Flapless Graft-Free Sinus Floor Elevation Simultaneously with the Placement of a Dental Implant "Aldary Technique": A Case Report with 5 Years Follow-Up.

Following the extraction of a tooth, the alveolar bone undergoes resorption, impacting the remaining bone volume. This phenomenon is particularly pronounced in the posterior upper jaw region, where the bone surrounding the extraction site undergoes physiological transformation, and potential pneumatization of the maxillary sinus. Consequently, there is a reduction in available bone volume and height. Various methods have been described in literature to address this issue. Two main scientifically based techniques for sinus lift are extensively studied and established today, each suitable for specific clinical scenario primarily determined by the residual bone height. The Tatum (direct) approach is recommended when there is less than 5 mm of remaining bone, while the Summer (indirect) technique is preferred when there is more than 5 mm of residual bone. This case report presents a novel technique that integrates the core principle of the above procedures, aiming to simplify indirect sinus lifts in situations that were previously considered challenging owing to inadequate bone volume. A patient with a 2 mm residual maxillary sinus floor height was selected for this case report. A flapless graft-free intracrestal approach was performed in two steps as follows: (1) a tissue-punch is used to harvest the soft tissue from the crest where the implant is to be placed, the graft is then relocated and placed buccal to the same site; (2) a circular knife is used at the exposed bone to cut an opening/bone window which allows performing the intra-crestal displacement of the Schneiderian membrane using curette and placing a dental implant through the same opening/implant bed. A six-month post-operative peri-apical radiograph and CBCT scan showed 4-5 mm extra height of newly formed bone around the implant in the lifted sinus. Also, CBCT scans after five years confirmed the stability, quality, and quantity of the newly formed bone. This novel approach of minimally invasive "flapless" intra-crestal sinus lifting, simultaneously with implant placement, may be effective in conducting bone formation in certain clinical conditions, where residual bone height is equal or less than 3 mm, even without utilizing bone substitute materials.