Crestal approach for repair of oroantral bone defects and subsequent implant placement.

Abstract

Background: Oroantral communication (OAC) can occur after a dental extraction. Occasionally, bony defects may persist despite successful soft tissue closure of the OAC. The absence of bone in these areas poses challenges for dental implant placement. This report describes a novel approach of vertical sinus elevation through the oroantral bony defect to address such scenarios.

Methods: A 36-year-old male (Patient 1) and a 62-year-old female (Patient 2) presented with OACs in the first maxillary molar region. Vertical sinus elevation was achieved through the existing defect. This was followed by placement of corticocancellous bone allograft mixed with platelet-rich fibrin (PRF) in the space surrounded by the elevated sinus membrane that was then covered with a resorbable collagen membrane. Implants were placed 9 and 6 months after the sinus lift in Patient 1 and Patient 2, respectively.

Results: In both cases, substantial radiographic bone fill of the oroantral bony defect was achieved allowing successful placement of dental implants. Following insertion of final restorations, the patients were satisfied with the esthetic outcomes and reported improved oral function.

Conclusions: Vertical sinus elevation through residual bony oroantral defects in conjunction with placement of bone allograft mixed with PRF yields sufficient alveolar bone for subsequent placement of dental implants.

Plain language summary: Bone defects secondary to oroantral communications resulting from dental extractions may persist despite successful soft tissue closure. Such oroantral communication (OAC) pose challenges for dental implant placement. This report describes a technique for repairing oroantral bony defects and subsequent placement of dental implants. Two patients presented with OACs in the first maxillary molar region. Vertical sinus elevation with corticocancellous bone allograft and platelet-rich fibrin, was achieved through the existing defect. Substantial radiographic bone fill of the oroantral bony defect was achieved and implants with final restorations were subsequently placed.

Key points: Elevation of the sinus membrane through an existing crestal defect resulting from an OAC allows the clinician to successfully elevated the sinus membrane for bone augmentation allowing eventual placement of an implant. The approach allows the clinician to achieve this goal without preparing a second window through a more invasive lateral approach.