MAXILLARY SINUS GRAFTING

with

IMPLANT PLACEMENT

One of dentistry’s goals is to make implant treatment available to all patients who may benefit from it. Unfortunately, the advanced bone loss that accompanies long term wearing of upper complete denture or upper removable partial denture renders these same patients poor candidates for dental implant treatment.

The patient with advanced bone loss in the posterior upper jaw poses serious challenges for implant therapy. Generally, the type of bone available in the upper jaw is spongy bone with its large spaces and non-dense, soft nature. This is not the quality of bone suited for dental implant therapy. Another factor influencing dental implant treatment in the upper jaw is with the lost of upper posterior teeth, enlargement of the sinuses occurs with encroaches on what little bone that remains. Successful implant therapy in the maxillary jaw is dramatically reduced if poor bone quality is combined with a lack of sufficient bone height and density. Management of these conditions is accomplished with the use of larger or wider and longer implants with a bioactive coating and sinus grafting.

Subantral augmentation or sinus grafting is a way to improve results in the severely resorbed posterior upper jaw. By increasing bone in the sinus region, the subantral augmentation enables the practitioner to use larger and longer implants that are indicated in the posterior region to replace molars to withstand the biting forces exerted there. Sinus augmentation should be considered whenever a lack of alveolar bone height prevents the use of implants of 10mm in length. Ridge augmentation and/or bone expansion is also advisable if the alveolar bone width is less than 4mm.

Original appearance		Initial radiograph
Original appearance intraoral		Start of sinus surgery
Lateral entrance into maxillary sinus with "collatape"		Grafting into sinus cavity
Suture closure of opening into sinus		One day post-op from surgery
Pre-op planning for implant placement		Completed restorative treatment of lower arch
Planning for aesthetics of the maxillary bridge		Treatment denture & surgical template for implant guide
Holes in CT scan appliance for radiopaque composite		"Simplant" program for implant planning & placement
"Simplant" program for implant planning & placement		Holes in CT scan appliance used for implant surgery
Holes in CT scan appliance used for implant surgery		Primary closure day of surgery
Two days post-op from surgery		Radiograph two days post-op from surgery
Treatment denture used for planning aesthetics		Diagnostic mounting for provisionals & abutments
Diagnostic wax-up		Wax-up for custom abutments
Provisionals used during initial implant loading		Provisionals used during initial implant loading
Final radiograph		Final aesthetic result

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