Lateral sinus elevation with 13-year follow-up
Clinical Challenge
A 63-year-old female patient presentswith hopeless maxillary teeth and a desire for a fixed reconstruction. A staged case was planned with the canines used as abutments for a fixed provisional while sinus augmentation and delayed implant placement were being accomplished. The case presented with 1-2mm of crestal bone in the molar sites. During sinus augmentation surgery the thin Schneiderian membrane on the right ride was extensively torn. A collagen membrane repair procedure was performed and bilateral sinus augmentations were completed with Geistlich Bio-Oss® as the sole grafting material covering the lateral window with a Geistlich Bio-Gide® membrane. After an extended delay (financial) implants were placed in the grafted sinuses and a bone core harvested through the lateral window. The anterior teeth were extracted and the provisional was extended to the posterior implants. Implants were later placed in the canine sites and the final prosthesis was fabricated. The final follow-up is 13 years on from the sinus augmentation.
Preoperative panoramic radiological view after posterior tooth extraction.
Preoperative paraxial radiological view of the right sinus showing limited crestal bone of 1–2mm.
Intraoperative view of the right sinus showing extensive perforation and the beginning of repair with suture "struts".
Completion of repair with a collagen membrane and bone tacks.
Sinus floor augmentation with Geistlich Bio-Oss® prior to placing Geistlich Bio-Gide® membrane to cover the lateral window.
1 year postoperative panoramic radiological picture showing both augmented areas.
1 year paraxial radiological picture of the right sinus showing excellent graft containment.
Bone core was taken between the distal implants on the right side (red arrow) prior to the radiological picture of implant placement after 1-year sinus floor elevation.
Histological picture of the harvested bone core showing 31% newly formed bone (dark orange), 25% Geistlich Bio-Oss® particles (light orange) and 44% bone marrow.
Postoperative radiological situation after 1.5 years. Anterior teeth removed, canine fixtures placed and provisional is on sinus fixtures.
Radiological picture showing final prosthesis in place at 10 years.
Clinical outcome at a glance
Objectives
- Staged sinus floor elevation with 100% Geistlich Bio-Oss® and Geistlich Bio-Gide® when only 1–2mm crestal bone remains.
- Fixed maxillary reconstruction on both sides.
- Successful implant Placement 1-year after sinus floor elevation.
Conclusions
- Two-stage sinus floor elevation treatment.
- Successful sinus floor elevation of severe pneumatization with Geistlich Bio-Oss® and Geistlich Bio-Gide® shows stable bony volume after 13-year follow-up.
Aim / Approach
There are 3 interesting challengesin this case:
- Sinus augmentations performed with100% Geistlich Bio-Oss® when only 1–2mm of crestal bone remains
- Achieving a successful result in theface of an extensive perforation
- Assuming some loss of the existingcrestal bone due to biologic widthformation, the molar implants haveexisted with Geistlich Bio-Oss® likely at the crest for close to 10 years.
Conclusion
- Cases with severe pneumatizationcan be grafted with Geistlich Bio-Oss® as the sole grafting material.
- Geistlich Bio-Oss® alone, coveredwith a Geistlich Bio-Gide® membranecan give successful results in compromisedclinical situations. Histomorphometricevaluation showed 31%vital bone with all implants successfulby any guidlines.
- Having Geistlich Bio-Oss® exposed atthe crest did not result in periimplantitis.
