Sinus floor augmentation through a rotated palatal flap at the time of tooth extraction

Rapid crestal bone resorption following maxillary tooth loss is further accentuated in the posterior regions because of pneumatization and enlargement of the maxillary sinuses. A treatment rationale that allows preservation and/or augmentation of vertical available bone at the time of posterior maxillary tooth extraction may offer numerous therapeutic benefits. The present study comprised 14 patients in whom 18 posterior maxillary teeth with no evident bone between the tooth apex and sinus floor, as estimated through preoperative radiographic analysis, were carefully extracted using a palatal approach. The empty alveolus was thoroughly debrided and incrementally filled with tricalcium phosphate. The graft material was gently pushed beyond the empty alveolus to elevate the sinus membrane using an osteotome. Primary soft tissue closure over the grafted sites was achieved by a rotated palatal flap. The distance between bone crest and sinus floor was radiographically estimated 6 to 7 months after the first procedure. Another procedure was then carried out to place the 10- to 14-mm implants, together with a bone-added osteotome sinus floor elevation. At uncovering, all implants were clinically stable, with no signs of infection. The presented surgical procedure performed at the time of extraction of posterior maxillary teeth in close proximity to the sinus floor allowed placement of implants of proper length and width, together with a bone-added osteotome sinus floor elevation during a second procedure.