Reduction Crestal-Alveoloplasty and Sinus Graft for Implant Stability

Case Summary 🔎

Patient Information

• Age/Gender: 33-year-old

• Systemic Condition: No underlying systemic disease, medically healthy

Clinical Findings

• Tooth Site: Multiple sites

• Diagnosis:

  • Recurrent caries on anterior abutment teeth

  • Severe inter-occlusal space deficiency due to progressive alveolar ridge resorption in the right partially edentulous maxilla

• Radiographic Findings:

  • Extensive maxillary sinus pneumatization, resulting in minimal residual alveolar bone height insufficient for restoration

Clinical Summary

• The patient returned 4 years after undergoing multiple retained root extractions and dental restorations. However, poor oral hygiene led to recurrent caries on the anterior abutments, requiring re-restoration.

• Additionally, due to progressive alveolar ridge resorption in the right partially edentulous maxilla, inter-occlusal space was insufficient for proper restoration.

• A portion of the residual ridge and gingiva needed to be removed, but this posed a risk of sinus membrane exposure due to severe maxillary sinus pneumatization.

Treatment Plan 

• Left-side sinus graft with a lateral approach, followed by an 8-month healing period

• Implant placement after reduction of the inferior part of the residual bone

Conclusion

• In this case, a sinus graft and crestal alveoloplasty were performed to secure inter-occlusal space for proper prosthetic restoration. Implants were successfully placed in the grafted bone, ensuring stable support for the final prosthesis.

• The treatment outcome was excellent, and the patient achieved both functional and esthetic satisfaction.

Case Presentation

1️⃣ Pre-Op

• The patient exhibited dental caries on #13 and #23 due to poor oral hygiene, with recurrent caries present beneath the crowns of the maxillary anterior teeth.

• Additionally, extensive maxillary sinus pneumatization led to progressive downward resorption of the maxillary posterior edentulous ridge, while mandibular overgrowth further reduced inter-occlusal clearance, making prosthetic restoration challenging.

• To address this, crestal alveoloplasty of the maxilla was planned following a sinus graft.

2️⃣ Surgery - Sinus Graft Lateral Approach (SLA)

• Due to extensive pneumatization of the maxillary sinus and mandibular posterior ridge overgrowth, inter-occlusal clearance was insufficient, making prosthetic restoration challenging. Crestal alveoloplasty of the maxilla was planned following the sinus graft to address this issue.

• A small vertical incision was made, and the periosteum was elevated to expose the lateral wall of the maxillary sinus.

• The LS-Reamer was used to create a lateral window, with careful depth control to prevent sinus membrane perforation. Within 30 seconds, the sinus membrane was successfully exposed without a bony disk.

• The #02 elevator (90° angle) was used to detach the sinus membrane from the inferior lateral wall, followed by the #03 elevator (30° angle) to separate the membrane over the sinus floor.

  

  

• For grafting, 2cc of DM bone (coral-based) and 2cc of Calpore were placed into the sinus cavity. The lateral window was then covered with a resorbable collagen membrane (Lyoplant) to protect the site.

  

  

• Simple interrupted sutures were placed along the vertical incision, and the site healed completely within 10 days, with no pain or swelling.

  

  

• A postoperative panoramic radiograph showed a residual bone height of only 1mm. Crestal reduction of the alveolar ridge was planned 8–9 months later to create sufficient inter-occlusal space for restoration.

3️⃣ Surgery - Reduction Crestal-Alveoloplasty

• A 3-unit provisional restoration on implants #45, #46, and #47 was used to assess inter-occlusal space. After 9 months, crestal alveolar ridge reduction was performed using a bone rongeur to further optimize the space for the definitive prosthesis.

• In the fully grafted site, four ∅5.0×13mm implants were successfully placed, as no residual bone remained. The lateral wall was completely filled with bone-like graft material, and an additional bone graft was performed at the apical area of implant #14 due to severe concavity.

• A trephine drill was used to harvest grafted bone from the third molar area (bone density: D3–2).

• A one-stage approach was applied, with implant fixation recorded as:

  • #14: D322 (40 Ncm)

  • #15: D333 (25 Ncm)

  • #16, #17: D334 (25 Ncm)

4️⃣ Post-Op

• A panoramic radiograph taken 9 months post-graft confirmed well-corrected crestal bone levels and secured inter-occlusal space, ensuring a stable foundation for restoration.

• A biopsy histology confirmed favorable bony remodeling around the graft material.

5️⃣ Final Restoration

• The entire treatment took approximately 14 months to complete. A periapical X-ray at restoration delivery confirmed successful implant placement.

6️⃣ Follow-Up

• A 2-year follow-up panoramic X-ray showed well-maintained marginal bone levels, with stable implants in the maxillary right posterior area, despite being supported only by grafted bone.