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6 Year Result of a 7mm Sinus Elevation with the Crestal Approach Utilizing Micro-elevators

Patient information Patient: 42 years old male Preoperative observation

Panoramic view at first visit. #25, #26, & #27 teeth were missing. 4-8mm residual bone heights were observed. Treatment planning 1) #25: Class II CMI Fixation 2) #26: Class III CM Fixation (with crestal bone graft) 3) #27: Class II or Class III Fixation Prostheses: Implant supported 3-unit FPD on the implants

 

After serial drilling with twist drills, S-reamers (Ø2.4mm S-reamer for #25 for Class II fixation, Ø3.6mm for #26 for Class III fixation, and Ø3.2mm for #27 for Class II fixation) were used with at least 1200 rpm, starting by drilling 1mm less than the depth to the sinus floor, then continuing up to the opening of the inferior wall of the sinus.

A periapical view after placing EB type CMI implant (4.0X11.5). The apex of the implant was placed 1-2mm into the sinus without bone graft (Class II CMI fixation) at #25 area. Bone density was D332 with 40 Ncm, which may be the result of obtaining Class II fixation.

At #26 area, the available bone height was 3-4mm. The micro-elevators of the SLA kit were used to elevate the maxillary sinus membrane through the crestal hole. This procedure can be done in case of limited bone height (1-3mm).


0.3cc of alloplastic bone graft material (Calpore) was inserted below the elevated Schneiderian membrane to fill about 5mm at the #26 area.

Two EB type CMI implants (5.0X8.5) were placed at the #26 and #27 areas. Insertion torques were 40 and 30 Ncm at #26 and #27 respectively. That amount of insertion torque might result from a combination of inferior cortical fixation and self-compaction technique.

Healing abutments were connected because of sufficient initial stabilities. Interrupted suture was performed with adequate attached gingiva.

Panoramic view right after surgery. About 7mm height of grafting material at the #26 fixture was observed as dome-shaped radiopaque mass. It was possible to obtain extensive elevation with the micro-elevator.

One month after implant placement surgery. Good soft tissue healing was seen. Impression was made at that time.

A temporary cemented crown of #24 was removed. SCRP abutments were connected at #25, #26, and #27 one week after the impression.

A definitive SCR 3-unit PFM FPD (SCRP) was completed within 40 days after the surgery by cementing it on the abutments with a permanent resin cement. This prosthesis is retrievable through the screw holes.

Buccal view of the prosthesis after final cementation.

Frontal view of the prosthesis.

Panoramic view at the delivery of the prosthesis. Marginal bone and elevated bone graft material seemed stable.

Periapical radiograph at the delivery of the prosthesis. No cement remnant was observed due to SCRP type prosthesis which can be removed and polished separately. Good marginal fit between abutments and FPD is observed.

A periapical view of 3 year follow-up. No specific difference was seen.

Panoramic view of 6 year follow-up.

A periapical view of 6 year follow-up. Peri-implant bone level is well maintained.

Occlusal view of the SCRP: 6 year follow-up.

CT images of #25, #26 and #27 implants at 6 year follow-up. Marginal bone levels were well maintained while 0.5mm of apices came out from the bone due to re-pneumatization, but were covered by the membrane. This may be a kind of bone remodeling phenomenon, explaining why no more bone is needed in the apex for occlusal support.

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