One-Stage Immediate ALX Implant Placement With Crestal Sinus Augmentation

Case Summary 🔎

Patient Information

• Medical History:  Osteoporosis

• Drug allergy: Loxoprofen

Introduction

Implant placement in the posterior maxilla often presents challenges due to limited bone height and proximity to the maxillary sinus. Recently, immediate implant placement after tooth extraction has become increasingly popular. It offers several advantages, including shorter treatment time, preservation of alveolar bone, and improved patient comfort.

This case describes the immediate placement of two implants in the posterior maxilla (#14 and #15) following tooth extraction. At site #15, a crestal sinus elevation was performed due to insufficient residual bone height. The ALX system was used for implant placement, providing excellent primary stability. This enabled early functional loading within just one month after surgery. This case highlights a predictable and efficient approach for managing posterior maxillary sites with simultaneous extraction, sinus grafting, and accelerated prosthetic restoration.

Treatment Plan

1. Extraction of #14 and #15 was planned on the same day as implant placement.

2. At site #15, a crestal approach using the SCA Kit was necessary due to insufficient vertical bone height.

3. Sinus grafting and implant placement were performed simultaneously.

4. Early loading was planned, aiming to deliver the final restoration 4 weeks post-operatively.

Case Presentation

1️⃣ Pre-Op

• Tooth #15 was located in close proximity to the maxillary sinus floor, and residual bone height was insufficient—indicating the need for sinus augmentation.

• The loss of lamina dura indicated a hopeless prognosis, supporting the decision for extraction and immediate implant placement.

2️⃣ Surgery - ALX Implant System

• Immediate post-extraction view of #14 and #15 showing intact socket walls, suitable for immediate implant placement.

• A crestal sinus elevation was initiated at site #15 using a ø3.2 S-reamer.

• S-reamer with a 10mm stopper used at site #15 to safely control the depth during crestal sinus elevation.

• The initial osteotomy was performed using a ø2.2 twist drill as the first step in the sequential drilling protocol.

• Final osteotomy performed with a ø3.5 twist drill in preparation for placement of ø4.5 ALX fixture.

• #15

  • Bone density: D332

  • Fixture size: ALXIT 4510 30

• #14

  • Bone density: D333

  • Fixture size: ALXIT 4512 30

• Scan bodies were placed on both implants for intraoral digital scanning on the day of surgery.

3️⃣ Post-Op

• A post-operative panoramic radiograph confirmed that the implants at sites #14 and #15 were well-positioned.

4️⃣ Prosthetics

• At the 1-month follow-up, healing abutments were placed. The surrounding soft tissue was well-maintained with no signs of inflammation, indicating a favorable peri-implant response.

  • ISTV: #14 - 82, #15 - 84

• A try-in of the final prosthesis was performed at the 1-month mark.

• The final restoration was delivered one month after surgery. Occlusal contacts were carefully evaluated and adjusted to ensure proper function.

• The final prosthesis showed satisfactory esthetics, proper occlusal contact, and healthy peri-implant soft tissue.

• A final panoramic radiograph taken after delivery of the definitive restoration confirmed stable implant integration at sites #14 and #15.

5️⃣ Conclusion

This case demonstrates the clinical predictability of immediate implant placement combined with crestal sinus augmentation and early loading.

Even in medically compromised patients—such as those with osteoporosis—favorable outcomes can be achieved when proper planning and implant selection are ensured.

In this case, the ALX implant system provided excellent primary stability at both sites, which enabled early functional loading just one month after surgery. This predictable stability was a key factor in achieving efficient treatment flow and a successful prosthetic outcome.