Case Presentation

1️⃣ Pre-Op

• Pre-Op panoramic view: Maxillary right 2nd molar (#17) was missing. Severe bone loss and widened PDL around the adjacent 1st molar (#16) was seen.

2️⃣ Surgery - Lateral Approach Using LS-Reamer

[Tooth Extraction]

• fig 1. Sufficient amount of keratinized gingiva around #16. Severe mobility (+2-3) and bleeding on probing were observed.

• fig 2. The tooth was extracted atraumatically.

[Lateral Approach]

• fig 1. A vertical incision was made on the mucosa around the apex of #16.

• fig 2. The remaining bone height was only 4-5 mm. The LS-Reamer, specifically designed for sinus surgery, was positioned in contact with the lateral wall of the sinus. It enables drilling through the bony wall while avoiding perforation of the sinus membrane, and its tip ensures stability during the drilling process.

[Sinus Graft]

• fig 1. A view of the lateral wall of the sinus after the osteotomy using the LS-Reamer. The sinus membrane was visualized through the window opening without a thin bone disk on the membrane this time. 

• fig 2. Lifting the sinus membrane using an elevator (from SLA kit) creates space for bone graft material. 

• fig 3. The space created from membrane lifting was filled with the mixture of autograft and allograft. 

[Implant Placement]

• fig 1. The amount of keratized gingiva in the maxillary right posterior region allows the use of a tissue-punch at the site for implant placement. 

• fig 2. For the drilling protocol, undersized drilling was used as low-density bone(D320) exists. 

• fig 3. Undersized drilling was also used in the extraction socket. 

• fig 4. The osteotomy was completed at the #16 and #17. The remaining bone at #16 was seen as around 3-4mm. 

  

  

  

  

  

  

  

  

• fig 5. Two 5.0 X 10mm CMI IS-II active fixtures were placed. 

• fig 6. At the #16, the gap between the fixture and the extraction socket was filled with the mixture of autograft and DM bone. 

• fig 7. Bone graft in the sinus was completed prior to suturing. No membrane was covered over the graft.

• fig 8. Simple interrupted suture with Supramid 4-0 was used for the vertical incision.

  

  

  

  

  

  

  

  

3️⃣ Post-Op

[4-week post-op]

• Intraoral Photo: The soft tissue healing around the healing abutments appears adequate.

• Periapical X-ray: The grafted bone appears to be stable and well-maintained in its position.

4️⃣Final Restoration - SCRP Prosthetics

• fig 1. 5 months after surgery, the SCRP implant prosthesis was placed, ensuring proper mesial proximal contact and verifying occlusion during the try-in process.

• fig 2. SCRP technique: The access hole should be filled with gauze balls to prevent cement from entering. The gauze ball should be taken out before the cement sets completely for cement cleansing.

• fig 3. The final prosthesis was unscrewed and removed for the removal of subgingival excess cement. 

• fig 4. Lateral view: The final prosthesis in occlusal contact.

5️⃣ Follow-Up

• Post-delivery X-ray: The connection between the abutment and the final prosthesis was verified. It also showed that the peri-implant bone level was maintained.

• 5-year follow-up X-ray: The peri-implant bone level was excellently preserved.

• 11-year follow-up panorama: It confirmed the successful maintenance of maxillary implants, supported by the sinus grafting approach using the SLA Kit. It also highlighted stable mandibular implants, showcasing the overall reliability of the CMI Implant system.