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IMMEDIATE LOADING IN UPPER JAW with surgical split sparing sinus lifting surgery

Dr. Gandi Gunther.
Patient (F) with no medical issues.
Upper jaw has a full bridge with fracture in tooth 15. This tooth supports distal cantilever, because tooth 16 is missing. The original treatment plan envisaged cutting the bridge and leaving only the left side, while placing a removable partial temporary denture on the right.
The patient rejected this solution. The decision – implants with surgical split and immediate load. The plan included an inclined implant in the tooth 16 region, sparing the patient sinus lifting surgery.
A temporary bridge (copy of old bridge) was created according to a 3D model integrating the position of future implants. After atraumatic extraction of tooth 15, implants were inserted (following the 3D plan and using surgical splint) and immediate load performed.
The patient expressed satisfaction with treatment outcomes and the fact that the rehabilitation was both functional and aesthetic.

A. Panoramic X-ray showing 15 root fracture and therefore the need for extraction and cutting bridge distal to tooth 21.
B. Implant placement plan, complete CT (2D)
C. Implant placement plan, complete CT (2D)
D. Sagittal section of the jaw for each planned implant
E. Sagittal section of the jaw for each planned implant
F. Sagittal section of the jaw for each planned implant
G. Sagittal section of the jaw for each planned implant
H. 3D Implant plan
I. 3D Implant plan
J. 3D Implant plan
K. 3D Implant plan
L. 3D plan and relation to teeth location
M. Surgical splint on model produced by 3D printing (with analogs)
N. Digital model with integrated analogs
O. Digital model with structures
P. Temporary bridge
Q. Old bridge in patient’s mouth
R. Bridge removal after section distal to tooth 21 and tooth 15 extraction
S. Surgical splint in patient’s mouth clearly showing splint’s colorful sleeves. Surgical evaluation accompanying every computerized implant plan. Each drill color matches specific sleeve
T. Tissue Punch
U. Post-implant images. Inclined implant (30 degrees) in tooth 16 location to avoid sinus lift
V. Implants and structures in place, accurate surgery without flap lift
W. Temporary bridge in patient’s mouth.
X. Temporary bridge in patient’s mouth.

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