Immediate Implant in Low Sinus floor case - Dr Vishal Jain

Описание: Immediate Extraction and Immediate Implant Placement in Upper First Molar with Low Sinus Lining -

Clinical Scenario Overview
Tooth: Maxillary first molar - 16

Procedure: Immediate extraction + immediate implant placement
Challenge: Low sinus floor (reduced vertical bone height)

Key Clinical Challenges

Low Sinus Floor:
Common in posterior maxilla due to pneumatization and bone loss.
Often results in less than 5–6 mm of residual bone height, which is not ideal for implant primary stability.

Socket Morphology:
Maxillary molar sockets have divergent roots and wide extraction sockets.
Often leads to gaps between implant and socket walls.
Risk of buccal plate dehiscence or thin walls.

Primary Stability Risk:
Essential for immediate implant success.
Low bone height + wide socket = reduced apical and lateral stability.

Case Selection Criteria
Favorable Cases for Immediate Implant in Upper Molar with Low Sinus:
Residual bone height - less than–6 mm.
Intact socket walls post-extraction.
No acute infection.
Adequate bone width (less than 7 mm).
Patient with good oral hygiene and no systemic contraindications.

Treatment Options Based on Bone Height
Residual Bone Height Recommended Approach

less than 8 mm - Immediate implant without sinus lift
5–8 mm - Immediate implant + trans alveolar sinus lift
more than 5 mm - Delayed implant + lateral or crestal sinus lift

Clinical Protocol for Immediate Implant with Low Sinus Floor

1. Pre-op Assessment
CBCT scan to evaluate:
Bone height from crest to sinus floor.
Bucco palatal bone width.
Sinus anatomy (septae, thickness of Schneiderian membrane).
Evaluate molar root anatomy (divergence, number of roots, pathology).

2. Atraumatic Extraction
Use periotomes, luxators, sectioning of roots if needed.
Preserve interradicular septum and socket walls.

3. Implant Site Preparation
If more than 5 mm bone height:
Use osteotomes or special sinus lift drills for trans crestal sinus lift.
Carefully elevate Schneiderian membrane 2–3 mm if needed.
Bone graft material can be used under sinus floor.

4. Implant Placement
Choose narrower implant (4.5–5.0 mm) to fit within interradicular septum.
Aim for primary stability (less then 30–35 Ncm torque).
Position: ~1–2 mm sub crestal.

5. Gap Management
Gaps between implant and socket wall (less than 2 mm) → fill with graft (e.g. xenograft or allograft).
Optional: Use collagen membrane to cover graft.

6. Closure
Primary closure ideal but not mandatory (healing abutment or cover screw can be used depending on flap design and loading protocol).
Consider temporary crown only if primary stability allows and occlusion is controlled (non-functional loading).

Post-op Care
Antibiotics (e.g. Amoxicillin or Clindamycin).
Chlorhexidine rinses.
Pain management.
Avoid nose-blowing or sneezing with closed mouth (sinus care).
Suture removal after 7–10 days.

Follow-Up and Restoration
Healing period: 4–6 months, depending on sinus lift and graft material.
Final prosthesis after confirmed osseointegration via ISQ or radiograph.

Alternative Plan
If Residual Bone more than 5 mm
Extract and graft socket.
Allow 4–6 months healing.
Place implant with lateral sinus lift.

In case of any further clarification -
Please contact
Dr Vishal Jain
Dr Jains Vitaldent
(CGHS, ECHS, CAPF Empaneled clinic)
9717200515