case_images: PMC3886442_01
case_images: Initial X-ray examination.
case_images: CRIM.DENTISTRY2013-612108.001.jpg
case_images: PMC3886442_01_CRIM.DENTISTRY2013-612108.001.jpg
case_images: fig1
case_images: A 51-year-old male patient (R.R.), with good general health (ASA 1), nonsmoker, was referred to our department for rehabilitation of the first molar (Figure 1).
case_images: X-ray examination after first extraction: residual root and insufficient bony support.
case_images: CRIM.DENTISTRY2013-612108.002.jpg
case_images: PMC3886442_01_CRIM.DENTISTRY2013-612108.002.jpg
case_images: fig2
case_images: Bone lesion occurred trying to retrieve the residual fragment before sinus lift approach.
case_images: CRIM.DENTISTRY2013-612108.003.jpg
case_images: PMC3886442_01_CRIM.DENTISTRY2013-612108.003.jpg
case_images: fig3
case_images: To avoid a higher bone loss and oroantral communication (Figure 3), it was decided to leave the last apical fragment in the alveolus.
case_images: ((a), (b)) Radiographic exams (paraxial images) also revealed not only the residual root apex in the palatal side, but also insufficient bone volume.
case_images: CRIM.DENTISTRY2013-612108.004.jpg
case_images: PMC3886442_01_CRIM.DENTISTRY2013-612108.004.jpg
case_images: fig4
case_images: As for any other sinus floor elevation case, reformatted computer tomography (CT) scans were required to examine insufficient bony support (Figure 4).
case_images: Surgical site.
case_images: CRIM.DENTISTRY2013-612108.005.jpg
case_images: PMC3886442_01_CRIM.DENTISTRY2013-612108.005.jpg
case_images: fig5
case_images: An intrasulcular and crestal incision was performed and a full-thickness mucoperiostal flap was reflected to expose the maxillary and palatal wall (Figures 5 and 6).
case_images: Alveolar bone exposed.
case_images: CRIM.DENTISTRY2013-612108.006.jpg
case_images: PMC3886442_01_CRIM.DENTISTRY2013-612108.006.jpg
case_images: fig6
case_images: An intrasulcular and crestal incision was performed and a full-thickness mucoperiostal flap was reflected to expose the maxillary and palatal wall (Figures 5 and 6).
case_images: Antrostomy on the lateral maxillary wall.
case_images: CRIM.DENTISTRY2013-612108.007.jpg
case_images: PMC3886442_01_CRIM.DENTISTRY2013-612108.007.jpg
case_images: fig7
case_images: (a), (b): Intra-operative images during retrieval of residual root apex through the antrostomy.
case_images: CRIM.DENTISTRY2013-612108.008.jpg
case_images: PMC3886442_01_CRIM.DENTISTRY2013-612108.008.jpg
case_images: fig8
case_images: The residual was removed without difficulty with hemostatic clamps (Figures 8(a) and 8(b)).
case_images: (a) Insertion of graft material; (b) collagen membrane positioned.
case_images: CRIM.DENTISTRY2013-612108.009.jpg
case_images: PMC3886442_01_CRIM.DENTISTRY2013-612108.009.jpg
case_images: fig9
case_images: Particulate graft material (Geistlich Bio-Oss) was inserted between Schneiderian membrane and sinus floor and also between implant and vestibular tissue to fill the gap (Figure 9(a)).
case_images: Reopening after 3 months.
case_images: CRIM.DENTISTRY2013-612108.010.jpg
case_images: PMC3886442_01_CRIM.DENTISTRY2013-612108.010.jpg
case_images: fig10
case_images: After three-months, the second-stage operation was carried out to expose the fixture and cover screw was placed (Figure 10).
case_images: X-ray control after 3 months.
case_images: CRIM.DENTISTRY2013-612108.011.jpg
case_images: PMC3886442_01_CRIM.DENTISTRY2013-612108.011.jpg
case_images: fig11
case_images: Radiograph examination showed (Figure 11) correct osteointegration, displaying good bone filling and the successful fractured apex retrieval (Figure 12).
case_images: Retrieved residual root fragment.
case_images: CRIM.DENTISTRY2013-612108.012.jpg
case_images: PMC3886442_01_CRIM.DENTISTRY2013-612108.012.jpg
case_images: fig12
case_images: Radiograph examination showed (Figure 11) correct osteointegration, displaying good bone filling and the successful fractured apex retrieval (Figure 12).