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24/05/2022

Maxilary sinus lift with the concomitant installation of implants: clinical case report.

Author: Dr. Augusto César Bessa Neves

40-year-old male patient, dissatisfaction with the absence of elements 26 and 27.

Initial evaluation

After detailed anamnesis, clinical and radiographic examination, the absence of elements 26 and 27 was noted, and, it was also noted that topographically, there was a pneumatization of the maxillary sinus floor.

Treatment carried out

Since the tomographic exam showed 6.79mm and 6.29mm remaining bone of the areas of elements 26 and 27 respectively (fig. 1), the plan made was to apply the surgical technique to lift the maxillary sinus SA3 described by Carl Misch et al. According to that technique, the lifting of the maxillary sinus floor is carried out at the same time of the installation of dental implants. In order to have access to the maxillary sinus, we used a neurologic mill (Fig. 2), with the purpose of achieving more preciseness in the osteotomy (Fig. 3). 

Working in a surgical site with low density and knowing that the geometry of the mills allows for single drilling, we chose that technique for the perforation of the surgical sites (Fig. 4). The tridimensional positioning of the implants must be perfect and, therefore, it is important to carry out an adequate reverse planning, working with a surgical guide and, in the trans-operatory phase, always verify parallelism, using the posts appropriate for that function (Fig.5). 

Afterwards, the L-PRF BLOCK was carried out associating FGM’s Nanosynt with particle granulations between 500 and 1000µ to the platelet aggregate, inserting it to the maxillary sinus (Fig. 6). Following that, implants were installed in the surgical sites and L-PRF membranes were inserted in the lateral wall of the maxillary sinus before suture (Fig. 7 and 8).

4 months later, the healing abutments were removed (Fig. 9) and the transmucosal measurer was positioned to select the mini abutments (Fig. 10). Then, those intermediate abutments were installed using the abutment placement tool (Fig. 11). Molding was then carried out (Fig. 12) and the plaster was applied (Fig. 13) and sent to the laboratory. In the laboratory, the plaster model was converted to a digital model, transferring the position of the implants by means of the Arcsys scan body, followed by a digital flow for the manufacture of the crowns over implants (Fig. 14). The crowns were finalized and installed over the implants (Fig. 15).

Fig. 1 – Aspecto da tomografia no pré-operatório.

Fig. 1 – Tomography in the pre-operative phase.

Fig. 2 – Fresa neurológica para acesso ao seio maxilar.

Fig. 2 – Neurological phase for the access to the maxillary sinus.

Fig. 3 – Precisão na osteotomia com o uso da fresa neurológica.

Fig. 3 – Precision in the osteotomy with the use of the neurological mill.

Fig. 4 – Sitio cirúrgico com boa indicação para fresagem única.

Fig. 4 – Surgical site with good recommendation for single drilling.

Fig. 5 – Verificação do paralelismo.

Fig. 5 – Checking parallelism.

Fig. 6 – L-PRF BLOCK realizado com o Nanosynt

Fig. 6 – L-PRF-BLOCK carried out with Nanosynt.

Fig. 7 – Implantes Arcsys sendo inseridos.

Fig. 7 – Arcsys implants being inserted.

Fig. 8 – Membranas de L-PRF na parede lateral do seio maxilar.

Fig. 8 – Membranes of L-PRF on the side wall of the maxillary sinus.

Fig. 9 – Após 4 meses, os cicatrizadores foram removidos.

Fig. 9 – 4 months later, healing abutments are removed.

Fig. 10 – Medidor transmucoso posicionado para realizar a escolha dos minipilares.

Fig. 10 – Transmucosal measurer positioned for the selection of the mini-abutments.

Fig. 11 – Martelete Arcsys ativando os minipilares.

Fig. 11 – Abutment placement tool activating the mini-abutments.

Fig. 12 – Moldagem de trabalho.

Fig. 12 – Molding.

Fig. 13 – Gesso vazado antes de ser enviado ao laboratório.

Fig. 13 – Plaster applied before shipment to the laboratory.

Fig. 14 – Modelo de gesso convertido em modelo digital.

Fig. 14 – Plaster model converted into a digital model.

Fig. 15 – Coroas sobre os implantes instalados.

Fig. 15 – Crowns over implants are installed.