Summer’s Lift Case: How Would You Perform the Technique?

There are several ways to approach this: 1. This tooth can be removed, and an implant can be placed immediately. No sinus lifting is required to do this. The root looks about 10-11 mm long, and you can see a radio-dense halo about the apex. This looks like a chronic process in response to an apical inflamatory process. This has actually "lifted" the floor of the sinus, giving you another 1-2 mm of length beyond the apex. This gets you to 13 mm of length without entering the sinus. If the socket can be cleaned, and there is no large buccal dehiscence, an immediate implant is acceptable. 2. The above suggestion does not address the spacing issues, however. Given the dip in the sinus distal to this tooth, I assume that your patient has been missing a first molar for quite some time. The adjacent molar has drifted mesially, and this will create restorative difficulties. I would suggest recontouring of the mesial side of the molar to create an acceptable embrasure space. 3. A lateral window technique to lift the sinus and "normalize" the anatomy for a molar size tooth/implant is another acceptable plan. As you noted the anatomy is challenging, so approach with care. To keep this simple for the patient, my choice would be to work within the socket of the tooth you are extracting. If you showed me this case five years ago, I may have recomended a lateral window. However, as I progress in my practice, I have noted that implant dentistry can really simplify life for the patient. I have treated cases like this both ways. Both have shown success over a five year period. (and hopefully longer!) It will be interesting to hear what others say.

While I don't have an answer to this question, I wonder if one of you folks would know who the Dr Summers is/was who developed the Summers technique? Thanks, and sorry for the interruption.

Dr. Summers original articles were published in the Compendium and then reprinted in Dentistry Today ( I think). Do a Google Search and you will find the definitive answer.

I disagree with Dr sb. Following the trajectory of the socket is a mistake. The proper trajectory of the implant would be distal to the socket and involve elevating the vertical wall of the "S" shaped sinus floor in this area. Doing a lateral lift works great but I think it is overkill when placing just one implant. This is not the case to start out doing a Summer's lift for the first time. Your preamble implies that this is the case. If I'm mistaken then I apologize. I would take out the tooth, upfracture the most coronal part of the sinus floor and graft the entire area with particulate. No immediate placement here. It's too risky and I don't think there is a hope of getting good primary stability. Once the grafted site heals you can then either place a short implant or do a routine Summers lift at that time.

I would not attempt an immediate placement in this particular case. There will be very little bony contact between the fixture and the surrounding extraction socket. And also, the presence of a chronic periapical lesion is a strong contraindication for any immediate placement. The closed approach may seem like a good option, but it would be very difficult to elevate the sinus membrane posteriorly to your osteotomy, since you will likely pierce it with the advancing edge of the osteotome, and will be difficult to get an instrument in the osteotomy to release the membrance inferiorly. I would treatment plan this case for extraction, followed by a period of healing 3-6 months, then lateral approach sinus lift with simultaneous or delayed placement of implant fixture.

Is it possible that bone may be too dense in which to place an implant? I attempted to place an implant in the lower left first molar site in a 47 year old man who was congenitally missing tooth #19. A primary tooth had recently been extracted. I had a very difficult time drilling with the pilot drill at 2000 rpm and could not get much past 10mm without using excessive force. I was afraid I would burn the bone. I attempted to place a Nobel Biocare 11.5 mm Tapered Groovy (after tapping the site)but the implant literally got stuck! I could not back it out nor advance it. It is now approximately 2 mm supracrestal. My feeling is that I should remove it. I am guessing that since a tooth never developed in that space there is some abnormality in the bone. Any thoughts and advice would be deeply appreciated. Thank you.

Any one that has used the Summers technique knows that after extraction of the premolar the Osteotoem will want to travel the same direction of the original root. The lamina of the bone around the root is so dense that it is hard to get a purchase point to redirect the osteotome. I would as a previous Dr said , Recontour #3 the first molar, take a flat ended diamion and widen the mesial septal bone close to #3. Widend adn remove enough bone so that you are into medulary bone. Take a wide osteotome and infracture to the level of the apex of the premolar adn graft. Place a graft in teh socket of the premolar adn cover with a membran adn wait four months and then your level of bone will be more managable.Hope this helps.

Dr. Robert Summers is still practicing in Narberth, Pa. He has a great practice and a wonderful teacher with this technique.

As some of the colleagues mentioned above i wouldn't go for an immediate placement as the primary stability would be questionable. personally i would extract the tooth, graft the socket and wait for 4-6 months. i would then do the closed sinus lift during implant placement.Good Luck!

I could not agree more with SB. Keep it simple. They do make implants 6mm in diameter. Check the fit with an oseotome and decide how wide. Make a spacer to prevent further mesial drift/ or make sure your "flipper" has good contacts. Recontour the mesial prior to restoration.

Sorry, I will ask a facetious question: Who needs the implant? Is it the patient? or is it the dentist's ego? (or his bottom line, whatever you prefer). As a periodontist who performs his own restorative dentistry, I would feel more comfortable simply extracting #4 and placing a #3-5 PFM bridge. If not I would go along with Dr. Weinberg's proposal of extraction and delayed implantation.

There are obviously different ways to approach this, but the way I would do it would be to extract the tooth and perform a Tatum Sinus lift at the same time. With this unusual anatomy and a steep slope of where you would do the summer lift, I perfer to actually see the sinus lifted and the membrane intact. The procedure is another 15 mins for direct visualization and ensuring that the lift is done properly. I do feel that immediate placement jeopardizes the distal of #5 and placed at a compromised angle, as well as tearing the membrane. The only thing that i do not like about the Summer's technique is that it is done blindly. I have done it many time, along the protocols of Misch, but still like Tatum's approach, especially with the unusual anatomy.

Anybody consider root canal ? post and crown!

I.m agree with yossi! And if the patients want a implant, the case needs more dignostic implements like a volumetric ct scan image, too evaluate the sinus floor and the heith of the boone! Good luck and thanks to share!

I would extract, degranulate, detoxify, decorticitate and perhaps lift the socket a little and graft with "Osteogen" and PRGF and use the PRF asa membrane. Reenter later and place an implant with ease.

The answer is easy and I will outline it for you. Step 1: Refer to someone who knows how to do the procedure. Best thing to do if you are not sure how to do a Summers technique or what it is. The patient will thank you for it.

in my opinion you can probably can get away with not grafting the sinus my only concern would be placing an implant too close to #5 and loosing the mesial pappilla

I agree with sb oms. and prefer his treatment option #!.