A patient with a missing upper first molar requested to replace the missing tooth. On examination, we found an upper left first molar missing and root caries on the second molar, which meant the second molar was unrestorable and a dental bridge would not be an option. The options left would be a removable denture or a dental implant. The patient chose the dental implant because he didn't like dentures.
After the x-ray was taken, it showed that it would not be a simple and straightforward case. The low sinus floor made it impossible to place a implant without sinus augmentation and bone grafting. Another challenge was the sinus septa presented in grafting area, which meant the sinus membrane elevation procedure would be "a winding road". All these findings were confirmed by CBCT scan.
After 3D planning, a surgical guide was made by a 3D printer. During the surgery, lateral window technique was used for accessing sinus and bone grafting, and a membrane was used for guided bone regeneration. A titanium dental implant was placed simultaneously. At last, the unrestorable second molar was removed.
The healing was uneventful and the implant will be ready for a crown in 6 months.