Successful Immediate Loading at One Week with ALX Implants Following Sinus Lift

Case Summary 🔎

Tooth #26 was extracted and immediately replaced with an implant combined with a sinus graft, while tooth #25 underwent delayed implant placement following alveolar ridge preservation.

Using Neobiotech’s new ALX implant system, high primary stability was achieved even in the compromised posterior maxilla, enabling immediate loading.

The final prosthesis was delivered one week after implant placement, and the 5-month follow-up demonstrated a stable and satisfactory clinical outcome.

Case Presentation

1️⃣ Diagnosis

Diagnosis

Teeth #25 and #26 were diagnosed with chronic periodontitis accompanied by noticeable mobility, indicating a poor long-term prognosis and the need for extraction.

Treatment Plan

The treatment plan was to first extract tooth #25 and perform alveolar ridge preservation using bone grafting materials, in order to maintain the site for future implant placement.

After a healing period of approximately 4 months, extraction of tooth #26 and simultaneous implant placement at both #25 and #26 sites were planned.

2️⃣ Surgical phase

[Extraction and Ridge Preservation]

• Tooth #25 was extracted, and granulation tissue was meticulously removed to eliminate residual infection and prepare a clean socket for grafting.

• Ridge preservation was performed using Neo Bone (100% cortical FDBA) to fill the socket, and a layer of bovine-derived S1 bone was placed over the graft to enhance stability and volume maintenance.

[Implant Placement and Sinus Lift]

• At the 4-month re-entry, drilling for implant placement at site #25 was initiated. During the same visit, tooth #26 exhibited increased mobility and was therefore extracted for immediate implant placement.

• Sequential drilling was performed for both implant sites, with final drilling completed to 3.5x10mm at site #25 and 4.0x10mm at site #26.

• At site #26, a crestal sinus lift was conducted due to insufficient vertical bone height, and the case was classified as Sinus Class II.

• At site #26, a D222 bone density was confirmed, and an ALX IT 5508 30WT implant was placed using a self-tapping technique with an insertion torque reduced from 80 to 40 Ncm for optimal control.

• At site #25, a D322 bone density was noted, and an ALX IT 4510 30 implant was inserted with self-tapping approach, with torque adjusted from 70 to 40 Ncm.

• Additional FDBA grafting (Neo Bone) was placed around the implant at site #26 to support the sinus area.

[Stability Check and Immediate Digital Workflow]

• Initial stability values (ISTV) were measured and adjusted as follows: #25 achieved 75, #26 achieved 86.

• Scan bodies were connected immediately after implant placement, and intraoral digital impressions were taken on the same day.

• A postoperative panoramic radiograph confirmed proper positioning of the implants.

3️⃣ Prosthetic phase - One Week Immediate Loading

• One week post-surgery, implant stability was re-evaluated using the AnyCheck device. Sufficient stability values (ISTV: #25 – 88, #26 – 88) allowed for immediate loading, and the final prosthesis was successfully delivered.

• Final occlusion was carefully adjusted to ensure even load distribution.

4️⃣ Follow-Up

• At the 5-week follow-up, the patient reported no discomfort, and the implants showed good stability. ISTV measurements remained consistent: #25 – 83, #26 – 85, indicating continued osseointegration.

• The 5-month follow-up confirmed a well-maintained, stable result, both clinically and radiographically.