PMC7787851_01
(a) Intraoral preoperatory frontal view. (b) Intraoral preoperatory frontal view. (c) Intraoral preoperatory occlusal view.
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A healthy 34-year-old woman presented to our observation requesting clinical evaluation of her upper left maxilla and implant prosthetic treatment of second left upper premolar edentulism (Figures 1(a)-1(c)).
Preoperatory endoral radiography.
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In fact, the radiographic examination clearly displayed that the bone height in this area was not sufficient for standard length implant placement (5 mm bone height) while the horizontal bone thickness appeared to be sufficient (Figure 2).
(a) Software evaluation and digital planning of the surgical procedure. (b-d) Digital modeling of the surgical template.
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(a) Template positioning before the surgery. (b) Rotating circular tissue punch. (c) Operculectomy through the gingiva.
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Under local anesthesia (2% lidocaine with 1 : 80,000 epinephrine), an operculectomy was performed with the use of a rotating circular tissue punch mounted on a handpiece, after which a pilot drill was used to cut the cortical bone and assess the tissue consistency (Figures 4(b) and 4(c)).
(a-c) Osteotomy by manual bone compactors (B&B Dental guided surgery kit, B&B Dental, San Benedetto, BO, Italy). (d) Filling of the implant site with inorganic bovine bone-derived mineral. (e) Dental implant positioning. (f) Positioning of the prosthetic abutment.
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We started with a 2.2 mm in diameter compactor for a working length of 6 mm (so as to reach the floor of the maxillary sinus); then, the following compactors were 3.0, 3.5, and 4.0 mm in diameter and have been used in sequence up to a length of 10 mm (Figures 5(a)-5(c)). The implant site was filled with inorganic bovine bone-derived mineral (ABBM) (Bio-Oss, Geistlich Pharma, Wolhusen, Switzerland) (Figure 5(d)). At this point, using the mounter from the surgical kit, a soft thread 4 x8 mm long implant was placed (Figure 5(e)). The faces of the hexagon must be matched to the direction of the sleeve inside the surgical guide that has been planned to allow the correct positioning of the prosthetic abutment (Figure 5(f)).
(a) Postoperatory endoral radiography. (b) Endoral radiography taken after 9 months from the surgery.
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