SFE with Smartgraft + hyaDENT BG and OSSIX Plus

History of hopeless maxillary molars

Residual subantral bone ≈ 2 mm

Lateral window approach ≈ 6 months following tooth loss

Sinus floor elevation and vertical application of biomaterials

Xenograft (Smartgraft®) hydrated with high weight hyaluronic acid (hyaDENT BG)

OSSIX®Plus membrane in place covers full extension of the grafted area

Separate membrane fixation unnecessary

Coronally advanced flap (CAF) and suture

Coronal advancement of the buccal flap (CAF)

Complete tension free closure of the site with PTFE and monocryl sutures

Suture removal ≈ 12 days post-op

Stage 2 surgery - re-entry and tissue sampling 8 months after SFE

Periapical x-ray displays gain in mineralized tissue at the sinus and supracrestally (arrows)

Soft tissue and ridge dimension at stage 2

Macroscopically mature crestal bone across the ridge

Stage 2 - implant placement 8 months later

Ridge dimension achieved 8 months after SFE and lateral/vertical augmentation

WNI (Straumann SP/WN/10 mm length) in place

Gingiva former in place for transmucosal healing

Histological observations in H.E. staining (courtesy Prof. Götz)

Decalcified serial sections reveal various stages of bone formation with appositional bone growth at the residual xenogenic particulate