Dental implants have been advocated as the treatment of choice for missing teeth and tooth replacements. Scientific evidence demonstrates their high success rates and therefore their clinical applicability. However, in some circumstances due to premature posterior tooth loss leading to severe sinus pneumatisation or a congenitally missed tooth causing alveolar bone collapse, implant placement can still remain challenging for clinicians. These circumstances could be present in one surgical target area at the same time, thus increasing treatment complexity. In such cases, available options such as short implants, ridge splitting, and internal and crestal sinus lifts have been proposed to minimise treatment cost and time, as well as co-morbidities but preserve treatment success rates.
In order to address clinical-related sinus pneumatisation issues, two main surgical approaches have been suggested: internal and lateral sinus lift techniques. The internal sinus lift approach is indicated whenever the residual bone height (RBH) is 4 to 7mm. First proposed by Summers, it entails performing a cortical greenstick fracture using osteotomes, allowing the Schneiderian membrane to be easily lifted.1 This technique has the advantage of allowing immediate implant insertion. The lateral sinus lift approach is suggested when the RBH is less than 4mm. With this skill-dependent technique, a bony lateral window has to be created, exposing the cortical bone. Once this has been achieved, membrane detachment with the use of curettes is performed, and an alloplastic material is injected as a bone graft. After a graft healing period of five to six months, the implants can be inserted. In order to address alveolar collapse issues, ridge splitting was proposed as a surgical approach, wherein the cortical plates are separated to allow the insertion of implants into the artificially created space.
All these options are of high clinical value when facing such scenarios. However, implant length is considered one of the most important predictors in treatment efficacy when performing these techniques. Likewise, short implants have been proposed, since they have marked clinical advantages, such as minimising the amount of sinus membrane to be lifted and grafting material to be injected, thus introducing the concept of minimally invasive implant dentistry. Short implants are widely discussed because of their increased use in recent years. Historically, long implants (>13mm) in combination with sinus lift procedures were recommended to restore function and aesthetics. Nowadays, improvement on implant design and scientific evidence have shown high success/ survival rates of short implants, thus indicating them to be among the most valuable approaches in modern dentistry. Having all these concepts in mind, the objective of this case report was to demonstrate the use of short implants in combination with ridge splitting and internal and crestal sinus lift in the same surgical area, thus applying a minimally invasive dentistry approach.