The Story:
An unique clinical case: Retained primary molar with advanced bone loss, pneumatized sinus floor, and sinus perforation with sinusitis. The key to management of such as case is ‘SLOW DENTISTRY’ (STAGED treatments) achieving one miracle at a time:
Extraction with 3-layer socket management (Atelocollagen at sinus floor, allogeneic particulate bone, Atelocollagen at crest + PRF)
No primary closure to help regenerate keratinized gingiva at crest Allow 4 months of healing Alveolar bone regenerated (3 mm height) and sinusitis resolved
Lateral window sinus lift bone augmentation Allowed to heal for 6 months. Achieved 11-13 mm of vertical bone height
Computer-assisted implant planning and 3-D printed surgical guide Placement of implant: 5 mm diameter, 8 mm height 2-4 mm of apical bone and > 3mm of bone on buccal and palatal aspect
Guided placement of dental implant with osseodensification Single stage placement of dental implant with healing abutment Anticipated D3-D4 bone calls for osseodensification technique for biotype conversion of bone to D2-D3 High stability and torque on implant achieved 4 months of integration before restorative phase.