TRANSCRIPT:

So this next case is a woman who's come back into your practice. She had tooth number 14 removed four months ago. A sinus preservation graft was completed at that time, and she's now come back and wants an implant at site number 14.

As we scroll through, again, kind of the overview panel here, but we're really focusing on, in my opinion, that coronal view is the most valuable for information in terms of bone height and width as well as sinus anatomy. And as we scroll through that coronal view, we can see that the sinus here does appear black, radiolucent, or clear, and that's important. It's indicating that there is apparent sinus health. I don't see any sinusitis, inflammation of the membrane, radio opacity, white or grayness in the sinus. We don't see any foreign bodies. We don't see any pathology. Things seem pretty clear and healthy, which is good.

As we scroll back over this implant site, we're looking kind of midway there between 13 and 15. Look for implant placement somewhere in this region. Let's take a measurement to that area. We know, again, the sinus appears healthy, so our focus now is on bone width and bone height. Bone width, we've got plenty there. We've got roughly eight, nine millimeters, so we should have no issue in terms of width. What about bone height? That's probably going to be the limiting factor.

And if we kind of come mid-ridge, we're looking maybe six and a half millimeters there. So when we consider our bone cut off of about six millimeters, this is indicating to us that we are able to do a predictable indirect sinus lift. Predictable meaning, again, we're going to get probably about two millimeters consistently. One to two millimeters is fairly consistent. Three or four can be done in an experienced provider, but is difficult and not predictable. So for a treatment planning standpoint, that six millimeter mark is that bone cut off that I like to adhere to that lets me know, hey, I can get an extra two millimeters or so in that area. Put me up at about eight and a half millimeters.

I like to use an implant that's not shorter than eight millimeters in the posterior in my practice. So I know in this particular patient, I can get a five millimeter width and an eight millimeter height implant into that region predictably with a two millimeter indirect sinus lift and I'll still have bone covering the apex of the implant. If this number falls below six, we get to that six to five range. That's that gray area where, yes, it can be done with an indirect sinus lift, but you've got to be experienced and you've got to be getting three to four millimeters on that lift, which can be difficult to predictably do. Once you're dropping below the five millimeter mark, we know that's very difficult to obtain with an indirect lift and you're going to be looking at a direct sinus lift to get that four, five, six millimeters of bone that you need to get an adequate implant placed in that area.

So this particular patient looks like our graft is healed well, we've got enough bone width, we've got enough bone height for an indirect lift and we'll move forward with an indirect lift and implant placement. That concludes this case.

Lesson Summary

In this case, a woman has returned to the practice after having tooth number 14 removed four months ago. A sinus preservation graft was previously completed, and she now desires an implant in that area. Upon examination of the radiographs, the sinus appears healthy, with no signs of sinusitis or inflammation. The bone width is sufficient, measuring approximately eight to nine millimeters, and the limiting factor is the bone height, which is around six and a half millimeters. This indicates that a predictable indirect sinus lift can be performed, with an expected gain of about two millimeters. If the bone height falls below six millimeters, a direct sinus lift may be necessary. In this particular patient, an eight-millimeter height implant can be predictably placed with a two millimeter indirect sinus lift. The graft has healed well, and there is enough bone width and height for the planned procedure. Thus, an indirect lift and implant placement will be performed.