedure. This approach can be used with simultaneous implant placement if there is at least 5mm of bone height.

In this case, #4 had been recently extracted. The #3 site had inadequate apico-occlusal dimension. Both implants were placed at the same time and the Summer’s osteotome technique was used to elevate the sinus for the posterior implant. Freeze-dried mineralized bone was used as a grafting material. The implants healed uneventfully and were restored 3 months later.

 

 

 

Pre-Op	Pre-Op X-Ray	Pre-Op 2
Implants Placed	Immediate Post-Op X-Ray Showing Sinus Floor Elevation	Sutured
Final Restorations / Occlusal View	Final X-Ray	Final Restoration