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Patient G.A. age 70, edentulous site 15.
Clinical examination: evidence of incongruous prosthetic crown on 24, edentulous seat 25, periodontitis of 26 with fork involvement.
OPT examination shows irregular pneumatization of the left maxillary sinus so further diagnostic investigation with CBCT is performed. Examination shows invagination of the sinus mucosa probable outcome of communication between the root of 25 and maxillary sinus and impairment of the distal fork of 26.
Treatment plan: at present, the ideal treatment would be extraction of 26, implants site 25, 26 and prosthesization of 24, 25, 26. As the patient does not accept the extraction of 26 and remain without two teeth for the period of osseointegration of the implants, we opt for the section of the distal root of 26, provisionalization from 24 to 26 and implant seat 25.
The anatomical conditions at seat 25 direct toward guided implant placement to avoid possible interference with the area affected by sinus mucosal eversion.

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Prof. Dr. Antonio Lanza