Combination with 3D via F. Khoury’s technique
Clinical challenge
A pneumatized sinus cavity was localized in the area of the anteriormaxilla. Due to the atrophic alveolar crest it was impossible to place the implant in a correct position to achieve an appropriate esthetic rehabilitation.
Preoperative radiography: panoramic slice of CT scan showing pneumatized sinus in canine area, combined with a coronal slice (n° 49) highlighting an atrophic alveolar crest.
Intraoral buccal view showing an atrophic alveolar crest.
Sinus floor elevation with a minimal invasive lateral approach filled with Geistlich Bio-Oss® particles.
Alveolar crest reconstruction with a bone block (F. Khoury’s technique). After fixation of the bone block the residual space was filled with a mix of 50% of autogenous bone and 50% Geistlich Bio-Oss®.
Modified cross and U sutures in order to maintain the flap airtight.
6-month postoperative radiography: panoramic slice of CT scan showing sinus graft result combined with a coronal slice (n° 53) highlighting a horizontal bone reconstruction.
Second surgery at 6-months postoperative: osteosynthesis screw is removed and dental implants are placed in the right 3D position according to the aesthetic project.
Intraoral view 12 months postoperative showing the 3rd surgery: temporary prosthesis restoration
combined with a bilateral connective tissue graft from the palate.1
15-month postoperative radiography showing the temporary prosthesis in function.
Occlusal intraoral view 15-months postoperative showing the tissue volume reconstructed and implant placement.
6-year postoperative radiography showing a stable bone volume.
Clinical outcome at a glance
Objectives
- Later sinus floor elevation in combination with bone regeneration with 3D using F. Khoury’s technique.
- Fixed prosthetic restoration in the upper and anterior area.
Conclusions
- Two-stage sinus floor elevation treatment.
- Sinus floor elevation using Geistlich Bio-Oss® maintains long term stability of the augmented bone volume.
- Using Geistlich Bio-Oss® particles in combination with autologous bone chips limits the resorption rate of the augmented site.
Aim / Approach
Lateral sinus floor elevation with Geistlich Bio-Oss® was performed in the area of the right canine/premolar. In this case the minimal invasivelateral window approach allows a better blood supply in the reconstructedregion.
Following the sinus floor elevation abone reconstruction of the alveolar crest was performed with 3D using F. Khoury's technique. The bone block was harvested from the ramus. After preparation of the two blocks each were fixed with a screw in the upper frontal area. The residual spaces between and around the blocks were filled with a mix of Geistlich Bio-Oss® particles and autogenous bone chips.
Conclusion
Grafting with Geistlich Bio-Oss® particles in the sinus cavity maintains the long term stability of the regenerated bone volume. It provides the patient a comfortable and predictable solution.
Reconstructing the alveolar crest with 3D via F. Khoury's technique in combination with the use of Geistlich Bio-Oss® minimizes the volume/size of the harvested bone block. Due to the slow resorption rate of Geistlich Bio-Oss® particles the bone volume is maintained and therefore the aesthetic result.
Reference:
- Hürzeler MB1, Weng D. 1999. Int J Periodontics Restorative Dent. Jun;19(3):279-87 .(clinical study)
- Dr. Neel Bhatavadekar - Management of a thin Schneiderian Membrane with a pouch technique
- Geistlich Bio-Oss®, Geistlich Bio-Gide®, Geistlich Mucograft® and Geistlich Fibro-Gide® - Product Information
- Patient Information - When your back teeth are missing
- Patient information video – Sinus floor elevation
- Surgical video Dr. Figueiredo - Sinus Floor Elevation using Geistlich Bio-Oss Pen® and Geistlich Bio-Gide®