Trans-Socket Elevation/Fracture/Perforation of the Sinus Floor Through the "Infected" Maxillary Tooth Socket to...

In the region of the posterior maxilla, a reduced bone depth implies a need for bone augmentation. Such augmentation has been performed via the lateral window approach or a transcrestal approach. Historically, the inferior bony crest opposite the maxilla has been edentulous and free of infection. This case series demonstrates that the maxillary extraction socket can be used predictably as the conduit for an intentional sinus penetration/perforation or fracture (sinus elevation) even in the presence of apical infection. This allows the full use of all the available bony depth below the sinus floor and the floor itself, to achieve acceptable primary fixation of an immediately placed dental implant. To the best of my knowledge, this is the first clinical and radiologic report of such a procedure.

All 10 cases presented had maxillary teeth whose extraction was planned. All teeth had areas of radiolucency (or infection) in close proximity to the sinus floor. The available depth of bone at all sites exceeded 5 mm. All the vacated sockets were prepared for implant placement, 1 to 2 mm below the sinus floor. Osteotomes were used through the socket to penetrate or fracture the sinus floor. No bone substitutes were used to augment the bone depth. The implants were immediately placed into the prepared sites with high primary stability.

This case series demonstrates that the presence of radiolucencies or infection does not contraindicate using the socket as a conduit for sinus floor penetration or fracture. The technique will be easily managed by clinicians who practice conventional sinus floor elevation.