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case report I ferred to using it in the maxillary posterior zone. The internal sinus-lift procedure was the most prefer- abletechniqueforthemaxilla.Overall,theclinicians found complicated alternatives, such as bone dis- traction and nerve transposition, the least prefer- able. _Clinical case II: Unilateral free-end saddle left maxilla In March 2008, a healthy, non-smoking 67-year- old female presented with a unilateral free-end saddle left maxilla and bilateral implants in the mandible.Medicalfindingsrevealedthatthepatient had been diagnosed with osteoporosis on 25 July 2006. She had undergone 21 months of treatment withFosavance(bisphosphonatesplusvitaminD)as recommended by her orthopaedic surgeon. The pa- tient’s chief complaint was difficulty in chewing food owing to missing teeth on the upper left side. The intra-oral examination revealed fixed dental prostheses on teeth #14, 15 to 17, and 34 to 43, a crown on #23 and an implant bridge on #35 to 37. Lingualstainsweredetectedonteeth#11to13,and 21 and 22, and three quarters of tooth #24 crown were broken. The radiographic findings confirmed a bridge over two implants on the posterior left mandible with insufficient marginal adaptation, root-canal treatment (teeth #14, 15, 23 and 24) and an implant posterior to tooth #43, which was ex- tended to the mental foramen. This explained the loss of sensation in the lower right lip and limited bone height on the upper posterior left from 7 to 8.5 mm (Figs. 1–3). The treatment plan was to avoid any extensive surgicalprocedurealternatives,forexamplebycon- sidering osteoporosis medication such as bisphos- phonates. It was therefore decided not to do the si- nus-lift procedure in the free-end saddle maxilla. In thiscomplicatedcase,theextractionplustechnique helped to simplify the procedure to extracting tooth #24 and replacing it with an immediately placed long implant (Tapered Effect, Straumann; 12 mm in length, 4.1 mm in diameter) in the left maxilla. This implant was combined with two short implants (Standard Plus, Straumann; 8 mm in length, 4.1 mm Fig. 4_Panoramic radiograph, left maxilla: limited bone height treatment plan. Fig. 5_Occlusal view of the cast: wax-up of the planned prosthesis. Fig. 6_Situation after extraction of tooth #24: alveolar walls intact. Fig. 7_Immediate placement of a Tapered Effect implant. Fig. 8_Use of the bone condenser to improve bone quality in the sites of the short implants. Fig. 9_Repositioning of the flaps and a single 3-0 silk suture. Fig. 10_Post-op radiograph: the insertion according to plan, tilting of the last implant to avoid perforation of the sinus floor. Fig. 11_Occlusal view of the implants after a long healing period. Fig. 12_Positioning the cylinder’s rest on the snap-on impression caps for the closed-tray impression technique. I 15implants1_2012 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12