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

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.