A 65 year old patient arrives at the dental clinic with the intention to rehabilitate element 16 with a dental implant. From the X-ray images (Orthopantomography and CAT Scan) the existing bone resorption can be observed as well as define the anatomical residual sinus structures.
After the evaluation of the patient’s clinical situation, the inter-maxillary relationship through the set up of the models in articulator and diagnostic wax-up, it is decided to perform the jaw sinus elevation technique with lateral approaching (Caldwell-Luc access). In this case is chosen the immediate insertion of the Outlink2 Sweden & Martina implant, thanks to the primary stability obtained with the implant insertion (30 Ncm) also with a residual bone height of 3-4 mm. The entire procedure was performed with local-regional anaesthesia and prophylactic antibiotics with 875/125 mg. amoxicillin/clavulanic acid. A flap with total thickness through a crestal incision slightly palatinized which allows to define the lateral wall of the jaw sinus correctly is performed. We practice one incision of intended release of
1 cm from the osteotomy and avoiding any type of mesial release realising in this case an intrasulcular incision at the height of elements 14-15. A trapdoor is opened. Once the structure is defined, often the sinus membrane is perforated; therefore an osteoplastic with a curved design adapted to the sinus profile is realized and in addition, with no edges, mainly protecting the membrane. The sinus membrane through round and short periosteal elevators is slid, initially with different angles ending with others longer and straight in order to slide the membrane from the back wall.
Once the membrane from all the walls is slid (because the bone walls are the most important passage ways for blood and osteogenic cells) the necessary vertical dimension for the implants which we will insert is verified: in this case an Outlink2 Sweden & Martina implant of 4.1 x 10 mm. No intrasinus bone septum or interossea artery are present. In this phase, having a residual bone of 3-4 mm in heigh, it is appropriate to insert the implant only if a torque greater than 25 Ncm is present; in this case the torque was 30 Ncm and so we decided to proceed with the insertion of bio-material with the implant in situ. The keraOs is mixed with serum so it is more malleable; initially the anterior and the posterior compartment are filled until completely filled without excessive compact, so to leave space for blood clotting. Once completed the KeraOs filling and the implant insertion a membrane to protect the access to the sinus at the antrotomy level is used. In this case a resorbable membrane of equine pericardium (Bone Two) with the purpose to avoid the infiltration of non osteogenic cells of connective tissue in the grafted area was used, to favour the graft integration and the protection of muco-periostal tissue. Once verified that there was no stress in the flap closing as primary intention, we proceed to the suture using a nonresorbable monofilament (Polimid), incorporating suture stitches at the palate level, except the distals to avoid muco-gingival issues in the vestibular area. 15 days after the surgery in the X-ray image (orthopantomography) it is possible to appreciate a significant increase (radiopacity) of the jaw sinus floor with the Outlink2 implant positioned.
After the evaluation of the patient’s clinical situation, the inter-maxillary relationship through the set up of the models in articulator and diagnostic wax-up, it is decided to perform the jaw sinus elevation technique with lateral approaching (Caldwell-Luc access). In this case is chosen the immediate insertion of the Outlink2 Sweden & Martina implant, thanks to the primary stability obtained with the implant insertion (30 Ncm) also with a residual bone height of 3-4 mm. The entire procedure was performed with local-regional anaesthesia and prophylactic antibiotics with 875/125 mg. amoxicillin/clavulanic acid. A flap with total thickness through a crestal incision slightly palatinized which allows to define the lateral wall of the jaw sinus correctly is performed. We practice one incision of intended release of
1 cm from the osteotomy and avoiding any type of mesial release realising in this case an intrasulcular incision at the height of elements 14-15. A trapdoor is opened. Once the structure is defined, often the sinus membrane is perforated; therefore an osteoplastic with a curved design adapted to the sinus profile is realized and in addition, with no edges, mainly protecting the membrane. The sinus membrane through round and short periosteal elevators is slid, initially with different angles ending with others longer and straight in order to slide the membrane from the back wall.
Once the membrane from all the walls is slid (because the bone walls are the most important passage ways for blood and osteogenic cells) the necessary vertical dimension for the implants which we will insert is verified: in this case an Outlink2 Sweden & Martina implant of 4.1 x 10 mm. No intrasinus bone septum or interossea artery are present. In this phase, having a residual bone of 3-4 mm in heigh, it is appropriate to insert the implant only if a torque greater than 25 Ncm is present; in this case the torque was 30 Ncm and so we decided to proceed with the insertion of bio-material with the implant in situ. The keraOs is mixed with serum so it is more malleable; initially the anterior and the posterior compartment are filled until completely filled without excessive compact, so to leave space for blood clotting. Once completed the KeraOs filling and the implant insertion a membrane to protect the access to the sinus at the antrotomy level is used. In this case a resorbable membrane of equine pericardium (Bone Two) with the purpose to avoid the infiltration of non osteogenic cells of connective tissue in the grafted area was used, to favour the graft integration and the protection of muco-periostal tissue. Once verified that there was no stress in the flap closing as primary intention, we proceed to the suture using a nonresorbable monofilament (Polimid), incorporating suture stitches at the palate level, except the distals to avoid muco-gingival issues in the vestibular area. 15 days after the surgery in the X-ray image (orthopantomography) it is possible to appreciate a significant increase (radiopacity) of the jaw sinus floor with the Outlink2 implant positioned.
