Sinus floor elevation from palatal approach with simultaneous implant placement : a case report

Sinus floor elevation from palatal approach with simultaneous implant placement : a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Sinus floor elevation from palatal approach with simultaneous implant placement : a case report Ding Jiamin, Wen Guo, Zhou Lin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6166669/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: In traditional maxillary sinus lift elevation with simultaneous implant placement, lateral window osteotomy is commonly employed. However, due to specific anatomical considerations, such as the thickness of the buccal bone wall, a palatal approach with simultaneous implant placement may be preferred in some cases. Case presentation: A 48-year-old male patient required implantation and restoration in the left upper posterior region. Preoperative cone-beam computed tomography (CBCT) revealed insufficient vertical bone height in the posterior maxillary region, which required maxillary sinus elevation surgery to treat. Given that the lateral wall of the maxillary sinus was thicker than the palatal wall and the alveolar crest was sufficiently wide, we opted for a palatal approach, using the DASK kit for maxillary sinus osteotomy, with simultaneous implant placement. Postoperative CBCT confirmed a maxillary sinus elevation height of 10 mm, with bone graft materials adequately surrounding the implants. Additionally, postoperative swelling was minimal. Conclusions: The palatal approach for maxillary sinus elevation with simultaneous implant placement is feasible under specific anatomical conditions and demonstrates satisfactory outcomes. Sinus floor elevation Palatal approach Implant placement Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction With the resorption of alveolar bone and the pneumatization of the maxillary sinus following tooth extraction, the height of the alveolar crest in the posterior maxilla can become severely compromised. Maxillary sinus floor elevation (MSFE) is a widely adopted technique for augmenting bone volume in the posterior maxilla when there is an insufficient vertical ridge height. Initially developed by Professor Boyne in 1980[ 1 ], the classical approach involves using the lateral window technique. Later, simultaneous MSFE with implant placement was introduced, and it achieved a survival rate exceeding 93%[ 2 ]. Conventional lateral window osteotomy is typically performed via a buccal approach due to its superior visibility and surgical convenience[ 3 ]. The maxillary sinus has an intricate anatomical structure, and the thicknesses of its lateral and palatal walls can vary significantly. Generally, the buccal wall is thinner than the palatal wall, with an average thickness of 1.95 ± 0.98 mm[ 4 ]. However, Jadach et al. reported that only 3% of patients have a palatal wall that is thinner than the lateral wall[ 5 ]. Fenestration for MSFE can be performed via buccal, palatal, or crestal osteotomies[ 6 ]. Although the lateral approach is commonly used in implant surgery[ 7 ], it is associated with several complications, including Schneiderian membrane perforation, postoperative swelling, and hematoma[ 8 ], all of which may compromise patient comfort. In contrast, there are few reports on the palatal approach for MSFE, particularly when combined with simultaneous implant placement. This report describes a palatal approach for MSFE with simultaneous implant placement in cases where the palatal bone wall is significantly thinner than the buccal side and the alveolar crest was sufficiently wide, which presents a unique anatomical challenge. Case Presentation A 48-year-old male patient was asmitted to the Departmemt of Implantology at the Affiliated Stomotological Hospital of Fujian Medical Univeristy due to a complaint of missing the right posterior maxillary region. Clinical examination revealed the absence of teeth #24, #26 and #27. However, there were no abnormalities in the gingival mucosa, the occlusal gingival distance was within the normal range, and the occlusal relationship was acceptable. Preoperative cone-beam computed tomography (CBCT) revealed that the available vertical bone height in the posterior maxillary region was insufficient, while the width of the posterior alveolar crest measured 11.7 mm. Moreover, the buccal bone wall was 3-4 mm thick, being thickest at the alveolar ridge, whereas the bone wall from the middle of the alveolar ridge to the palatal side was thinner as show in Figure 1. A septa formation was also observed between the teeth #26 and #27 as show in figure 2. Considering these factors, we decided to perform maxillary sinus lift surgery via a palatal approach with simultaneous implant placement at teeth #26. The patient received local infiltration anesthesia with Primacaine® (4% Articaine, 1/100000 adrenaline, ACTEON) from teeth #24 to #27. Then, full-thickness mid-crestal incisions were made at sites #24, #26, and #27. Additionally, an intra-sulcus incision was made on the palatal site of tooth 25 and a distal release incision was made to achieve adequate palatal flap elevation. Bone osteotomy of the palatal window was performed using DASK drills 4# and 5# (XRT064025 and XTR084025, DASK, Dentium Implant System, Seoul, South Korea), and a round bone window was formed. The maxillary sinus mucosa was lifted inside the maxillary sinus with a domed sinus curette (XSE1L, DASK, Dentium Implant System), and then the maxillary sinus membrane was further elevated to sufficient height with another curved sinus curette (XSE3L and XSE4L, DASK, Dentium Implant System). Finally, the implant site was prepared as normal on the crestal alveolar bone at the sites of teeth #26 and #27. Xenogenic bone (Geistlich Bio-Oss) was then used to fill the sinus cavity through the palatal bone window and the prepared hole for the alveolar crest implant, and the bone was pushed toward the buccal side. After that, 4.2 × 8-mm and 4.8 × 6-mm implants (Astra EV, Astra Tech Impant System, Dentsply Sirona, Charlottae, USA) were placed at the sites of teeth #26 and #27, as show in Figure 3. Next, the xenogenic bone was placed to fully fill the sinus cavity, and a resorbable collagen membrane was used to cover the bone window. Finally, the flap was repositioned and sutured. The patient underwent CBCT examination immediately after surgery, and antibiotics were prescribed to prevent wound infection. The postoperative CBCT showed that the sinus membrane was elevated approximately about 10mm from the alveolar crest, the three-dimensional positioning of the implants was acceptable, and the bone graft materials were adequately wrapped around the implant roots, as shown in Figure 4. The postoperative CBCT visualization of the fenestration position and the implant position was proximity to the preoperative design as shown in Figure 5. Discussions and Conclusions This article describes a palatal approach for sinus floor elevation surgery with simultaneous implant placement. There are three reasons justifying the utilization of a palatal approach for maxillary sinus elevation with simultaneous implant placement. First, the buccal bone wall exhibited a substantial thickness, that progressively increased toward the alveolar crest. Meanwhile, the bone wall from the middle of the alveolar ridge to the palatal site was thin as 1-2 mm. Second, there was an intra-osseous artery in the buccal bone. Third, the transversal width of the posterior alveolar crest was sufficient to accommodate the placement of the implant. Therefore, the uniqueness of this case stems from the distinct local anatomical characteristics of the maxillary posterior dental region and the maxillary sinus. The postoperative swelling in patients after using the palatal approach is notably less pronounced than when the lateral approach is used[9]. This difference can be attributed to the dense nature of the palatal gingive and its reduced susceptibility to edema. Nevertheless, there is a risk of damaging the greater palatine artery upon removal of the palatal flap, which may lead to hemorrhage[10]. In this case report, we used ligation and suture to stop bleeding from the great palatine artery. The necessity of using the palatal approach has many indications, such as a thick buccal bone wall, intraosseous vascular alignment on the buccal side, and patients with scarred buccal soft tissue and poor wound healing, as reported by Seemann et al [11]. The concurrent placement of implants during lateral maxillary sinus augmentation is contingent upon the transversal width of the posterior alveolar crest[9]. In this case, the transversal width at tooth #26 was sufficient to prepare the implant cavity in an ideal three-dimensional location via palatal window osteotomy. In conclusion, the palatal approach for maxillary sinus elevation with simultaneous implant placement is feasible when the palatal wall is thin and the posterior alveolar crest is sufficiently wide. Abbreviations CBCT: Cone-beam ComBputed Tomography MSFE: Maxillary Sinus Floor Elevation Declarations Acknowledgements We are grateful to the patient for his permission of the use of clinical data. Funding The study was financially supported by Fujian provincial healthy technology project (No.2024GGA068). Author information Authors and Affiliations School and Hospital of Stomatology, Fujian Medical University, Fujian, PR China. Ding Jiamin, Guo Wen and Zhou Lin Institute of Stomatology Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fujian, PR China. Guo Wen and Zhou Lin Contributions Ding Jiamin contributed to date collection and drafting article. Guo Wen contributed to date collection. Zhou Lin (corresponding author) contributed to operation of the surgical proceduce. All authors read and approved the final manuscript. Corresponding author Correspondence to Zhou Lin (Email: [email protected] ) Ethics declarations Ethics approval and consent to participate The patient was informed about the surgical treatment procedure and written informed consent was obtained prior to surgery. Consent for publication The patient had gave written informed consent for her personal or clinical details along with any identifying images to be published in this study. Competing interests All authors declare that they have no competing interests. Availability of data and materials The figures in the current study are available from the corresponding author on reasonable request. References Boyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg. 1980;38:613–6. Raghoebar GM, Onclin P, Boven GC, Vissink A, Meijer HJ. A. Long-term effectiveness of maxillary sinus floor augmentation: A systematic review and meta-analysis. J Clin Periodontol. 2019;46(Suppl 21):307–18. Raja SV. Management of the posterior maxilla with sinus lift: review of techniques. J Oral Maxillofac Surg. 2009;67:1730–4. Lozano-Carrascal N, Salomó-Coll O, Gehrke SA, Calvo-Guirado JL, Hernández-Alfaro F, Gargallo-Albiol J. Radiological evaluation of maxillary sinus anatomy: A cross-sectional study of 300 patients. Ann Anat. 2017;214:1–8. Jadach R, Asa'ad F, Rasperini G, Osypko K. Classifying Maxillary Sinuses of Polish Patients for Sinus Lift: A Pilot Study. Dent J (Basel), 2024; 12. Wagner F, Dvorak G, Pillerstorff R, Traxler H, Nemec S, Pietschmann P, Seemann R. Anatomical preconditions for the palatal sinus floor augmentation—A three-dimensional feasibility study. J Craniomaxillofac Surg. 2015;43:1303–8. Alshamrani AM, Mubarki M, Alsager AS, Alsharif HK, AlHumaidan SA, Al-Omar A. Maxillary Sinus Lift Procedures: An Overview of Current Techniques, Presurgical Evaluation, and Complications.Cureus, 2023; 15: e49553. Molina A, Sanz-Sánchez I, Sanz-Martín I, Ortiz-Vigón A, Sanz M. Complications in sinus lifting procedures: Classification and management.Periodontol 2000, 2022; 88: 103 – 15. Stübinger S, Saldamli B, Landes CA, Sader R. Palatal piezosurgical window osteotomy for maxillary sinus augmentation. Int J Oral Maxillofac Surg. 2010;39(6):606–9. Yin S, Tarnow D, Wallace SS. Remediation of a Failed Lateral Window Sinus Augmentation via a Palatal Approach: Rationale and Case Report. Int J Periodontics Restor Dent. 2022 Mar-Apr;42(2):177–84. Seemann R, Wagner F, Ewers R, Ulm C. Palatal sinus elevation revisited: a technical note. J Oral Maxillofac Surg. 2013;71(8):1347–52. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6166669","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":440810048,"identity":"8fed8505-c7fb-4d1e-80fe-03596585178f","order_by":0,"name":"Ding Jiamin","email":"","orcid":"","institution":"Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ding","middleName":"","lastName":"Jiamin","suffix":""},{"id":440810051,"identity":"753a68e9-d5a8-4b67-a01d-d1c71d1bd288","order_by":1,"name":"Wen Guo","email":"","orcid":"","institution":"Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wen","middleName":"","lastName":"Guo","suffix":""},{"id":440810054,"identity":"c45abb6a-f6c8-48ba-bd81-6ec1ecdf3e9c","order_by":2,"name":"Zhou Lin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYDACCSB+YMAgx95wAMRlJlJLggGDMc8B0rQwMCT2gHUQo0V+dvMxiYSCO+k9jKfTJBgqrBMb2M8ewKuFcc6xNIkEg2e5PQxnt0kwnElPbODJS8CrhVkixwyo5XDufpAWxrbDiQ0SPAZ4tbBBtaTzgLX8I0ILD1RLAkRLAxFaJCTSki2AWgyBftlskXAs3biNJwe/FvkZyQdvfPhzWJ5H4uzGGx9qrGX72c/g14Jk3wFwBDGwEakeCPgbiFc7CkbBKBgFIwsAAH7eQ3wo5zqWAAAAAElFTkSuQmCC","orcid":"","institution":"Fujian Medical University","correspondingAuthor":true,"prefix":"","firstName":"Zhou","middleName":"","lastName":"Lin","suffix":""}],"badges":[],"createdAt":"2025-03-06 03:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6166669/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6166669/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80583731,"identity":"c555e864-7bf8-4dc2-a8bf-0d19567c874b","added_by":"auto","created_at":"2025-04-15 00:12:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":235285,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative CBCT demonstrated the available vertical bone height in the teeth #6 was insufficient, while the width of the alveolar crest was wide. The buccal bone wall was thick and the bone wall from the middle of the alveolar ridge to the palatal side was thinner.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6166669/v1/deeea2136e3768def65add2f.png"},{"id":80583733,"identity":"ca4dcb70-460d-41bd-87e4-2540353f5f37","added_by":"auto","created_at":"2025-04-15 00:12:47","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":183819,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative CBCT demonstrated a septa formation between the teeth #26 and #27.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6166669/v1/bd79394d9237d44164e086b1.png"},{"id":80585113,"identity":"de21d5c9-2e27-4595-ae43-9091f399bed9","added_by":"auto","created_at":"2025-04-15 00:28:47","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":575171,"visible":true,"origin":"","legend":"\u003cp\u003eThe briefly process of the surgery. A: The palatal flap elevation and a round bone window was created. B: The maxillary sinus mucosa was lifted and the implant site was prepared. C: Xenogenic bone was filled the sinus cavity and the implant was placement.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6166669/v1/8d48d40f4622f412010a3188.png"},{"id":80583737,"identity":"117428b5-6c29-4c97-a87b-88df0fea37cb","added_by":"auto","created_at":"2025-04-15 00:12:47","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":166983,"visible":true,"origin":"","legend":"\u003cp\u003ePostoperative CBCT demonstrated that the bone graft materials were adequately wrapped around the implant roots. A: Sagittal cross-section. B: Coronal cross-section. C: Axial cross-section.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6166669/v1/54e5c24f74d8d6d3b45987c3.png"},{"id":80584209,"identity":"06d09122-8d1c-4789-9e57-d16134610412","added_by":"auto","created_at":"2025-04-15 00:20:47","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":438746,"visible":true,"origin":"","legend":"\u003cp\u003ePostoperative CBCT visualization of the fenestration position and the implant position was proximity to the preoperative design, and the sinus membrane was elevated approximately about 10mm from the alveolar crest, the three-dimensional positioning of the implants was acceptable. A: Preoperative design. B: Postoperative CBCT.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6166669/v1/e0d9a78fa42408cad4844be1.png"},{"id":84453167,"identity":"01a5ed78-68c3-4d94-ab43-d3bbc14b3a9d","added_by":"auto","created_at":"2025-06-12 07:17:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2394180,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6166669/v1/9b4e605c-2b96-45c1-ace1-974dfe4bf019.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sinus floor elevation from palatal approach with simultaneous implant placement : a case report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith the resorption of alveolar bone and the pneumatization of the maxillary sinus following tooth extraction, the height of the alveolar crest in the posterior maxilla can become severely compromised. Maxillary sinus floor elevation (MSFE) is a widely adopted technique for augmenting bone volume in the posterior maxilla when there is an insufficient vertical ridge height. Initially developed by Professor Boyne in 1980[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], the classical approach involves using the lateral window technique. Later, simultaneous MSFE with implant placement was introduced, and it achieved a survival rate exceeding 93%[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Conventional lateral window osteotomy is typically performed via a buccal approach due to its superior visibility and surgical convenience[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe maxillary sinus has an intricate anatomical structure, and the thicknesses of its lateral and palatal walls can vary significantly. Generally, the buccal wall is thinner than the palatal wall, with an average thickness of 1.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98 mm[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, Jadach et al. reported that only 3% of patients have a palatal wall that is thinner than the lateral wall[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Fenestration for MSFE can be performed via buccal, palatal, or crestal osteotomies[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Although the lateral approach is commonly used in implant surgery[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], it is associated with several complications, including Schneiderian membrane perforation, postoperative swelling, and hematoma[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], all of which may compromise patient comfort. In contrast, there are few reports on the palatal approach for MSFE, particularly when combined with simultaneous implant placement.\u003c/p\u003e \u003cp\u003eThis report describes a palatal approach for MSFE with simultaneous implant placement in cases where the palatal bone wall is significantly thinner than the buccal side and the alveolar crest was sufficiently wide, which presents a unique anatomical challenge.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 48-year-old male patient was asmitted to the Departmemt of Implantology at the Affiliated Stomotological Hospital of Fujian Medical Univeristy due to a complaint of missing the right posterior maxillary region. Clinical examination revealed the absence of teeth #24, #26 and #27. However, there were no abnormalities in the gingival mucosa, the occlusal gingival distance was within the normal range, and the occlusal relationship was acceptable.\u003c/p\u003e\n\u003cp\u003ePreoperative cone-beam computed tomography (CBCT) revealed that the available vertical bone height in the posterior maxillary region was insufficient, while the width of the posterior alveolar crest measured 11.7 mm. Moreover, the buccal bone wall was 3-4 mm thick, being thickest at the alveolar ridge, whereas the bone wall from the middle of the alveolar ridge to the palatal side was thinner as show in Figure 1. A septa formation was also observed between the teeth #26 and #27 as show in figure 2. Considering these factors, we decided to perform maxillary sinus lift surgery via a palatal approach with simultaneous implant placement at teeth #26.\u003c/p\u003e\n\u003cp\u003eThe patient received local infiltration anesthesia with Primacaine® (4% Articaine, 1/100000 adrenaline, ACTEON) from teeth #24 to #27. Then, \u0026nbsp;full-thickness mid-crestal incisions were made at sites #24, #26, and #27. Additionally, an intra-sulcus incision was made on the palatal site of tooth 25 and a distal release incision was made to achieve adequate palatal flap elevation. Bone osteotomy of the palatal window was performed using DASK drills 4# and 5# (XRT064025 and XTR084025, DASK, Dentium Implant System, Seoul, South Korea), and a round bone window was formed. The maxillary sinus mucosa was lifted inside the maxillary sinus with a domed sinus curette (XSE1L, DASK, Dentium Implant System), and then the maxillary sinus membrane was further elevated to sufficient height with another curved sinus curette (XSE3L and XSE4L, DASK, Dentium Implant System). Finally, the implant site was prepared as normal on the crestal alveolar bone at the sites of teeth #26 and #27.\u003c/p\u003e\n\u003cp\u003eXenogenic bone (Geistlich Bio-Oss) was then used to fill the sinus cavity through the palatal bone window and the prepared hole for the alveolar crest implant, and the bone was pushed toward the buccal side. After that, 4.2 × 8-mm and 4.8 × 6-mm implants (Astra EV, Astra Tech Impant System, Dentsply Sirona, Charlottae, USA) were placed at the sites of teeth #26 and #27, as show in Figure 3. Next, the xenogenic bone was placed to fully fill the sinus cavity, and a resorbable collagen membrane was used to cover the bone window. Finally, the flap was repositioned and sutured. The patient underwent CBCT examination immediately after surgery, and antibiotics were prescribed to prevent wound infection.\u003c/p\u003e\n\u003cp\u003eThe postoperative CBCT\u0026nbsp;showed that the sinus membrane was elevated approximately about 10mm from the alveolar crest, the three-dimensional positioning of the implants was acceptable, and the bone graft materials were adequately wrapped around the implant roots, as shown in Figure 4. The postoperative CBCT visualization of the fenestration position and the implant position was proximity to the preoperative design as shown in Figure 5.\u003c/p\u003e\n\n\n\n\n\n\n"},{"header":"Discussions and Conclusions","content":"\u003cp\u003eThis article describes a palatal approach for sinus floor elevation surgery with simultaneous implant placement.\u003c/p\u003e\u003cp\u003eThere are three reasons justifying the utilization of a palatal approach for maxillary sinus elevation with simultaneous implant placement. First, the buccal bone wall exhibited a substantial thickness, that progressively increased toward the alveolar crest. Meanwhile, the bone wall from the middle of the alveolar ridge to the palatal site was thin as 1-2 mm. Second, there was an intra-osseous artery in the buccal bone. Third, the transversal width of the posterior alveolar crest was sufficient to accommodate the placement of the implant. Therefore, the uniqueness of this case stems from the distinct local anatomical characteristics of the maxillary posterior dental region and the maxillary sinus.\u003c/p\u003e\u003cp\u003eThe postoperative swelling in patients after using the palatal approach is notably less pronounced than when the lateral approach is used[9]. This difference can be attributed to the dense nature of the palatal gingive and its reduced susceptibility to edema. Nevertheless, there is a risk of damaging the greater palatine artery upon removal of the palatal flap, which may lead to hemorrhage[10]. In this case report, we used ligation and suture to stop bleeding from the great palatine artery.\u003c/p\u003e\u003cp\u003eThe necessity of using the palatal approach has many indications, such as a thick buccal bone wall, intraosseous vascular alignment on the buccal side, and patients with scarred buccal soft tissue and poor wound healing, as reported by Seemann et al [11].\u003c/p\u003e\u003cp\u003eThe concurrent placement of implants during lateral maxillary sinus augmentation is contingent upon the transversal width of the posterior alveolar crest[9]. In this case, the transversal width at tooth #26 was sufficient to prepare the \u0026nbsp;implant cavity in an ideal three-dimensional location via palatal window osteotomy.\u003c/p\u003e\u003cp\u003eIn conclusion, the palatal approach for maxillary sinus elevation with simultaneous implant placement is feasible when the palatal wall is thin and the posterior alveolar crest is sufficiently wide.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCBCT: Cone-beam ComBputed Tomography\u003c/p\u003e\n\u003cp\u003eMSFE: Maxillary Sinus Floor Elevation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to the patient for his permission of the use of clinical data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was financially supported by Fujian provincial healthy technology project (No.2024GGA068).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors and Affiliations\u003c/p\u003e\n\u003cp\u003eSchool and Hospital of Stomatology, Fujian Medical University, Fujian, PR China.\u003c/p\u003e\n\u003cp\u003eDing Jiamin, Guo Wen and Zhou Lin\u003c/p\u003e\n\u003cp\u003eInstitute of Stomatology Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fujian, PR China.\u003c/p\u003e\n\u003cp\u003eGuo Wen and Zhou Lin\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDing Jiamin contributed to date collection and drafting article.\u0026nbsp;Guo Wen contributed to date collection. Zhou Lin (corresponding author) contributed to operation of the surgical proceduce. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to Zhou Lin (Email: [email protected])\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient was informed about the surgical treatment procedure and written informed consent was obtained prior to surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient had gave written informed consent for her personal or clinical details along with any identifying images to be published in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe figures in the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBoyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg. 1980;38:613\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaghoebar GM, Onclin P, Boven GC, Vissink A, Meijer HJ. A. Long-term effectiveness of maxillary sinus floor augmentation: A systematic review and meta-analysis. J Clin Periodontol. 2019;46(Suppl 21):307\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaja SV. Management of the posterior maxilla with sinus lift: review of techniques. J Oral Maxillofac Surg. 2009;67:1730\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLozano-Carrascal N, Salom\u0026oacute;-Coll O, Gehrke SA, Calvo-Guirado JL, Hern\u0026aacute;ndez-Alfaro F, Gargallo-Albiol J. Radiological evaluation of maxillary sinus anatomy: A cross-sectional study of 300 patients. Ann Anat. 2017;214:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJadach R, Asa'ad F, Rasperini G, Osypko K. Classifying Maxillary Sinuses of Polish Patients for Sinus Lift: A Pilot Study. Dent J (Basel), 2024; 12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWagner F, Dvorak G, Pillerstorff R, Traxler H, Nemec S, Pietschmann P, Seemann R. Anatomical preconditions for the palatal sinus floor augmentation\u0026mdash;A three-dimensional feasibility study. J Craniomaxillofac Surg. 2015;43:1303\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlshamrani AM, Mubarki M, Alsager AS, Alsharif HK, AlHumaidan SA, Al-Omar A. Maxillary Sinus Lift Procedures: An Overview of Current Techniques, Presurgical Evaluation, and Complications.Cureus, 2023; 15: e49553.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMolina A, Sanz-S\u0026aacute;nchez I, Sanz-Mart\u0026iacute;n I, Ortiz-Vig\u0026oacute;n A, Sanz M. Complications in sinus lifting procedures: Classification and management.Periodontol 2000, 2022; 88: 103\u0026thinsp;\u0026ndash;\u0026thinsp;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSt\u0026uuml;binger S, Saldamli B, Landes CA, Sader R. Palatal piezosurgical window osteotomy for maxillary sinus augmentation. Int J Oral Maxillofac Surg. 2010;39(6):606\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYin S, Tarnow D, Wallace SS. Remediation of a Failed Lateral Window Sinus Augmentation via a Palatal Approach: Rationale and Case Report. Int J Periodontics Restor Dent. 2022 Mar-Apr;42(2):177\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeemann R, Wagner F, Ewers R, Ulm C. Palatal sinus elevation revisited: a technical note. J Oral Maxillofac Surg. 2013;71(8):1347\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Sinus floor elevation, Palatal approach, Implant placement","lastPublishedDoi":"10.21203/rs.3.rs-6166669/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6166669/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e In traditional maxillary sinus lift elevation with simultaneous implant placement, lateral window osteotomy is commonly employed. However, due to specific anatomical considerations, such as the thickness of the buccal bone wall, a palatal approach with simultaneous implant placement may be preferred in some cases.\u003cbr\u003e\n\u003cstrong\u003eCase presentation:\u003c/strong\u003e A 48-year-old male patient required implantation and restoration in the left upper posterior region. Preoperative cone-beam computed tomography (CBCT) revealed insufficient vertical bone height in the posterior maxillary region, which required maxillary sinus elevation surgery to treat. Given that the lateral wall of the maxillary sinus was thicker than the palatal wall and the alveolar crest was sufficiently wide, we opted for a palatal approach, using the DASK kit for maxillary sinus osteotomy, with simultaneous implant placement. Postoperative CBCT confirmed a maxillary sinus elevation height of 10 mm, with bone graft materials adequately surrounding the implants. Additionally, postoperative swelling was minimal.\u003cbr\u003e\n\u003cstrong\u003eConclusions:\u003c/strong\u003e The palatal approach for maxillary sinus elevation with simultaneous implant placement is feasible under specific anatomical conditions and demonstrates satisfactory outcomes.\u003c/p\u003e","manuscriptTitle":"Sinus floor elevation from palatal approach with simultaneous implant placement : a case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-15 00:12:43","doi":"10.21203/rs.3.rs-6166669/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bb404f15-50fb-45d0-95be-58c6116d5fc2","owner":[],"postedDate":"April 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-12T07:09:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-15 00:12:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6166669","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6166669","identity":"rs-6166669","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}