case_images: PMC10513874_01
case_images: (a) Panoramic radiograph showed a radiopacity in the left maxillary sinus (arrow: border of the cyst). (b) A sagittal cut of the CBCT displayed a round-shaped radiopaque lesion on the left maxillary sinus (arrow: border of the cyst). (c) Axial cut revealed the radiopacity lesion inside the sinus, 4 mm residual bone height, and the ostium remains clear (arrow: ostium).
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case_images: PMC10513874_01_CRID2023-6968487.001.jpg
case_images: fig1
case_images: A panoramic radiograph showed a missing first and second maxillary molars with a residual bone height of less than 4 mm, and a radio-opacity image was observed in the left maxillary sinus (Figure 1(a)). CBCT revealed a round-shaped radio-opaque lesion on the left maxillary sinus with a clear ostium (Figures 1(b), 1(c) and 1(d)).
case_images: (a) Mucoperiosteal flap was elevated, and the bone wall of the sinus was exposed. (b) Osteotomies of the bony window were performed with the piezo surgery. (c) The bony window was detached in one piece, and a small perforation of the sinus membrane was observed in the upper mesial part of the window. (d) The yellow cystic fluid was aspirated with a sterile syringe with a 22 G needle. (e) The Schneiderian membrane was lifted carefully through the bony window area, and the perforation was sealed with a collagen membrane.
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case_images: fig2
case_images: Then, a muco-periosteal flap was elevated and the bone wall of the sinus was exposed (Figure 2(a)). The bony window was removed in one piece, and then the sinus membrane was lifted by a special curette and raised to achieve a curtain effect (Figure 2(b)). A small perforation of the sinus membrane was observed in the upper mesial part of the window (Figure 2(c)). The aspirated fluid color was yellow, and the cyst membrane was sent for histological evaluation (Figure 2(d)).
case_images: (a) Implant sites were prepared. (b) The first layer of bone substitute was packed into the cavity. (c) 2 implants were placed, and the final layer of bone substitute was placed. (d) Resorbable membrane was positioned under the bony wall. (e) Interrupted O sutures were made using a 3-0 silk suture. (f) Panoramic radiograph showed a well-defined area with two implants in the middle.
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case_images: fig3
case_images: Implant sites were drilled, and the first layer of bone substitute was packed into the cavity between the residual crestal bone, the palatal bone, and the Schneiderian membrane (Figures 3(a) and 3(b); Puros Cortical 0.25-1.0 mm particulate; Zimmer Biomet). Tech-Dentsply ) were then placed. The final layer of bone substitute was placed (Figure 3(c)) and a resorbable membrane was positioned under the bony wall (Figure 3(d)). Interrupted O sutures were made using a 3-0 silk suture (Figure 3(e)).
case_images: (a, b) The histological sections showed a virtual cystic cavity lined by a columnar pseudo-stratified epithelium with an underlying layer of loose connective tissue and a mononuclear inflammatory infiltrate was noted in the underlining tissue (H&E x20 and H&E x40).
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case_images: fig4
case_images: In addition, the histological sections showed a virtual cystic cavity lined by a columnar pseudo-stratified epithelium with an underlying layer of loose connective tissue, and a mononuclear inflammatory infiltrate was noted in the underlining tissue [hematoxylin and eosin (H&E) x20 and H&E x40)] (Figures 4(a) and 4(b)).
case_images: (a) Panoramic reconstruction showing well-limited grafted material within the middle of the two implants. No pathology was detected in the sinus. (b) The para-axial cut of the mesial implant completely embedded in the graft material. (c) The para-axial cut of the distal implant also well surrounded by the bone graft.
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case_images: fig5
case_images: CBCT at 5 months showed a well-limited augmented area covering from the buccal to the palatal bone, and no pathologies were detected inside the maxillary sinus (Figures 5(a), 5(b), and 5(c)). Crowns were fabricated and cemented to the abutments.
case_images: Axial cut of the left maxilla, one year after loading, showing the implant surrounded by the grafted material without any recurrence of the mucous retention cyst. (a) The first implant. (b) The second implant.
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case_images: fig6
case_images: The para-axial cut of the CBCT one year after loading showed a very integrated graft inside the sinus, and the implants are well integrated (Figures 6(a) and 6(b)).