Case provided By Prof. Dr. Anton Friedman (Chair and Head Department of Periodontology, School of Dentistry, Faculty of Health, University of Witten, Germany)
History of hopeless maxillary molars
Residual subantral bone ≈ 2 mm
Lateral window approach ≈ 6 months following tooth loss
Sinus floor elevation and vertical application of biomaterials
Xenograft (Smartgraft®) hydrated with high weight hyaluronic acid (hyaDENT BG)
OSSIX®Plus membrane in place covers full extension of the grafted area
Separate membrane fixation unnecessary
Coronally advanced flap (CAF) and suture
Coronal advancement of the buccal flap (CAF)
Complete tension free closure of the site with PTFE and monocryl sutures
Suture removal ≈ 12 days post-op
Stage 2 surgery - re-entry and tissue sampling 8 months after SFE
Periapical x-ray displays gain in mineralized tissue at the sinus and supracrestally (arrows)
Soft tissue and ridge dimension at stage 2
Macroscopically mature crestal bone across the ridge
Stage 2 - implant placement 8 months later
Ridge dimension achieved 8 months after SFE and lateral/vertical augmentation
WNI (Straumann SP/WN/10 mm length) in place
Gingiva former in place for transmucosal healing
Histological observations in H.E. staining (courtesy Prof. Götz)
Decalcified serial sections reveal various stages of bone formation with appositional bone growth at the residual xenogenic particulate
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