Wide-Diameter Implant Placement and Internal Sinus Membrane Elevation in the Immediate Postextraction Phase: Clinical and Radiographic Observations in 12 Consecutive Molar Sites

Purpose: To evaluate whether the combination of 5 surgical techniques in implant dentistry could be performed simultaneously in a predictable manner as effectively as each technique separately. Materials and Methods: Immediately postextraction, 12 wide-diameter (WD) implants were placed in maxillary first or second molar sites. The residual vertical bone height ranged between 6 and 9 mm (average 7.8 mm). An internal sinus elevation, via the osteotomy site, was carried out in 10 sites using an osteotome tool. Implants were then self-tapped into the osteotomy site followed by insertion of a customized healing screw. Consequently, horizontal gaps between the bony walls and the implant neck were filled by either bovine bone mineral or tricalcium phosphate particles. Full soft tissue closure around the healing cap screw was achieved by coronal positioning of the buccal flap. Results: Soft tissue healing around the 12 implants was immaculate. In 10 sites, internal osteotome sinus membrane elevation resulted in a height gain of between 2.5 and 6 mm (average 4.3 mm). Radiographically, bone-to-implant contact was evident. All implants were integrated and the prosthetic phase was completed after 6 months. Discussion and Conclusions: The combination of 1-stage technique and immediate placement of WD implants, along with internal sinus floor elevation and no soft tissue reflection at the time of implantation, is an achievable task and can be performed predictably. Time, cost, and morbidity are reduced, and the prosthetic solution is also eased for the benefit of the patient.