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