The old reconstructions have to be replaced. But how? A challenging case treated by Dr. Sven Mühlemann, University of Zurich.

Contents - Incision technique for lateral sinus floor augmentation - Creation of a lateral bone window in the facial maxillary sinus wall - Maxillary sinus floor elevation - Chin bone graft harvesting - Retromolar bone harvesting - Sinus floor augmentation using autologous bone, beta- tricalcium phosphate (1:1) and PRP Synopsis: Maxillary sinus augmentation may be indicated in cases where it is desirable to increase the vertical bone stock in the upper lateral tooth region. Maxillary sinus floor augmentation entails the implantation of autologous bone or bone replacement material in the spaces between the bony floor and elevated membrane of the maxillary sinus. This video demonstrates the techniques for palatal incision, access preparation, and exposure of the facial wall of the maxillary sinus. A diamond drill is used to create a bony window in the facial wall of the maxillary sinus taking care not to perforate the sinus membrane. After completely detaching the basal parts of the membrane, the flap is advanced cranially using angular elevation instruments. Regarding the procedure for autologous bone grafting, the steps for incision, prepping and harvesting of monocortical chin bone transplants with a trephine drill are demonstrated. An alternative procedure for harvesting retromolar bone material is also shown. A bone mill is used to particulate the autologous bone material. The autologous bone chips are then mixed 1:1 with beta-tricalcium phosphate (and PRP) and inserted in the sinus floor.

Content: Description of system and instruments. The patient had a considerable bone deficit at tooth 21. Augmentation was therefore required and was carried out using calibrated instruments. The augmentation site was prepared using instruments that matched the tools used to harvest the cylindrical bone graft at the donor site. This perfect match between the augmentation region and the bone transplant accelerated osseointegration, there by shortening the required waiting time for implant placement.

Missing posterior teeth and old unesthetic reconstructions - see how this case was solved by Dr. Christian Leutert at the University of Zurich.

Comprehensive case in a periodontally compromised patient.

To create optimal chewing efficiency the lower jaw was reconstructed with mixed implant- and tooth-supported bridges containing cantilevers. The abraded front teeth were crowned to improve the esthetics.

Hopeless lateral incisor in a young patient with a high smile line.

Female patient *1979 by Dr. Oberhansl (Dr. Nölken). The aggressive periodontitis was treated during 3 years. Then, a fractured molar was replaced with an immediate implant.

Dr. Dominik Büchi performed an immediate implant placement in the aesthetic area. Therefore the esthetic risk factors had to be evaluated carefully before starting the treatment.