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36 Dental Tribune Middle East & Africa Edition | May - June 2014implant tribune Periodontist Dr. Stavros Mas- tronikolas received his dental degree at University of Illinois at Chicago. He completed his advanced training in periodon- tology and implantology at Uni- versity of Maryland at Baltimore. He is a Diplomate of the Ameri- can Board of Periodontology. At the moment Dr. Mastronikolas is working full time as a Periodon- tist and Implant Surgeon at Drs Nicolas and Asp (Dubai, UAE). Email: dr.mperio@gmail.com About the Author Case Report Maxillary Implant ByStavrosMastronikolas D.D.S.,M.Sc.Periodontist (Dubai,UAE) E xtraction, site preserva- tion and delayed place- ment of maxillary im- plant using the bone added osteotome sinus floor elevation technique. Initial Presentation Pt is a 28 y.o. female, medically healthy,deniestakinganymed- ications, reports a heavy smok- er, NKDA’s. A cone-beam com- puterized tomographic scan was acquired pre-operatively. A prophylaxis was completed and oral hygiene instructions were given. Surgical treatment plan consisted: a) extraction, site preservation on #3 (Eu.#16) and distal crown lengthening on #17 (Eu.#2), b) three months later, implant placement on #3 (Eu.#16) using the bone added osteotome sinus floor elevation technique.‡ ExtractionandSitePreservation Pt was pre-medicated, one day pre-operatively, with 4mg Me- drol (1 week dose pack) and 875+125mg Augmentin, two times daily for 9 days. Atrau- matic tooth extraction on #3 (Eu.#16) was performed us- ing a piezotome. The deficient alveolar socket on #3 (Eu.#16) was carefully enucleated, soft tissues were manipulated and 0.7cc DFDBA (Demineralized Freeze Dried Bone Allograft) and (15x30mm) X-Sm Fascia Lata membrane were placed. DFDBA vs FDBA was placed on the extraction site to facilitate greater new bone formation.* DFDBA was hydrated with physiologic saline. Fascia Lata membrane was allowed to be soaked into saline for 10-15 minutes. Allograft ID stickers are always kept for traceability purposes. Primary closure was achieved with minimal tension. Post op instructions were given. Su- tures were removed 2 weeks after the site preservation was performed. Implant Placement Three months later, pt was pre- medicated 1 day pre-operative- ly with 875+125 mg Augmentin, two times daily for 9 days and an implant (5x11.5mm) was placed flapless. An internal si- nus technique was performed using osteotome instruments and 0.25cc FDBA (Freeze Dried Bone Allograft). The technique employed a specific set of os- teotome instruments to tent the sinus membrane with bone Initial Presentation Extraction and Site Preservation Implant Placement C.T/Scan and Restoration graft material placed through the osteotomy site. Implant sur- vival expected to be high since preexisting bone height be- tween the sinus floor and crest was more than 5mm.‡ Fixture stability>45N/cm allowed for a healing abutment to be placed (Stage I). Post op instructions and sinus precautions were given. C.T/Scan and Restoration Three months later a maxil- lary C.T/Scan was prescribed to verify the amount of floor el- evation achieved. Soon after an implant supported crown was fabricated and delivered. Pt was placed on a 6-month peri- odontal and restorative recall. Results Pre-treatment the alveolar dimensions of the first maxil- lary molar were 12mm widthx 8mm height and 3 months post fixture placement the ridge di- mensions were 9mm width x 7,5mm height. Verified with the cone-beam computerized tomographic scan a 4mm in- ternal sinus lift was achieved using FDBA (Freeze Dried Bone Allograft) and osteotome instruments. Conclusions Ridge dimensions can be pre- served on extracted molar teeth with deficient alveolar architecture. Successful site preservation can favor placing fixtures flapless decreasing patients’ morbidity and chair time. Internal sinus lift with the bone added osteotome si- nus floor elevation technique is a successful procedure. The FDBA placed into the maxillary sinus cavity appears to sur- round circumferentially the implant having intimate con- tact with it. Acknowledgments The author wants to thank Li- fenet Health for providing the allograft materials used in this case report. Furthermore spe- cial thanks to Dr. Paul Rosen (www.psrperioimplant.com) for his review for this case re- port. References ‡ Rosen PS, Summers R, et al. The bone added osteotome si- nus floor elevation technique: Multi-center retrospective report of consecutively treat- ed patients. Int J Oral Maxil- lofac Implants 1999;14:853- 858. * Wood R, Mealey, B. Histo- logic comparison of heal- ing after tooth extraction with ridge preservation us- ing mineralized versus de- mineralized freeze-dried bone allograft. J Periodontol 2012;83:329-336. Two weeks post-op Periapical X-Ray CT-Scan/Coronal Periapical X-Ray Periapical X-Ray CT-Scan/Coronal CT-Scan/Axial