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Internal Sinus Elevation with Osseodensification and i-PRF Sticky Bone Graft: A Case Report
Mohammed Samir
1  Department of Oral Medicine, Periodontology and Oral diagnosis faculty of dentistry, Ain Shams University, Cairo, Egypt
Academic Editor: Marco Cicciù
Published: 05 December 2025 by MDPI in The 1st International Online Conference on Prosthesis session Innovations and Challenges in Dental Implants
Abstract:

Background:
Posterior maxillary rehabilitation is often complicated by sinus pneumatization and reduced residual ridge height. Traditionally, multiple adjacent implant placements in such situations require an open lateral sinus elevation. Minimally invasive internal sinus lift techniques, particularly when combined with biologically active grafts, offer a promising alternative. This case highlights the novelty of performing closed sinus elevation at multiple adjacent sites in a subantral Class 3 case, supported by the use of platelet-rich fibrin (PRF)-based sticky bone to enhance osteogenesis.

Case Description:
A 43-year-old female patient (ASA I) presented with multiple missing posterior teeth in the right maxillary arch, impairing mastication. CBCT revealed sinus pneumatization with reduced alveolar bone height, classifying the case as subantral Class 3. Internal sinus elevation was performed using osseodensification burs. Sticky bone was prepared by combining autologous PRF with a xenograft (Bio-Oss, Geistlich Pharma, Switzerland) using a centrifugation protocol (2700 rpm for 12 minutes). Three implants (4.0 × 10 mm) were simultaneously placed at the first premolar, second premolar, and first molar sites.

Results:
Sinus membrane elevations of 3.58 mm, 4.45 mm, and 6.69 mm were achieved. Implants demonstrated primary stability of 30–40 Ncm and ISQ values of 62–74. Post-operative CBCT confirmed complete bony housing along the full implant length, indicating substantial bone gain and increased peri-implant bone density. After 3 months, osseointegration was achieved, and a cement-retained zirconia fixed partial denture was delivered.

Conclusion:
Closed sinus elevation across multiple adjacent implant sites in a subantral Class 3 case, combined with PRF-enriched sticky bone, enabled predictable vertical bone gain and complete implant housing without the need for open sinus augmentation. The incorporation of growth factor-rich PRF enhanced the osteogenic potential of the sinus membrane, supporting rapid healing and successful implant integration. This approach demonstrates a minimally invasive and biologically favorable strategy for managing posterior maxillary edentulism with reduced ridge height.

Keywords: Internal Sinus Elevation, Osseodensification, i-PRF Sticky Bone Graft, Dental Implants, Sinus Membrane Elevation
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Comments on this paper
Marvin Ortega
23 December 2025
This is a very interesting and well-presented case report. The minimally invasive approach using osseodensification and i-PRF sticky bone for multiple adjacent internal sinus elevations is impressive, especially in a subantral Class 3 scenario where a lateral window is usually expected. The clinical outcomes, stability values, and CBCT findings really highlight how effective biologically driven techniques can be when combined with proper case selection. Funny enough, reading about precision, incremental gains, and gradual progress actually reminds me of how progression works in games too. In Brainrot Clicker, you also start with limited “resources,” then slowly build up through upgrades and smart progression until everything clicks into place.
Marvin Ortega
23 December 2025
This is a very interesting and well-presented case report. The minimally invasive approach using osseodensification and i-PRF sticky bone for multiple adjacent internal sinus elevations is impressive, especially in a subantral Class 3 scenario where a lateral window is usually expected. The clinical outcomes, stability values, and CBCT findings really highlight how effective biologically driven techniques can be when combined with proper case selection. Funny enough, reading about precision, incremental gains, and gradual progress actually reminds me of how progression works in games too. In brainrot clicker, you also start with limited “resources,” then slowly build up through upgrades and smart progression until everything clicks into place.


 
 
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