Posterior Maxillary Implant Rehabilitation Using Staged Ridge Preservation and Soft‐Tissue Augmentation: A 2‐Year Case Report

Abstract

Background Rehabilitation of the posterior maxilla is challenging due to sinus pneumatization, limited vertical bone height, and thin peri‐implant soft tissues. Minimally invasive, biologically guided approaches aim to reduce morbidity while ensuring predictable outcomes. This report presents a staged protocol integrating hard‐ and soft‐tissue augmentation to optimize implant site development. Case Presentation A 48‐year‐old female presented with a missing maxillary left first molar (#26) and impaired mastication. The left premolars (#24 and #25) were buccopalatally malaligned and exhibited a poor periodontal prognosis. Radiographic examination revealed poor‐prognosis premolars, advanced ridge atrophy, and sinus pneumatization, with a residual bone height < 6 mm. Initial alveolar ridge preservation was performed, but vertical bone gain remained insufficient after 6 months. Intervention Following extraction of the premolars, socket preservation with bone grafting and a barrier membrane was performed. Implant placement was performed using a minimally invasive crestal sinus floor elevation with simultaneous grafting, achieving vertical bone augmentation and primary stability. Standard OSSTEM implants (4.5/11 and 4.5/10 mm) were used. After osseointegration, staged peri‐implant soft‐tissue augmentation increased keratinized mucosa width and mucosal thickness to improve tissue stability. The implants were restored with delayed‐loading, screw‐retained metal‐ceramic single crowns following complete soft‐tissue maturation. Results The staged protocol achieved stable vertical bone gain, healthy peri‐implant soft tissues, and successful functional and esthetic rehabilitation. These outcomes were maintained at the 2‐year follow‐up after crown delivery, with no biological or prosthetic complications, stable marginal bone levels, a favorable emergence profile, and high patient satisfaction. Conclusion Sequential alveolar ridge preservation, minimally invasive crestal sinus elevation, and delayed soft‐tissue augmentation provide a safe, predictable approach for atrophic posterior maxillary sites. This strategy minimizes surgical morbidity while enhancing implant stability, peri‐implant tissue health, and long‐term clinical outcomes.