PMC5748318_01
Maxillary left posterior PFM bridge must be replaced. Two implant-supported crowns need to be placed. In both surgical sites, reduced basal bone height is available.
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fig1
The first surgical site presented a Bbh of 6 mm, while the second a Bbh of 2 mm (Figures 1-3).
CT scan pre-op showing 6 mm Bbh at mesial site.
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fig2
The first surgical site presented a Bbh of 6 mm, while the second a Bbh of 2 mm (Figures 1-3).
CT scan pre-op showing 2 mm of Bbh at distal site.
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fig3
The first surgical site presented a Bbh of 6 mm, while the second a Bbh of 2 mm (Figures 1-3).
Crestal sinus floor elevation was performed. In the premolar site, collagen sponges were placed, and a 4.25 x 8.5 mm long implant was inserted. In the molar site, a "future site" elevation was achieved with collagen sponges deeply together with a xenograft at the base of the sinus and into the osteotomy.
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fig4
Due Carrare, Padova, Italy), with the smooth collar placed at the bone level. Differently, in the first molar site, sinus floor elevation was performed by applying collagen sponges together with xenograft (Bio-Oss, Wolhusen, Switzerland) at the basal bone level and in the osteotomy site, to provide more stability to the collagen (Figure 4).
After 6 months, the mesial implant was uncovered, and a short implant was positioned in the molar site with an ulterior crestal sinus floor elevation. Note the new sinus floor level on the apex of the implant #25 and the displacement of collagen and basal bone on the top of the distal fixture.
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fig5
Also in this case, osteotomy was done with SCA technique and collagen sponges were positioned to displace the Schneiderian membrane (Figure 5).
4 years' follow-up radiography. Sinus floor level is maintained on the top of both implants' apex and appears well corticalized. Crestal bone remodelling occurred around implant #26, not exceeding the smooth collar.
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fig6
Control radiographies were taken after 3 months from the first surgery, after 4 months from the second surgery, at the time of provisional crown setting, at 12 months, and then yearly (Figure 6). Radiographs were taken at 3, 6, 10, and 14 months starting from the baseline (Figures 6-8).
Implant site #25 CT scan at 4 years.
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fig7
Radiographs were taken at 3, 6, 10, and 14 months starting from the baseline (Figures 6-8).
Implant site #26 CT scan at 4 years.
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fig8
Radiographs were taken at 3, 6, 10, and 14 months starting from the baseline (Figures 6-8).