PMC9893428_01
Panoramic radiograph pretreatment with floor of the maxillary sinus outlined (red) demonstrating insufficient alveolar height to support implant placement without sinus augmentation and delayed implant placement.
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F3
The right quadrant radiographically presented with a 'L' concave shape of the anterior wall of the sinus and suited for use of a trans-sinus implant (Fig. 3).
Placement of the implant with a trans-sinus approach following a lateral window approach and Schneiderian membrane elevation.
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F4
The membrane was dissected from the osseous walls of the sinus then lifted anteriorly to the mesial border of the canine pillar, medially to the osseous border and distally to the first molar area (Fig. 4).
Following trans-sinus implant placement on the right quadrant and zygomatic implant placement in the left quadrant.
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F5
Trans-sinus placement followed with primary stability exceeding 50 Ncm, and implants were placed at the other planned sites on the arch (Fig. 5).
Panoramic radiograph following implant placement with a pterygoid implant in the posterior right, trans-sinus implant in the right quadrant (sinus augmentation outlined in red), anterior implants in the premaxilla and zygomatic implant in the left quadrant.
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F6
MUAs were connected to the implants and the patient was restored with an immediate screw retained provisional prosthesis (Fig. 6).
Panoramic radiograph following restoration with final hybrid prosthesis.
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F7
At 1-year follow up a panoramic radiograph was taken (Fig. 7).
PMC9893428_02
Pretreatment radiograph demonstrating pneumatization of the maxillary sinus with failing dentition.
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F8
Sinus anatomy analysis revealed a deep mesial concavity indicating the use of a trans-sinus as an alternative to usage of a zygomatic implant (Fig. 8).
Following extraction of the failing dentition and placement of a lateral window into the maxillary sinus with elevation of the Schneiderian membrane in preparation for immediate trans-sinus implant preparation.
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F9
The lateral sinus window was created to allow access to the mesial portion of the maxillary sinus (Fig. 9).
Line indicating the angulation of the implant placed to transverse the mesial of the sinus and have its apex engage the medial nasal wall with an angled multiunit abutment on the implant to parallel it to the other implants that had been placed.
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F10
The implant was placed in the posterior right, angled mesially to engage the cortices for a trans-sinus implant (Fig. 10).
Augmentation of the maxillary sinus to cover the portion of the implant sitting within the sinus not within bone prior to closure, along with socket grafting of the extraction sites.
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F11
Allograft was placed into the sinus filling the elevated area, covering the portion of implant transversing the sinus to encase the entire implant in bone once healing had completed (Fig. 11).
Radiograph of the trans-sinus implant and the associated graft placed within the maxillary sinus with points of engagement with the three cortices.
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F12
Radiographs were taken to document implant placement in relation to the anatomy and the grafted sinus (Fig. 12).
Radiograph following full arch implants with pterygoid implants (bilateral), a trans-sinus on the right, anterior implants in the premaxilla, and a tilted implant on the left to bypass the sinus.
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F13
A panoramic radiograph following full arch implant placement with pterygoid implants (bilateral), a trans-sinus on the right, anterior implants in the premaxilla, and a tilted implant on the left to bypass the sinus (Fig. 13).
Panoramic radiograph following implant placement demonstrating the implants in the posteriors bilaterally in relation to the sinus floor prior to surgery (red) and level of graft placement (yellow).
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F14
The sinus floor and medial wall can be noted in the radiograph bilaterally (red line) as well as the new sinus floor on the right following placement of the sinus augmentation (yellow line) (Fig. 14).
A polymethyl methacrylate hybrid was fabricated as a provisional restoration.
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F15
A polymethyl methacrylate provisional hybrid prosthesis was fabricated (Fig. 15) and seated intraorally on the MUA's that had been placed on the implants.