Periodontitis is a disease caused by bacteria present in the oral cavity that, for one reason or another, take over and trigger a pathological process. It has a multifactorial origin and for this reason it is important to keep risk factors under control and above all to maintain good oral hygiene by going frequently to your dentist and behaving correctly at home.

Carmen went to FisioEuropa years ago suffering from an important chronic generalized periodontitis. Over time and with the right therapies, together we have managed to improve her situation to the point of freeing her from this age-old problem.

Periodontitis, however, had resulted in the loss of two teeth, the two upper left molars, at the same time causing severe bone resorption.

Having acquired the confidence she lacked, Carmen’s request to recover her teeth in that area was not long in coming.

Discussed with Carmen about her situation, we talked about the concrete possibility of rehabilitating her in that area. I like to quote the phrase of a famous dentist who contains my guiding philosophy of treatment:

“There is only one diagnosis and dozens of treatment plans” – Dr. Morton Amsterdam

Carmen’s possibilities were a mobile prosthesis, which gave her back the minimum functionality, a fixed prosthesis cemented on natural teeth, that is a bridge on the adjacent teeth, or implants.

Carmen immediately ruled out the first two possibilities and chose with me what I consider the best way when practicable, the insertion of the implants.

However, Carmen’s severe bone resorption put us in front of the need to perform a bone regeneration called maxillary sinus lift, a technique that I have performed hundreds of times, gaining excellent experience.

This operation consists in the insertion, inside the maxillary sinus, of a bio-material which, thanks to the intervention of the blood clot that will form and the peculiar properties of the tissues present in that area, will lead to the formation of new bone. This newly formed bone will, within a few months, become stable and consistent enough to allow for implant placement at a later time.

Carmen’s journey lasted between 12 and 14 months marked by the following phases:

1. surgery for maxillary sinus lift
2. wait for 6 months
3. intervention for implant placement
4. wait 4 months
5. positioning of the prosthetic crowns on the implants

On the day of the first surgery, under the effect of adequate local anesthesia, we performed the procedure without Carmen feeling any pain, according to the steps that I will illustrate in detail:

Carmen’s journey lasted between 12 and 14 months marked by the following phases:

1. opening of an access flap
2. detachment of the flaps and periosteum
3. opening of a side hatch on the bone table using Piezosurgery®, an essential tool for protecting the integrity of soft tissues
4. sampling and removal of the material present in the cavity to send it for histological examination
5. detachment of the Schneider membrane, to be absolutely preserved because it will be the key to the success of the regeneration and repair of the hole drilled for the collection with a collagen membrane
6. insertion of the bio-material and positioning of collagen membranes to stabilize it
7. repositioning of the flaps and suturing

From a clinical point of view, it was important to empty the material present inside the sinus. The histological analysis was performed at a facility with which we have been collaborating for some time. As per the report, the content of the sample is typical of the mucocele of the sinus cavities, a diagnostic hypothesis made at the start.

This manifestation consists in the swelling of one or two contiguous paranasal sinuses, due to the accumulation of a mucous secretion which, in the long run, can lead to thinning of the sinus walls, sometimes jeopardizing the success of bone regeneration.

The analysis of the report was then submitted to Prof. Umberto Romeo (→ know the Team), an expert and teacher of Oral Pathology, with whom I consulted and who suggested further precautions to be taken, given the peculiarity of the case.

After another 4 months, necessary for the implants to integrate into the regenerated bone, we proceeded to the prosthetic phase, with a first sub-occluded and non-functionalized temporary prosthesis, that is, which did not come into contact with the lower teeth called antagonists.

After about 2 months we placed the provisional in occlusion and, after another two months, the delivery of the definitive prosthetic product followed, two metal-ceramic crowns integral with each other.