PMC5418928_01
CT scan of the upper maxilla with severe posterior bone atrophy.
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F1
Trephine burs with increasing diameters are used to harvest a cylinder of bone from the fresh bone block and to create a trapdoor on the recipient site with the same diameter. The small hole in the middle of the circle is useful to guarantee the stability of the bur.
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F2
Treviso (Italy), certified by the National Health Ministry. The ELS technique is simplified by the use of special trephine burs (Physioplant Dental Implant System, Roncadelle, Italy). This system is a set of 4 burs with increasing diameter that allows the surgeon to harvest a cylinder of bone from the fresh block graft and to simultaneously create with the same diameter a trapdoor on the recipient site (Fig. 2).
Trephine burs with increasing diameters are used to harvest a cylinder of bone from the fresh bone block and to create a trapdoor on the recipient site with the same diameter. The small hole in the middle of the circle is useful to guarantee the stability of the bur.
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F3
A trapdoor was created on the patient ridge with the exact diameter of the bone graft previously prepared (Fig. 3) and the host cortical bone was detached from the sinus membrane and gently pushed within the sinus (Fig. 4a, b).
Implant placement into the graft before grafting procedure.
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F5
Perfect match obtained between the graft and the recipient site, in order to achieve a good stability. (The second implant placed mesially has been placed in an experimental way, not described in this article).
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F6
After its placement, the cortical part of the block was gently thinned down until its removal, in order to allow its complete substitution during the healing processes (Fig. 6).
PMC5418928_02
CT scan of the upper maxilla with severe posterior bone atrophy.
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F7
Creation of the trapdoor with the ESL dedicate bur.
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F8
Using the ESL dedicated burs, a circular trapdoor was created in the posterior area (Fig. 8) and the host cortical bone was detached from the sinus membrane and removed (Fig. 9).
Perfect match obtained between the graft and the recipient site.
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F10
Since the shape of the cylindrical graft matched perfectly the size of the recipient site, the combination of graft and implant was inserted into the recipient site (Fig. 10).
PMC5418928_03
CT scan of the upper maxilla with severe posterior bone atrophy.
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F11
The patient presented a bilateral edentulous posterior atrophic bone crest of the upper maxilla (Fig. 11).
Simultaneous placement of the graft and the implant in the recipient site.
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F12
Taking advantage of the perfect match between graft and recipient site, the cylindrical block with the dental implant was placed and resulted clinically stable (Fig. 12).
PMC5418928_04
CT scan of the upper maxilla with severe posterior bone atrophy.
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F13
Due to the extremely atrophic crest (Fig. 13), it was chosen to perform implant therapy in association with the ESL technique.
Implant placement into the cylindrical graft before grafting procedure.
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F14
A dental implant (Physioplant Dental Implants, Roncadelle, Italy) was placed in the graft (Fig. 14) before the grafting procedure.
Periapical x-ray showing the implant and the graft in place after sutures.
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F15
The graft perfectly matched the recipient site and appeared clinically stable (Fig. 15).