Transcrestal sinus floor elevation with delayed implant insertion

Prof. Claudio Stacchi
Initial situation

A female patient (66 years old) is considered eligible for transcrestal sinus floor elevation

Used biomaterials
  • Gen-Os®
1. Pre-operative X-ray, showing 2.5 mm residual bone height and the presence of an Underwood septum

1. Pre-operative X-ray, showing 2.5 mm residual bone height and the presence of an Underwood septum

2. After raising a minimally invasive full thickness flap, the crestal access was performed mesially to the septum

2. After raising a minimally invasive full thickness flap, the crestal access was performed mesially to the septum

3. Maxillary sinus floor was interrupted, showing intact Schneiderian membrane

3. Maxillary sinus floor was interrupted, showing intact Schneiderian membrane

4. One gram of OsteoBiol® Gen-Os® was mixed with autologous i-PRF

4. One gram of OsteoBiol® Gen-Os® was mixed with autologous i-PRF

5. Sinus was grafted by condensing gradual increments of xenogeneic granules with osteotomes, until a minimum height of 10 mm was obtained (comprising the residual bone crest)

5. Sinus was grafted by condensing gradual increments of xenogeneic granules with osteotomes, until a minimum height of 10 mm was obtained (comprising the residual bone crest)

6. CBCT scan taken 1 week after surgery, showing good contact of the grafting material with lateral and medial sinus walls. Schneiderian membrane is hypertrophic due to the surgical trauma

6. CBCT scan taken 1 week after surgery, showing good contact of the grafting material with lateral and medial sinus walls. Schneiderian membrane is hypertrophic due to the surgical trauma

7. CBCT scan taken 1 week after surgery showing good contact of the grafting material with lateral and medial sinus walls. Schneiderian membrane is hypertrophic due to the surgical trauma

7. CBCT scan taken 1 week after surgery showing good contact of the grafting material with lateral and medial sinus walls. Schneiderian membrane is hypertrophic due to the surgical trauma

8. CBCT scan taken 1 week after surgery showing good contact of the grafting material with lateral and medial sinus walls. Schneiderian membrane is hypertrophic due to the surgical trauma

8. CBCT scan taken 1 week after surgery showing good contact of the grafting material with lateral and medial sinus walls. Schneiderian membrane is hypertrophic due to the surgical trauma

9. CBCT scan taken six months after surgery. Schneiderian membrane appears healthy

9. CBCT scan taken six months after surgery. Schneiderian membrane appears healthy

10. CBCT scan taken 6 months after surgery. Schneiderian membrane appears healthy

10. CBCT scan taken 6 months after surgery. Schneiderian membrane appears healthy

11. CBCT scan taken 6 months after surgery. Schneiderian membrane appears healthy

11. CBCT scan taken 6 months after surgery. Schneiderian membrane appears healthy

12. Bone-core biopsy of the grafted area was harvested by using 3-mm diameter trephine drill

12. Bone-core biopsy of the grafted area was harvested by using 3-mm diameter trephine drill

13. A dental implant (4.0x10 mm) was inserted in the biopsy site

13. A dental implant (4.0x10 mm) was inserted in the biopsy site

14. A dental implant (4.0x10 mm) was inserted in the biopsy site

14. A dental implant (4.0x10 mm) was inserted in the biopsy site

15. Residual biomaterial particles appeared surrounded and joined together by newly-formed bone (magnification 200×). Toluidine blue and pironine G stain (courtesy Prof. Tonino Traini). Histomorphometric analysis showed 25.4% newly-formed bone, 19.9% residual graft particles and 54.7% marrow spaces

15. Residual biomaterial particles appeared surrounded and joined together by newly-formed bone (magnification 200×). Toluidine blue and pironine G stain (courtesy Prof. Tonino Traini). Histomorphometric analysis showed 25.4% newly-formed bone, 19.9% residual graft particles and 54.7% marrow spaces

16. Detail of Fig. 15: an active site of bone formation, as indicated by the presence of an osteoid rim, is represented at higher magnification (1000× - courtesy Prof. Tonino Traini)

16. Detail of Fig. 15: an active site of bone formation, as indicated by the presence of an osteoid rim, is represented at higher magnification (1000× - courtesy Prof. Tonino Traini)

17. 3-year post loading follow up X-ray, demonstrating marginal bone stability and maturation of the grafted area

17. 3-year post loading follow up X-ray, demonstrating marginal bone stability and maturation of the grafted area

Used biomaterials
genos
Gen-Os®
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