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ePaper created 2017-05-12, 09:42:21 | version 1.38.0
case report | Fig. 4: a) The 3.5 mm osteotome inserted into the osteotomy pushing the material against the Schneiderian membrane; b) X-ray image showing the 3.5 mm osteotome position and also the grafting material; c) 4 mm osteotome performing the green stick fracture; d–f) implant insertion into the osteotomy with the straight handle and the 3 mm seating tip. Fig. 4a Fig. 4b Fig. 4c Fig. 4d Fig. 4e Fig. 4f A 4.5 x 6.0 mm Implant (Bicon Dental Implants, Boston, USA) was inserted into the grafted oste- otomy using first an implant inserter and retriever mounted in a straight handle and then by gently tap- ping with a seating tip (Figs. 4d–f). If the remaining RBH is more than 3 mm, the first plateaus following the sloping shoulder will be en- gaged against the osteotomy walls and this press fit implant will not move during the healing because a primary stability is achieved. When a RBH ≤ 3 mm is present, a sinus lift abutment (Bicon Dental Im- plants, Boston, USA) needs to be placed in order to avoid implant displacement into the lifted sinus. This implant design will not have a primary stability along the osteotomy walls because it is placed 2 mm under the crest and the implant body would be fully im- merged into the grafting material. Plateau-formed implants with healing chambers between the pla- teaus do not need a primary stability but the internal sinus abutment stabilises the implant into its final prosthetic position. Single suture with polyglycolid acid (PGA) was used to close the mesial and distal relieving incisions (ACE Surgical Supply CO, Brockton, USA). After implant insertion, immediate post-op X-ray was performed (Fig. 5). The Patient received post-op instructions and homecare in- structions. Antibiotics (Amoxicillin) and analgesics (Nimesulide) were prescribed to avoid infections and pain/swelling. Discussion Dental implantation is still the most effective ap- proach to replace a missing tooth due to the ob- served survival rates over the time. However, some- times the anatomic conditions could restrict implant positioning into the ideal space, thus limiting the prosthetic options.9 Maxillary sinus pneumatisation occurs as the result of the upper posterior tooth loss. As a consequence, internal sinus lift (ISL) has been documented as one of the surgical approaches to accomplish implant placement in the same surgical procedure.10 Results of this case report suggest that ISL and simultaneous implantation were success- fully performed on the patient with no intraopera- tive or early postoperative complications. The employment of sinus grafting in conjunction with the ISL procedure is still open to debate. Accord- ing to Summers’ recommendation, autogenous, allo- genic or xenogenic grafting materials are often in- serted into the elevated area to maintain the space for new bone formation. Moreover, several studies have implants 2 2017 23