The conventional insertion of osseointegrated implants inserted with a staged approach were used for many years. However, this method is almost always combined with the need to reconstruct the soft and hard tissues in order to restore the original clinical situation of both soft and hard tissues. For this reason, actually it has been preferred to proceed with the simultaneous extraction and insertion of the implant combined with a heterologous bone graft as to maintain the bone and mucosal volumes at the initial levels.
In this clinical case, in addition to the need to extract the teeth 16 and 15 for periodontal reasons and high mobility, it was simultaneously necessary to perform a lift of the Schneider membrane with a trascrestal technique with rotary instruments in order to be able to insert two implants at the same time of the extractions.
Fig.1
The coronal view of the CBTC conducted exactly at the height of the teeth 16 and 15 allows us to appreciate the residual height of the bone crest equal to approximately 5,51 mm for the tooth number 16. Furthermore, it also allows us to evaluate the presence of patency at the level of the osteomeatal complex, a fundamental condition for proceeding with the maxillary sinus lift surgery.
Fig.2
Surgical extraction phases that must be as atraumatic as possible to maintain the full volume of hard and soft tissues at the surgical sites.
Fig.3
Immediately after extraction of the two teeth, the osteotomy was created, followed by elevation of the Schneiderian membrane using special burs that do not cut at the tip and are completely non-traumatic.
Fig.4
Once the transcrestal sinus lift was completed, the implant site was prepared in the area of tooth 15 with the dedicated bur for the insertion of a Dental Tech FTK implant diameter 3.75 × 11,5 mm.
Fig.5
Insertion of a Dental Tech FTK 4.25 × 11.5 mm implant in area 16 after the transcrestal elevation of the sinus membrane with insertion of heterologous bone granules.
Fig.6
Clinical situation at the end of the surgery with insertion of healing screws and filling of the space between the implants and the residual socket with heterologous bovine bone and positioning of collagen membrane to contain the granules.
Fig.7
Radiographic image where is possible to see the implant in area 15 inserted in the post-extraction socket entirely within the patient’s native bone and the implant in area 16 also post-extraction with trans-crestal maxillary sinus lift and the view of the classic “dome”image containing the biomaterial above the implant.
Fig.8
At the end of the healing phase, which in this case lasted four months, we are ready to take the intra-oral scan for the creation of the prosthesis screwed onto the Dental Tech implants.
The maintenance of the bone and hard volumes obtained can be easily appreciated in the ST file.
Fig.9
Correct positioning of the metallic rough Dental Tech scan-abutment which greatly facilitate the detection of the intraoral scan.
Fig.10
Control X-ray that highlights the correct positioning of the scan abutment inside the implants thanks to the radiopacity generated by the metal structures.
Fig.11
Intraoral clinical situation with monolithic zirconium screw-retained prostheses showing good quality of hard and soft tissues around the implants.
Fig.12
Radiographic control of the exact seating of the prosthetic structures on the implants which once again highlights the good maintenance of the bone levels around the implants and in addition it is possible to see the progressive maturation of the heterologous bone graft inside the maxillary sinus.
Conclusions
Nowadays, the possibility of reducing the number of interventions to which our patients are subjected and also of shortening the treatment times appears to be of notable importance. The possibility of maintaining the bone and mucosal volumes through the use of post-extraction implants makes the use of regenerative procedures almost unnecessary during the insertion phase of a deferred implant. All this allows us to obtain aesthetically and functionally better results provided that a correct selection of the case and materials is carried out. Even complex procedures such as maxillary sinus lift for implant purposes can be performed at the same time as the extraction of missing teeth, significantly reducing the therapeutic phases with great advantages for patients and operators themselves.
Bibliography
- Araujo MG & Lindhe J “Dimensional ridge alterations following tooth extraction. An experimental study in the dog” J Clin periodontol 2005;32:212-218.
- Ferrus J et Al “Factors influencing ridge alterations following immediate implant placement into extraction sockets” Clinical Oral Impl. Res. 21, 2010; 22-29.
- Wei Y. et al “Ridge preservation in periodontally compromised molar sockets with or without primary wound closure: a comparative controlled clinical trial” Clinical Oral Implant Research 2024; 35:131-139.
