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Volume 2 | Issue 1/2016 45 Journal of Oral Science & Rehabilitation Tra n s c res ta l s in us f lo o r e le vati o n wi th a so ni c i nstru me nt implant collar on the walls of the access. The buccal and lingual flaps were sutured with api- cal repositioning at the buccal aspect (Fig. 6d). A low-dose CBCT scan was taken immediately afterthe second surgery (Figs. 7a–c). Prosthesis d elivery a n d follow -up Afterfourmonthsofuneventfulhealing,impres- sions were taken and a metal–ceramic crown was fabricated and seated over the implant (Figs. 8a–c). Checkups were performed during thehealingperiodandregularlyuptothreeyears afterward.Intra-oralradiographsweretakenim- mediately after prosthesis seating and yearly thereafter. Results Afterthree years, from the analyses ofthe CBCT scans, no marginal losswasfound and bonewas observed all around the implant surface. The lo- cation of the implant apex corresponded to the newsinusfloor(Figs. 9a–c).Nocomplaintswere reported by the patient. At the clinical follow- ups, no clinical signs of periimplant soft-tissue inflammation and no technical complications were noted during the three-year period of ob- servation(Fig. 9d). Discussion The surgicaltechniquewith a crestaltrapdoorap- proach may present advantages over classical sinus floor elevation performed through a lateral window access. The crestal approach, conversely to the lateral access, avoids opening large flaps, performing long vertical releasing incisions, and strong pulling on the flaps during surgery. More- over, it allows for easier access to the distal zones withlessexposureofthesurgicalarea. Theabsenceofbiomaterialgrafts,otherthan the rapidly resorbable collagen sponge, de- creases the possible loss of material into the sinus and, consequently, the risk of infection in case of unexpected perforation ofthe sinus mu- cosa. Moreover, no membranes are needed to cover the access osteotomy, reducing the total biomaterialcost.36 Theabsenceofgraftedmate- rial allows a more reliable radiographic evalua- tion of the progressive mineralization within the elevatedarea,whereaswhenaradiopaquegraft- ing material is used, its radiopaque nature may hindertheevaluationofboneformation. The use of a crestal access may avoid cross- ing the anastomosis between the posterior su- perior alveolar artery and the infraorbital ar- teries. This anastomosis may be quite large in diameter and may cause severe hemorrhages when it is unintentionallydamaged and possibly Figs. 8a–c Clinical view of the outcome. (a) Implant four months after the second sinus floor elevation. (b & c) Crown just seated over the implant from the occlusal and buccal views, respectively. Figs. 9a–d Low-dose CBCT scan taken after three years. (a) Panoramic view. (b) Cross-sectional view. (c) Axial view. (d) Clinical view. Figs. 8a–c Figs. 9a–d a b c a b c d Volume 2 | Issue 1/201645