Background information
This 46 year old patient lost her endodontically treated tooth 26 restored with a ceramic crown due to a vertical root fracture . The tooth presented a severe root infection with a fistula , mobility and pain after percussion . The patient was advised that the tooth would need to be extracted immediately to avoid any progression of the infection and further bone loss . We explained to the patient that we need to wait 6 months to achieve sufficient bone volume and soft tissue healing . After this period we would take a CBCT scan and determine the most suitable technique for implant placement and subsequent tooth rehabilitation . 1 The patient decided to forgo a provisional prosthesis because the lost tooth did not influence her smile . She had already experienced a similar situation with tooth 16 which was rehabilitated with a lateral sinus floor augmentation approach , delayed implant placement and delayed ceramic crown loading . 2 – 4
2 . Aims of the therapy
> After healing , the CBCT scan showed 4 – 5 mm of bone height , sufficient to achieve primary implant stability . So , the aim of the treatment was to rehabilitate tooth 26 performing an indirect crestal sinus floor augmentation approach with immediate implant placement using Geistlich Bio-Oss ® Collagen . This protocol allows us a big reduction in the treatment period by performing only one single surgery . 5 – 12
3 . Surgical procedure
Fig . 1 Initial panoramic image obtained from the Cone Beam examination .
Fig . 2 Cone Beam analysis showing only 3 to 4 mm of bone height in region 26 .
Fig . 3 Occlusal view of the missing tooth 26 region . This technique of implant placement with simultaneous indirect sinus floor augmentation is performed in accordance with microsurgical principles involving optical magnification .
Fig . 4 Bone grafting and implant placement begins with the usual implant drills until we reach the cortical bone plate on the sinus floor . The cortical bone plate is opened with a round piezosurgical insert , exposing the same diameter of membrane as the implant preparation .
Fig . 5 After bone preparation , Geistlich Bio-Oss ® Collagen ( 100mg ) is divided into smaller blocks . The blocks are slowly inserted into the implant site one by one and compressed with vertical and lateral pressure to detach the Schneiderian membrane .
Fig . 6 When Geistlich Bio-Oss ® Collagen absorbs blood , it takes on a spongy consistency . This is ideal for exerting pressure on the membrane without any risk of injury . After graft placement we can confirm the resistance of the membrane .
2 I CASE 1