Even Sinus Floor
Immediate preop PA shows that the bone height reduces from 7 mm to 3.5 mm in 2.5 years post extraction of the tooth #3 (Fig.1,2). Bone expansion and condensation is tried with difficulty because of high bone density. On the other hand, the sinus floor is relatively even. After a 4 mm trephine bur is used for depth of 3.5 mm (Fig.2), the cylindrical bone is easily elevated with tapping without air leakage. In contrast, when the sinus floor is not even, sinus lift with trephine bur is associated with sinus membrane perforation.
Allograft and the cylindrical bone block are pushed upward (Fig.3 *) when 5 and 6 mm taps (T) are being used at 15 RPM (Fig.3). More allograft (Fig.4 *) is lifted while a 5.9x6 mm submerged implant (I) is placed with insertion torque ~ 55 Ncm. The lingual exposed threads are covered by allograft and collagen membrane after placement of a healing abutment (8.2x5(4) mm, Fig.5). Perio dressing is applied to cover the wound. The patient is doing well postop.
The bone around the apex of the implant appears to have undergone remodeling 4 months postop (Fig.6).
There appears no bone loss 6 months post cementation (11 months postop, Fig.7), although crown/implant ratio is not favorable.
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