1 . Indication profile ( CASE 2 )
Region
Bone situation
Soft tissue situation
Implantation
n aesthetic region |
n non-aesthetic region |
n single tooth gap |
n multiple tooth gaps |
n bone defect present |
n no bone defect present |
n maxillary atrophy |
n recession |
n no recession |
|
n inflamed |
n infected |
|
n thick biotype |
n thin biotype |
|
n primary wound closure possible |
n primary wound closure not possible |
|
n intact papillae |
n impaired , missing papillae |
|
n adequately keratinised mucosa |
n inadequate keratinised mucosa |
n uneventful |
n simultaneously with bone augmentation ( 1 step ) |
n successively to bone augmentation ( 2 steps ) |
Background information
This 60 year old patient presents total upper edentation with severe bone atrophy . She wears a fully removable prosthesis in the upper jaw and a partial one in the lower jaw . She is a heavy bruxer and due to the presence of the lower anterior teeth she is a typical case of Kelly ’ s combination syndrome . The CBCT scan shows complete reabsorption of bone in the anterior region of the upper jaw and a very thin crest in the molar region . In such a case the only way to perform implants in the maxilla is by using bone grafts . The patient has requested a totally fixed upper and lower rehabilitation . 1
2 . Aims of the therapy
> In order to perform a full-arch fixed rehabilitation involving eight implants , three implants are placed using the lateral sinus floor augmentation approach on each side and two implants are placed in the anterior region in positions 13 and 23 with simultaneous Geistlich Bio-Oss ® Collagen grafting , thus elevating the sub-nasal membrane . 2 – 10
3 . Surgical procedure a ) b )
Fig . 1 Initial photo of the upper jaw showing the typical Kelly ’ s combination syndrome .
Fig . 2 Cone Beam examination used for treatment planning , showing the maxillary atrophy in the posterior and anterior region of the upper jaw .
Fig . 3 a ) Surgical flap opening for lateral sinus floor augmentation approach . b ) Osteotomy with piezosurgery . a ) b )
Fig . 4 a ) Finger support for better control when reaching the membrane . b ) Membrane detached , prepared for Geistlich Bio-Gide ® protection before grafting .
Fig . 5 Filling the sinus cavity and horizontal augmentation with Geistlich Bio-Oss ® Pen , small particles .
Fig . 6 The Graft is covered with a Geistlich Bio-Gide ® membrane .
4 I CASE 2