PMC5346398_01
Intraoral radiograph at the patient presentation. Tooth 26 is affected by an endoperiodontal lesion and is lost.
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The patient underwent clinical examination and radiographic assessment, and the intraoral radiograph (Figure 2) showed an endoperiodontal lesion affecting the first molar.
OPT recorded after sectioning the prosthesis and extracting the compromised element. The residual ridge presents a significant defect.
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After sectioning the old prosthesis, the affected tooth was atraumatically extracted, and an orthopantomography (OPT) was collected (Figure 3).
Intraoral radiograph collected two months later showing the limited thickness of the residual posterior ridge.
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Two months later, the residual bone height was found to be insufficient to place osseointegrated implants (Figure 4).
CBCT of the sinuses. The maxillary intraosseous anastomosis at the left sinus is 16.8 mm above the ridge coronal bone level.
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A CBCT examination was performed to evaluate the health and anatomical status of the left sinus (Figure 5).
The position of the implants is preplanned on the CBCT scan. A surgical guide is designed that includes also the frame of the sinus antrostomy designed according to the low window principles.
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The design of the surgical guide also included a guide for carrying out the lateral antrostomy according to the low window scheme previously described (Figure 6).
The clinical appearance of the edentulous posterior maxilla (a) and the flap design (b) at no more than 10 mm from the ridge.
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No releasing incisions were performed either distally or mesially; that is, the incision had no vertical components (Figures 7 and 8).
A single incision is performed on the medial, occlusal line of the ridge, preserving the papilla of the most distal residual element (a). No release incisions are carried out, and a full-thickness mucoperiosteal flap is elevated (b).
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No releasing incisions were performed either distally or mesially; that is, the incision had no vertical components (Figures 7 and 8).
The preparation of the antrostomy and the elevation of the sinus membrane. First, the window is drawn on the vestibular bone wall with the aid of the surgical guide (a). The window is no more than 6 mm high (b). After performing the osteotomy (c), the sinus membrane is fully elevated (d).
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The sinus membrane was carefully elevated (Figure 9), and equine-derived cortical-cancellous granules, sized 0.5-1 mm (Osteoxenon,
After partially filling the grafting site, implants are being placed with the aid of the surgical guide (a) and filling is complete (b). Implants are left submerged (c), and an intraoral control radiograph is collected (d).
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Filling of the cavity was then completed, and the mucoperiosteal flaps were sutured using nonresorbable 5.0 sutures (Figure 10).
The final prosthetic rehabilitation.
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This was delivered after 10 days, and the patient wore it for approximately three months, at which point the definitive abutments and metal-ceramic crowns were delivered (Figure 11).
At the one-year control after definitive prosthetic rehabilitation, implants are successful and the prosthesis is fully functional.
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The maintenance program included professional oral hygiene at six and 12 months after rehabilitation with the definitive prosthesis (Figure 12). The prosthesis was fully functional (Figure 12).