DentaltownUK April 2018 - 38
until we were down to clean, healthy bone.
The area was grafted with Steiner Socket
Putty Plus (a fully synthetic graft material
containing b-TCP and osteogenic factors) and
covered with a Cytoplast titanium-reinforced
membrane. The membrane was removed
three weeks later. Fig. 2 shows the sagittal
CBCT image from the healed defect.
Fig. 3 shows the coronal CBCT image
three months postop. We were able to regenerate only about 50 percent of the bone height,
but we got a nice, wide ridge with resolution
of the sinus thickening. The patient was aware
of the amount of bone loss on #5, and knew it
would most likely be replaced by an implant
at some point. However, his home care had
been exemplary; all his probings were at 3
millimeters or less, and he is staying on a
three-month recare schedule.
At this point, the patient was ready
to place implants on the UR. We would
be extracting #31 because the restorative
prognosis was poor, so we were looking to
replace #3 and #4 with implants. Fig. 4 shows
a sinus septum directly at the #3 position.
The decision was made to place implants
at #2 and #4, bypassing the septum (which
appeared fairly high, had a sloping ridge, and
was therefore more difficult to augment via
crestal approach), and to make a three-unit
bridge from #2 to #4.
Fig. 5 shows the implant and sinus graft
treatment plan in the Anatomage software.
The plan was sent to the Anatomage lab
for fabrication of a surgical guide (Fig. 6).
Surgical treatment begins
On the day of surgery, the patient was
anesthetized with three carps of Septocaine
and rinsed with Peridex before the procedure.
The surgical guide was tried in to confirm
fit. A flap was laid with the WaterLase iPlus
dental laser, and the surgical guide was
used to make the initial pilot hole for the
osteotomy position.
Using the pilot holes as a guide and
the CBCT measurements to gauge depth,
38
APRIL 2018 // dentaltownuk.com
Fig. 2
Fig. 6
Fig. 3
Fig. 4
Fig. 7
Fig. 5
Fig. 8
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