[The maxillary challenge in oral implantology]

The implant recipient site may at times be inadequate or absent due to the presence of an oro-antral fistula, and procedures have to be implemented to remove the fistula, debride, and bone graft the implant site. This presentation and paper address several innovative procedures and their indications. Four sinus augmentation modalities and a "T.L.C. Window Approach" are described and illustrated. The first three modalities are classified as Sinus Augmentation No. 6. The debridement procedure is outlined in 4 steps: Deepithelialization of the soft tissue aspect of the oro-antral fistula; a circumferential incision; debridement and suture of the fistulous tract; and augmentation of the sinus. The extent of the osseous oro-antral fistulae involvement is classified as Types S, M, and L (small, medium, and large), and the measurements are indicated. The fourth modality is titled Sinus Augmentation No. 7, and it is concerned with the treatment of large sinus, further underlined by a severely lingualized "available bone" trajectory. To correct this type of case, the author suggests the Sinus Augmentation No. 7 modality, which, by definition, is the extemporaneous correction of the aforementioned deficiency, using a sinus augmentation (SA.4 modality) coupled to an autogenous inlay-onlay bone graft (endchondral or membranous), bearing root form implants and osteosynthesized to the palatal osseous wall of the S.4 type sinus. The "T.L.C. Window Approach" is used when a foreign body is present in the antral area and has to be removed to avoid the possibility of infection or impaired osteal drainage at the same time a sinus augmentation is performed.