Diagnosis & CBCT 3D Evaluation for Sinus Augmentation

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Posted on By Maurice Salama In Sinus Augmentation

Patient presents 6 months after extraction and socket grafting that healed exceptionally well. PA radiograph displays robust healing and adequate length for implant placement. BUT, CBCT 3D evaluation reveals a completely different situation. What say the group? Crestal or Lateral Approach? Which technique? Or Short Wide Implant instead of sinus augmentation? Dr. Salama

6 months PA of Socket Graft
CBCT same day as above PA

Dimensions measured
Socket at crest 3D CBCT


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5 Comments

On this case personally I would prefer to see a longer implant with grafting over a shorter wide implant. As far as lateral vs crestal approach I believe either could work perfectly well. For me this would be a crestal approach for the following reasons.
1) roughly 5mm of remaining bone which will Provide good implant stability (bicortical) even in the unforseen event that the graft is less than ideal
2) a broad sinus floor (buccal-palatal) which will make membrane elevation through the osteotomy more forgiving than a narrow “V” shaped floor

This may be a good case for osseodensification burs (versa) and the slow addition of PRF and sticky bone to assist with the sinus floor elevation. I say this because of the very small septum which sits just distal to the potential osteotomy. This small septum could make elevation of the membrane alone through the osteotomy slightly more difficult. By using osseodensification the septum would be elevated simultaneously with the membrane in theory. Interested to hear some other thoughts. Thanks!


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Brad; You are a good....regards Dr. S

Osteotomy thru crest
Versah OD mode


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Versah crestal approach...

Implant placed 6.0 X 8mm
PA post op


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Nice work Maurice! nice work. This drills are incredible. I can not wait to try. Is the Drill system universal? Thank you! What is your experience with narrowed crest?

My best,

Emilio


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Versah crestal approach...Protocol for sinus

Part 1
Part 2


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