Patient Profile: Patient is a 68-year old retired male who presented with a missing upper right first molar space. He wishes to explore treatment options to restore the missing space. 

Chief Complaint: “I miss the upper right molar when eating and find I am eating constantly on the other side. I’m concerned I may fracture another tooth on the left side and need an extraction”

Dental History: His last dental appointment was to remove the fractured non-restorable upper right first molar. 

Medical History: The patient reported several stents placed four years ago without complication. He was medicated on Nu-seal, an anti-hypertensive and a statin. Most recent cardiology review was favourable. ECG normal. Cardiac echo was normal with favourable ejection fraction. His blood pressure was recorded at 135/85 mm/hg and recent bloods were all within normal limits. 

Extraoral Examination:

• Assessment reported all within normal limits.

Supplemental Information:

• There is not enough vertical bone height to facilitate routine dental implant treatment.
• The socket is three months post-extraction.
• The solution will require bone grafting in the form of an indirect sinus lift.
• This involves bone chips (Creos particulate graft) placed into the floor of the sinus with simultaneous implant placement.
• The implant and graft are left 4/6 months to covert to bone (ossify) and fuse together (osseointegrate)
• Implant placement is under local anaesthesia with IV sedation. 
• A digital scan is taken after 4/6 months and the crown is screwed onto the implant and is permanent.