Case report on managing incomplete bone formation after bilateral sinus augmentation using a palatal approach and a dilating balloon technique

Tobias K Boehm

doi:10.1186/s40729-017-0065-7

Abstract

BackgroundPatients with resorbed edentulous alveolar ridges in the posterior maxilla often require lateral window sinus augmentation procedures prior to implant placement. Lateral window sinus augmentation procedures can produce incomplete bone augmentation as consequence of surgical and healing complications producing unusual and complex sinus anatomy. Although incomplete bone formation after sinus augmentation has been described in a previous case reports, this is the first case report that describes grafting these compromised sites prior to implant placement.Case presentationA 65-year-old male patient with no known medical conditions presented with severe chronic localized periodontitis and a combined periodontal-endodontic lesion affecting three first molars. Initial ridge preservation and lateral window sinus augmentation resulted in incomplete bone formation and complex sinus floor anatomy on both right and left sides. A dilating balloon technique on one side and a palatal approach on the other side were utilized for additional sinus augmentation using particulate allograft and resorbable collagen membranes. Healing was uneventful, and implants could be placed and restored at all sites. Periodontal maintenance was conducted every 3 months, and the implants have been in function and periodontally healthy for 2 years.ConclusionDespite initial failure of sinus augmentation to produce suitable implant sites, it is possible to rescue these sites with re-entry grafting procedures and allow successful implant placement and restoration.

Highlights

Patients with resorbed edentulous alveolar ridges in the posterior maxilla often require lateral window sinus augmentation procedures prior to implant placement
A recent case report describes an unconventional palatal approach for managing sinus floor anatomy complicated by previous sinus grafting [15]
There is still little data on the long-term success of these unconventional re-entry procedures after incomplete bone formation, and here, we present a case with 3-year follow-up after re-entry grafting procedures using either a palatal window or balloondilating device for management of previously failed sinus augmentation

Summary

Introduction

Patients with resorbed edentulous alveolar ridges in the posterior maxilla often require lateral window sinus augmentation procedures prior to implant placement. Implant therapy can be a challenge for those patients as available bone height is limited by the maxillary sinus. The most common complication during sinus augmentation surgery is tearing of the Schneiderian membrane. Piezoelectric surgery and surgical planning can reduce this complication [4], tears still remain a possible surgical complication and there may be incomplete bone augmentation [5].

Results

Conclusion