Extraction and crestal approach sinus lift vs extraction and delayed implant placement?

As with all aspects of Implant dentistry it is all about what you are comfortable with . Personally I would extract and leave for 3 or 4 weeks to heal then flap and lift sinus and place the molar implant into the trifurcation and the premolar into the socket with good curretage of granulation tissue . I prefer lateral windows still only takes 5 minutes with Dask , no tears in the last couple of hundred cases due to this piece of kit so safe easy and predictable but with this amount of residual bone internal is OK if you are comfortable with it ,although I like to see what is happening and like predictability . Seen a lot of great internal work with PRF by a colleague which is impressive , in fact having Dr Choukron coming to talk to us next month. Nice case but not immediate as will introduce risks . Peter

Well According to me do first extraction..then crestal sinus lift..with good quality graft packing..something like Auto if possible..or you can go for cerabone..nova bone putty and ofcourse PRF to cover all..and then place implants . Do loading after 6 to 8 months.. very good results seen with this protocol..take care..thanks

well sorry in place of crestal ..please read it as lateral approach sinus lift..Mistake regretted. regards dr nardeep insan

For the site of #14' extract, detox, decorticitate, uplift and or graft. Give it tincture of time to turn over. PRF/PRP with the graft is your choice. I do use it. Place an easy implant later.

This is everyday bread and butter implant dentistry for my implant center. This case 100 percent immediate Exo, clean up, sinus lift through the socket, immediate implant and always screw retained temporary, no cuts, no stitches, and after 4 months impression with custom impression copings( made from the screw retained temporaries), funk rock cast,scan bodies, trios or D900 scanner, full contour screw reasoned zirconium crowns cemented to tibases ( all done in office milling Center) and unsurpassable cosmetics......10k. Case finished in 4 months and only one surgery with no cuts and no stitches, and Px leaves with no open wound. Only few motrins next day. Once u lift the gum from the bone, the god given archetecture gets wiped out right in front of your eyes. To be a good implantologist, you gotta be restoring your cases. Knowing surgery only is not good enough. That's the nature of the beast. Since there are no cuts, there is no lateral approach. Sam Jain, DMD Center for Implant Dentistry Fremont, CA

I use 13mm (or 16mm) mplants always (except mandibular nn problem) If I need a couple of mm bone in the sinus, I use transaveolar, with verticle osteomy at same time as implant. If I need say 3-5mm I consider lateral window lift at same time as implant (prepare site, make sinus window and lift membrane, then implant, then pack bone (I use puros) around implant, if more than that ,I do sinus lift alone first, then implant 3 months later, restoration three months later. Success >99% for 20 years. (so far!) None of these surgeries are very tramatic. Implant alone of transalveolar, to work after appt. The rest, to play or work the next day, although some swelling with lateral approach, not much discomfort.

Can someone add more info on PRF/PRP. Would like to read further on this. Thank you.

Used prf for 2 yrs. don't use it any more. No benefit observed.

It is really a matter of what the clinician is comfortable with. I would extract and socket lift at the same time , place implants without raising flap (I use Ankylos) ,try to temporize with final abutments if possible and in few months proceed with final prosthesis . Simple and predictable.

Some of you make this sound straightforward etc as a one visit procedure-without even suturing in some cases. However, how do you deal with the inability to obtain primary closure after sinus lift and grafting, and how do you temporize on implants placed into newly grafted bone? I personally would extract and wait until soft tissue heals well-then I know I can re-enter a clean site and close properly after sinus elevation, grafting and implant placement.