DMD (Kaunas University of Medicine) · GPR, Assaf Harofeh · General Anesthesia certified (MoH) · ha-shomer Medical Centers (MCH), Haifa & Kiryat Tivon · Tel Hashomer (oral rehab)
Using Surcam since 2010·Published May 2026
A 58-year-old patient presented with a non-restorable upper-right first molar and pain on mastication. The treatment plan combined an atraumatic extraction, a lateral-window sinus augmentation to address pneumatization, and a guided U-Type placement aiming for an immediate provisional where primary stability allowed. This case follows each stage as it happened.
Case report
01Pre-operative assessment
Single-unit posterior, Maxilla
The first molar showed a vertical root fracture with localized inflammation. Soft tissue was healthy enough to plan an immediate approach. Baseline photographs were taken at presentation to document the starting point.
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02Pre-surgical imaging
D3 bone, Maxilla
CBCT revealed 4.5 mm of residual bone height below the sinus floor and D3 density, confirming the need for a lateral-window sinus augmentation before predictable primary stability could be achieved.
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03Surgical procedure
Guided Surgery
A full-thickness flap was raised and a lateral window prepared. The Schneiderian membrane was elevated intact and grafted with a xenograft. Guided surgery kept the osteotomy on the planned trajectory.
04Fixture placement
35 Ncm · Immediate loading
The U-Type 4.2 × 10 mm seated at 35 Ncm — sufficient for an immediate screw-retained provisional. The progressive thread geometry achieved stability in the soft D3 bone without overpreparation.
05Prosthetic phase
Screw Retained
At four months, a screw-retained zirconia crown was delivered on a Ti-base. The emergence profile was developed through the provisional phase, so the soft tissue framed the definitive restoration naturally.
06Delivery
Screw Retained
Function and esthetics restored. The patient reported full comfort on chewing at the delivery appointment.
074 months recall
Clinical and radiographic review
The six-month radiograph shows stable crestal bone and full graft consolidation around the implant. The case held exactly as planned.
Outcome
Uneventful healing with stable crestal bone at six months. The patient reported full comfort on chewing at delivery. A predictable result in a compromised posterior maxilla, achieved by staging the augmentation and relying on implant thread geometry rather than overtorque.
Clinical takeaway
In D3 maxilla I rely on the U-Type's thread geometry for primary stability rather than overtorquing. 35 Ncm here was the right call — and the immediate provisional protected the graft site through healing.
