Internal sinus elevation - immediate implant placement - socket grafting

Bone grafting - upper jaw

Internal sinus elevation

Sinus elevation using the minimal invasive balloon technique

Prosthetic driven implant placement

"Comp up technique" for optimal anatomy in posterior direct adhesive restorations

Crestal bone stability with implants placed in previous sinus elevated area - long term recall

Guided bone regeneration using autologue bone graft for the aesthetic area.

Clinical picture showing how graft recipient area is adjusted for optimal graft fit and passive imobilization.

Tooth loss means bone loss. Vertical and horizontal bone regeneration can be very challenging.

The most predictable procedure is bone grafting.

This case has been solved using bone graft from ramus mandibulae of the patient.

Aesthetic and functional restoration with implant supported crowns

Clinical picture of implant supported crowns

Preoperative clinical pictures of fractured anterior teeth

Wax up of study casts for correct treatment planning

The buccal wax up preview

The ready waxed up study casts mounted in the articulator

Study casts before and after wax up

The "Comp up technique" used for direct posterior adhesive restorations

Patient treatment decision tree

Chronic Apical Periodontitis with sufficient orthograde RCT

CAP persistence (Mah TF, O Toole GA. Mechanisms of biofilm resistance to antimicrobial agents. Trends Microbiol 2001;56:672-7 / Russel AD. Biocide use and antibiotic resistance: the relevance of laboratory findings to clinical and environmental situation. Lancet Infect Dis 2003; 3:794-803)
Factors influencing Periapical Wound Healing:
1. Infection
2. Foreign bodies
3. Systematic disease
4. impaired host s immune system
Treatment options
1. Surgical retreatment
1.1 Surgical Retreatment RCT without graft
1.2 Surgical Retreatment with guided bone regeneration
Evidence for both procedures is controversial.
Evidence available for the use of autogenous bone graft.
Evidence available for the use of growth factors (PRGF).
2. Extraction
2.a Without socket preservation
Risk of bone resorption ==> buccal bone plate to resorp faster (first 3 months)
2.b With socket preservation
Evidence available to support procedure.
2.1 No further treatment
2.2 Removable device
2.3 Bridge
2.4 Implant


No further treatment

Benefits
"0"

Disadvantages
Bone resorption
Function limitations
Aesthetics issues
Tilting of neighbough teeth
Extrusion of antagonist teeth

Removable device

Benefits
Fast
Reduced costs

Disadvantages
Bone resorption
Function limitations
Aesthetic issues
Reduced retention

Bridge

Benefits
Time saving
Costs

Disadvantages
Bone resorption
Aesthetic issues
Removal of healthy tooth structure (adjacents teeth) long term ==> creates problems?

Implant

Benefits
Maintain bone
Preventive treatment measure

Disadvantages
Costs
Prolonged treatment time
Optional graft needed
Temporization

Clinical value of 3 dimensional x-ray (CbCT) for root canal treatment