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ePaper created 2017-05-12, 09:42:21 | version 1.38.0
| case report Fig. 5: a) Clinical picture showing the implant position after its place- ment via gentle tapping; b) placed implant with the healing plug; c) cut- ted view of the healing plug for the placed implants in the zone; d) autol- ogous bone graft over the implant with the collected bone during the osteotomy; e) immediate final X-ray views of the placed implant together the internal sinus lifts procedure. On the apical portion of the implant the grafting material is observable. Fig. 5a Fig. 5b Fig. 5c Fig. 5d implant with convergent crest module, represented by the sloping shoulder geometry, which enhances the platform switching (PS) to occur. This PS allows an increase in residual crestal alveolar bone volume around the neck of the implant, repositions the papilla to a more aesthetic and apposite level, reduces me- chanical stress in the crestal alveolar bone area and assists in enhancing the vascular supply to hard- and soft-tissue in case of reduced interdental space.16,17 ISL is reliable if used with the proper protocol, less time consuming procedure, with lower rates of com- plications that can be considered in patients with up- per posterior decreased alveolar ridge. In a non-trau- matic way and during the same surgical procedure it allows implant placement with no immediate compli- cations during the procedure nor a short postopera- tive time period._ Conflict of interest statement: Authors declare they do not have any conflict of interest. Source of funding: None Author details Literature contact Miguel Simancas Pallares Avenue Del Consulado 48-152 University of Cartagena Health Sciences Campus Faculty of Dentistry, Research Department, Suite 301 Cra. 6 #36, Cartagena, Bolívar, Colombia Tel.: +57 5 6698172-110 msimancasp@unicartagena.edu.co Fig. 5e suggested that the Schneiderian membrane elevation by itself promotes bone regeneration by means of the formation of a fibrin clot in the created space. This clot, which is stabilised and protected from external trauma and intra-sinus pressure, would have the po- tential to stimulate bone formation.11,12 However, this option is highly susceptible to membrane perforation or membrane invagination around the implant apex. We then decided to use pure-phase tricalcium phos- phate, a synthetic material into the created space to avoid the collapse of the Schneiderian membrane around the internal sinus implant portion and pro- mote bone formation during the osseointegration period also around the implant apex. Associated complications with the sinus augmen- tation procedures are well described in the literature. The most common complication is membrane perfo- ration during procedure and its prevalence is between 7 and 44 %. Haemorrhage, infection and rhinosinus- itis are also described as expected complications.13 However, none of them were present in our patient, indicating an immediately successful surgical proce- dure which was specially developed for clinicians with no experience in sinus lift elevation. Implant survival placed in conjunction with ISL has been also well reported in the literature ranging from 94 % to 100 %.14,15 Nevertheless, the most critical is- sue is the crestal bone level maintenance over the time. This is achieved by placing the implant in a sub- crestal (submerged) fashion and by the usage of an 24 implants 2 2017