Staged osteotome sinus floor elevation for progressive site development and immediate implant placement in severely resorbed alveolar bone: a case report

Abstract

This case report discusses osteotome sinus floor elevation (OSFE) and immediate placement in 2 stages in severely resorbed alveolar bone height in which multiple implant placement is not otherwise feasible due to a lack of initial stability. The first implant placed using OSFE without bone grafting prepares the adjacent resorbed sites for further implant placement in the sinus areas, which allows for better initial stability and early functional loading. This process avoids the conventional extensive lateral approach for sinus lifting and bone grafting procedures even in extremely resorbed alveolar bone.

Figure 1

Baseline orthopantomogram showing that the subantral bone height was limited at the maxillary posterior left quadrant, with severely resorbed alveolar bone height at the site of the first maxillary molar.

Figure 2

Radiograph taken after completion of the OSFE procedure without bone grafting with 8 mm lifting of the sinus membrane and a residual bone height of less than 3.0 mm and the amount of sinus floor elevation.

Figure 3

The CT and DentaScan reformatted flythrough image of the staged osteotome sinus floor elevation showing the intact Schneiderian membrane over the projection of the apical border of the first implant.

Figure 4

Postoperative radiograph of the left maxillary quadrant four months after the placement of three implants with better initial stability medially and distally to the first implant showing the new sinus floor with all the implants appropriately positioned and inclined.

Figure 5

Periapical radiograph after 12 months of prosthetic loading showing a stable clinical situation in the area around the apex of the implants.

Figure 6

Periapical radiograph after two years of prosthetic loading showing a stable clinical situation in the area around the apex of the implants. A dome-shaped structure was apparent at the sites of the first and second molars.

Figure 7

(a) CT scans showed the implant and surrounding bone and the new sinus floor using the staged osteotome sinus floor elevation technique on the left side 2 years after the operation. (b) Selected magnifying images for CT scans showed the implant, apical borders for these implants, surrounding bone, and the new sinus floor using the staged osteotome sinus floor elevation technique on the left side 2 years after the operation.