ALX Implant Placement with Lateral Sinus Approach in the Maxillary Posterior Area

Case Summary 🔎

Patient Information

•Age/Gender: 77-year-old, Male

•Past Medical History: None

•Dental History: Previously restored maxillary left posterior area with bridge; abutment teeth showed mobility and periodontal deterioration

•Drug allergy: None

•Chief complaint: “I want to replace the unstable bridge and regain comfortable chewing.”

Introduction

Implant rehabilitation in the maxillary posterior region can be challenging due to limited residual bone height, especially in elderly patients. In this case, a 77-year-old male underwent extraction and socket grafting at sites #26 and #27, but insufficient bone remained after healing, necessitating a lateral sinus augmentation.

With SLA kit, a lateral window sinus lift was performed, followed by placement of two ALX implants (#26: 5.5×6 mm, #27: 5.5×8 mm). Both implants achieved stable fixation despite softer bone at the sinus-augmented site. After six months of submerged healing, osseointegration was confirmed, and final prostheses were delivered using the CL-Link system.

This case demonstrates the predictable use of ALX implants combined with a lateral sinus approach to restore the maxillary posterior region with limited bone availability.

Treatment Plan

1. 1.Extraction of compromised teeth and socket grafting

2. Lateral window sinus augmentation for #27 site

3. Placement of ALX implants (#26: 5.5×6mm, #27: 5.5×8mm)

4. Submerged healing for 6 months

5. Final prosthesis delivery using CL-Link system

Case Presentation

1️⃣ Pre-Op

• Pre-operative view showing root exposure and gingival recession around the existing prosthesis. Due to tooth mobility and underlying bone loss, extraction was planned

  

• Extracted bridge showing severe root damage and bone loss

• Extraction socket after removal of infected tissue

  

• Bone graft was performed with suture. Implant placement is planned after a 6-month healing period

• 6-month after bone grafting, the soft tissue showing complete healing, but the ridge still shows significant bone deficiency, indicating inadequate regeneration and the need for additional augmentation before implant placement

  

2️⃣ Surgery

• VAROGuide surgical guide is positioned, and a tissue punch is used to precisely remove the soft tissue at the planned implant site, enabling a minimally invasive implant placement

• Guide drilling is performed, preparing the osteotomy with precision for ALX implant placement

  

• ALX fixture (5.5 X 6.0mm) with a 3mm cuff height is prepared for placement at the #26 site

  

• Following implant placement of #26, LS-reamer is used to create lateral window at the #27 site. This approach allows access for sinus augmentation, compensating for insufficient residual bone height prior to implant placement

• The lateral window has been created

  

• Lateral sinus augmentation was performed, and the graft material has been placed to elevate the sinus membrane and create sufficient vertical bone height for implant placement in the #27 region

• ALX fixture (5.5 X 8.0mm) with a 3mm cuff height is prepared for placement at the #27

  

• Both fixtures (#26 and #27) have been successfully placed following sinus augmentation. Bone density measurements showed D333 at site #26 and D300 at site #27. The insertion torque achieved was approximately 35 Ncm for #26, indicating solid primary stability, while #27 achieved around 10 Ncm, consistent with the softer bone quality in the augmented sinus area

• A collagen membrane has been carefully positioned to cover the lateral window after sinus augmentation. This ensures stabilization of the graft material and supports proper bone regeneration

  

• Suturing has been completed around the #26 and #27 implant sites, securing the flap and providing stable coverage over the augmented sinus and grafted area

• Post-op panoramic radiograph showing the placement of two implants in #26 and #27. It confirms proper positioning of both fixtures following sinus augmentation and implant surgery, with grafted sinus area visible around the #27 site

  

3️⃣ Prosthetic Fabrication & Final restoration

• 6-month post-op view showing well-healed soft tissue around implants #26 and #27. The peri-implant mucosa appears healthy and stable, indicating successful osseointegration and readiness for the prosthetic phase

• IT scan posts were connected to implants #26 and #27 for intraoral scanning

  

• The final prosthesis was delivered using the CL-Link system, allowing for a simple and efficient seating of the restoration

• Buccal view of the delivered prosthesis showing a natural emergence profile and harmonious integration with the adjacent dentition

  

  
  

4️⃣ Final restoration

• Final prosthesis fabricated with the CL-Link was delivered 4 weeks after impression, 6 weeks post-surger

• Final panoramic radiograph after prosthesis delivery, showing well-positioned implants at #26 and #27 with stable surrounding bone levels. The sinus-augmented area appears uniform, and the prosthetic components are seated correctly without signs of complication

  

  
  

Conclusion

This case demonstrates the successful use of a lateral approach sinus augmentation combined with ALX implant placement to restore the maxillary posterior region with severely limited residual bone. Despite inadequate bone height even after initial socket grafting, the lateral window technique provided sufficient vertical space for stable implant insertion. The ALX implant system delivered predictable mechanical engagement in both sites, even with lower bone density at #27, ensuring reliable primary stability for submerged healing.

After 6 months of osseointegration, soft tissue maturation allowed for precise digital impressions and efficient final prosthesis delivery using the CL-Link system. This case highlights how proper surgical planning, guided osteotomy, and the use of ALX implants can facilitate predictable outcomes in complex posterior maxillary rehabilitation requiring sinus augmentation.