Clinical Challenge

A 62-old female healthy patient was referred to the Schwartz-Arad surgical center for an extraction of the first right maxillary molar. This clinical case was performed in 1997 with a 20-year follow-up period. The region of interest is the right maxillary molar. In this region the 1st right maxillary molar was untreatable due to a perio-endo defect. The first and second right maxillary premolars were missing as well. The existing bridge included the right maxillary canine and the first molar. The available alveolar ridge was not sufficient for implant placement due to the pneumatization of the right maxillary sinus and the endo- perio-lesion of the tooth. The patient came for a treatment to obtain a fixed prosthetic restoration. The clinical challenge was to simultaneously reconstruct the ridge volume in the vertical dimension via a sinus augmentation procedure, and ridge preservation at the time of tooth extraction, for second stage implants placement.

Clinical outcome at a glance

Objectives

• Sinus floor elevation through a lateral window.
• Bone augmentation of the maxillary sinus cavity prior to implant placement after 5 months.

Conclusions 

• Two-stage sinus floor elevation treatment.
• Sinus floor elevation using Geistlich Bio-Oss^® and Geistlich Bio-Gide^® leads to long-term clinical success.
• Perfect prosthetic situation after 20-year follow-up.

Aim/Approach

Sinus augmentation procedure via lateral window Approach¹

Prophylactic oral pre-medication of amoxicillin (1 g) and dexamethasone (8 mg) an hour before the procedure and a local application of 0.5% chlorhexidine for 2 min. An incision was made on the alveolar crest and a vertical incision distal to the tuberosity was made to allow bone harvesting from this area to be mixed with the Geistlich Bio-Oss^® . A window was cut through the lateral sinus wall cortex using a slow-speed round bone bur. At this point, the sinus membrane was carefully elevated from the sinus floor and medial sinus wall. Geistlich Bio-Gide^® was used to repair the perforation. Since primary implant stability could not be attained, a delayed 2-stage implant placement was performed 5 months later. The maxillary sinus compartment was augmented with Geistlich Bio-Oss^®. The fenestrated lateral wall of the maxillary sinus was covered with a Geistlich Bio-Gide^® and the mucoperiosteal flap repositioned and sutured with a 3/0 Vicryl.

Conclusion

This case, with 20 year follow-up, is only one example of many patients with insufficient alveolar ridges, treated in the Schwartz-Arad surgical center with Geistlich Bio-Oss^®. Bone augmentation using Geistlich Bio-Oss^® and Geistlich Bio-Gide^® for the sinus augmentation procedure is a predictable treatment approach for the long run. Furthermore, sinus membrane perforation did not influence implant success negatively when corrected with Geistlich Bio-Gide^®.

References:

1. Schwartz-Arad D et al. 2004. J Periodontol. Apr;75(4):511-6. (clinical study)