and 1 other(s)
Background: The atrophy of edentulous ridge and pneumatization of the maxillary sinus often limit the implant placement on posterior maxilla. The success of maxillary posterior implant depends on the increase of the available bone and initial stability of the implant after maxillary sinus reconstruction. Less morbidity and complications after operation is major advantage of crestal approach than lateral approach. However, when the residual ridge height is less than 5 mm, it is known that lateral approach is appropriate and delayed implantation is recommended in severely atrophic ridge. However, in recent studies, unlike the conventional concept, it is believed that simultaneous placement of the long implant using the crestal approach is reliable, even if the residual bone is less than 4 mm Aim: We present the three cases of implant placement simultaneously sinus augmentation using crestal approach in posterior maxilla site with 3 mm or less of residual alveolar bone height. The objective of this study was to suggest implant placement simultaneously crestal approach as the treatment option in severely atrophic maxilla. Material and Methods: After extraction of hopeless teeth, cone beam computed tomography was taken to determine the bone quality and quantity of intended implant sites. In first case, residual vertical bone height was 1.4mm and bone quality was type 4. In second case, 2.2mm of vertical bone height and type 2 bone quality was observed. In third case, 2.9mm of vertical bone height and type 3 bone quality was observed. In all three cases, sinus elevation with CAS kit (Crestal approach sinus kit, Osstem, Seoul, Korea) was performed and the trapped space was filled with xenograft (Bio-Oss, Geistlich, Wolhusen, Swiss). Xenograft was spreaded by bone spreader, so that would be reduce the tension of lifted sinus membrane. To ensure the stability of implant, underdrilling with CAS drill was performed. Internal connection type implants of 13 mm length with SLA surface were placed and initial fixation was stable in all three cases. After 6-7months later, 2nd surgery was performed. Results: In first case, there is no complications during the healing period and implant stability quotient (ISQ) was 85 at 2nd surgery. Five months later, final prosthesis was delivered. At one year follow up, marginal bone and augmented bone level was stable and soft tissue around implant was healthy. Patient had no discomfort and were satisfied with this results. In second case, ISQ was 85 at 2nd surgery and then final prosthesis was delivered. A great amount of bone fill in maxillary sinus was observed in radiography. Marginal bone and augmented bone level was stable at 1.5 year after final prosthesis delivery. In third case, ISQ was 74 at 2nd surgery and then final prosthesis was delivered. In radiographic view, augmented bone in sinus and marginal bone around implant was not resorbed in one year follow up. Also, newly formed maxillary sinus inferior border was clearly observed. Soft tissue around implant was healthy and no complications were reported. Conclusion: In this study, at the severely atrophic maxillary posterior site with 3 mm or less of residual vertical bone height, 10 mm sinus membrane elevation and bone graft was performed with crestal approach and implants were placed simultaneously. In short-term follow up observation, augmented bone and soft tissue around implant was stable and healthy. The use of crestal approach in severely atrophic maxilla and simultaneously implant placement was suggested as the treatment option, however, further follow-up is needed about long term success rate of these implants.
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