Case Presentation

1️⃣ Pre-Op

• Pre-Op X-ray & Intraoral Photo

  • Edentulous site at #27

2️⃣ Surgical Plan

• #27 VAROGuide Implant planning

• Residual Bone Height at #27: Approximately 6.91 mm.

• Plan: Use of a surgical guide and sinus graft.

• Implant Size: Ø5.0 x 10.0 mm / Sleeve Offset: 9.0 mm

• Sinus Class Ⅲ CMI Fixation

During the crestal approach, the inclination of the sinus floor is crucial. For a flat area similar to #27, a lifting of up to 3mm is feasible. If lifting exceeds 3mm, detachment of the sinus membrane around the entire area is required. The buccal side of the sinus membrane is thicker, causing bone grafts to shift toward the lingual side during grafting.

3️⃣ Surgery - Maxillary Sinus Lift Procedure

1. Soft Tissue Removal

[Accessory Kit]

• For flapless surgery, a tissue punch Ø5.0 from the Accessory Kit was used, and soft tissue removal was performed before drilling.

2. Maxillary Sinus Lift

[SCA Kit & Master Kit]

• Fig 1. SCA Kit - Initial Drill(ø2.0) - 6 mm Drill Stopper

  • Given the residual bone height of approximately 6.9 mm, a 6 mm drill stopper was used

• Fig 2. Master Kit - Surgical Drill(ø3.0/F3.5) - 4.0 mm Drill Stopper

  • The surgical drill, including the triangular zone, is 1.2 mm longer than the length set by the drill stopper. So the actual drilling depth is 5.2 mm.

• Fig 3. Master Kit - Surgical Drill (ø3.5/F4.0) - 4.0 mm Drill Stopper

  • Due to the low bone density of soft bone, under-drilling was performed up to Ø3.5.

• Fig 4. SCA Kit - S-reamer(ø3.2) - 7.0 mm Drill Stopper

  • Drilling was performed at over 1,000 rpm (20:1)."

• Fig 5. SCA Kit - Depth Gauge

  • The sinus membrane was assessed using a depth gauge.

• Fig 6. SCA Kit - S-reamer(ø3.2) - 8.0 mm Drill Stopper

  • Drilling was performed at over 1,000 rpm (20:1)."

• Fig 7. SCA Kit - S-reamer(ø3.2) - 9.0 mm Drill Stopper

  • Drilling was performed at over 1,000 rpm (20:1)."

  • Confirmed membrane detachment.

• Fig 8. SCA Kit - Depth Gauge

  • Reconfirmed membrane detachment using a depth gauge.

The Aqua system was prepared, requiring approximately 0.1 cc of material per 1 mm elevation of the sinus membrane. The Aqua system's silicon connector (Aqua Connector) was used to slowly lift the sinus membrane through hydraulic pressure applied via a syringe.

3. Bone Graft

[SCA Kit]

• Fig 1. Hydration of the bone graft was performed using synthetic bone (HA: β-TCP = 6:4)

• Fig 2. The bone graft was loaded into a bone carrier and inserted into the sinus

• Fig 3. The bone graft was elevated using a bone condenser.

• Fig 4. SCA Kit - Bone inserter - 9 mm Drill Stopper

  • The bone graft was elevated using a bone condenser.

  • A bone inserter was used to laterally spread the bone graft without irrigation at 80 rpm.

• Fig 5. SCA Kit - Bone Spreader(ø3.1) - 10 mm Drill Stopper

  • The bone graft was laterally spread using a bone spreader.

4. Final Drilling & Implant Placement

[Master Kit & IS-II Active Fixture]

• Fig 1. Master Kit - Surgical Drill (ø4.0/F4.5) - 10.0 mm Drill Stopper

  • Drilling was performed at 100 rpm (20:1) without irrigation.

• Fig 2. Master Kit - Surgical Drill (ø4.5/F5.0)

  • Drilling was performed only in the cortical bone area to facilitate the placement of the IS-II active Ø5.5 x 10.0 mm (BIS5510A) - Functioning as a cortical drill

  • Drilling was performed at 100 rpm (20:1) without irrigation.

• Fig 3. The IS-II active Ø5.5 x 10.0 mm (BIS5510A) was placed using a handpiece at 40 rpm, with the apex of fixture positioned into the grafted bone inside the maxillary sinus.

• Fig 4. A torque ratchet was used to control insertion depth and measure the ITV, which was recorded at 40 N/cm.

• Fig 5. The IS Healing Abutment Ø6.0 x 3.0 mm (ISH603) was connected.

• Fig 6. IST was measured using AnyCheck, resulting in a value of 81.

4️⃣ Post-Op

• Post-Op PA

  • PA radiograph was taken to assess the bone level and the status of the bone graft within the maxillary sinus.

• Post-Op Panoramic Radiograph

• Post-Op CT imaging

  • Postoperative CT imaging revealed that the sinus membrane was inclined, with the bone graft shifted towards the buccal side.

• Intra Oral Scanning

  • Achieved successful CMI fixation of D442 on the inferior wall, with an ITV of 40 Ncm and an ISTV of 81. Therefore, on the day of implant placement, the YK Abutment and YK Scan (Healing) Cap were connected, followed by intraoral scanning.

  • Maxilla, mandible, and occlusion were assessed with intraoral scanning at the abutment level, with plans to place the prosthesis after 4 weeks.

5️⃣ Final Prosthetics: 4-week Early Loading

• Stability Measurement

  • After 4 weeks, the implant stability measurement using AnyCheck on the YK abutment showed an ISTV of 77.

• Final Restoration

  • The final zirconia implant crown was fabricated using the YK system in a hook type design. Resin was added to the contact box on the mesial side of the prosthesis, adjusted intraorally, and light-cured. Occlusion was adjusted before the final setting

• After final prosthetics

6️⃣ Follow-Up

• 1 month follow-up showed that the marginal bone was well maintained.

7️⃣ Clinical Video

• Explore the comprehensive surgical procedure in the video below to gain a deeper understanding.