Surgical Lateral Window Sinus Lift and Maxillary Sinus Augmentation with Bone Grafting Under Local Anesthesia
Surgical Procedure
Chief Complaint
Px wished to replace missing #24, #25, #26, and #27 with dental implants.
Clinical Findings
Maxillary sinus highly pneumatised
Poor ridge bone height at posterior left maxilla
Ridge width relatively adequate
Inadequate vertical bone height for implant placement
#25 severely distally tilted and supra-erupted
#26 severely supra-erupted
Treatment Plan
Surgical lateral window sinus lift at posterior left maxilla
Maxillary sinus augmentation with bone grafting material
Extraction of #25 and #26
Socket preservation and guided bone regeneration
Risks, benefits, treatment limitations, grafting procedures, and post-operative expectations explained.
Pre-operative Assessment
CBCT reviewed prior to surgery.
Posterior maxillary bone height inadequate for implant placement due to sinus pneumatisation.
Risks including sinus membrane perforation, infection, bleeding, swelling, graft failure, sinus complications, and delayed implant placement discussed.
Px understood and agreed to proceed.
Informed consent obtained for surgical lateral window sinus lift and augmentation with bone grafting material.
Anesthesia
LA infiltration administered to posterior segment of left upper quadrant.
Surgical Procedure
Px cleaned and draped in sterile manner.
Incision made and buccal flap raised.
Lateral buccal window prepared at posterior left maxilla.
Maxillary sinus membrane carefully elevated and displaced medially.
Procedure limited by access and instrument length.
A 2mm sinus membrane tear occurred secondary to bone irregularity around #26 root apices during membrane separation.
Px informed intra-operatively.
Jason Membrane collagen membrane (20mm x 30mm) placed over perforated sinus membrane to repair defect and act as protective roof prior to graft placement.
Dentium Osteon II collagen bone graft material placed into sinus cavity.
Intra-operative CBCT taken.
Additional grafting performed to improve augmentation at #27 region.
Total:
5 packs Dentium Osteon II collagen bone graft material used for sinus augmentation
LA XAP #25 and #26 performed.
Socket preservation completed using additional Dentium Osteon II collagen bone graft material.
Palatal flap raised and buccal flap released.
Guided bone regeneration performed using second Jason Membrane collagen membrane (20mm x 30mm).
4/0 BSS x7 placed for primary closure.
Haemostasis achieved.
POI given.
Post-operative Assessment
Post-operative CBCT taken.
Sinus lift and augmentation satisfactory for future implant placement.
Bone graft adaptation adequate.
Primary wound closure achieved.
Px reassured and discharged in stable condition.