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Implant Placement with Internal Sinus Lift – Tooth #16

Surgical Procedure

Chief Complaint

Missing upper right molar (#16) requiring implant rehabilitation.

Clinical Findings

  • Edentulous site at #16

  • Adequate ridge width for implant placement with requirement for internal sinus lift

  • CBCT confirmed appropriate anatomy for crestal approach sinus elevation

Treatment Plan

  • Implant placement at #16

  • Internal sinus lift (crestal approach)

  • Sinus augmentation with collagen xenograft

  • Buccal bone grafting

  • Healing abutment placement

  • Post-operative CBCT for verification

Pre-operative Assessment

  • Pre-op CBCT reviewed

  • Risks and surgical steps explained

  • Implant position planned

  • Patient understood and agreed

  • Informed consent obtained for implant placement with sinus lift and augmentation

Anesthesia

Local anesthesia.

Surgical Procedure

  • Patient cleaned and draped

  • Incision made; buccal flap raised

  • Osteotomy prepared using implant drills and osteotomes

  • Internal sinus lift performed via crestal approach

  • Sinus augmented with Dentium Osteon II Collagen xenograft (6.0 × 10.0 mm)

  • Megagen AnyOne Implant (5.0 × 7.0 mm, plasma-blasted) placed at #16

  • Healing abutment 7.5 mm (M) attached

  • Buccal bone grafting performed using additional Dentium Osteon II Collagen xenograft

  • Flap released and advanced

  • BSS × 4 placed for primary closure

  • Hemostasis achieved; POI given

Post-operative Assessment

  • Pre-op CBCT reviewed

  • Risks and surgical steps explained

  • Implant position planned

  • Patient understood and agreed

  • Informed consent obtained for implant placement with sinus lift and augmentation

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