{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T09:43:11Z","timestamp":1775554991153,"version":"3.50.1"},"reference-count":25,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T00:00:00Z","timestamp":1762473600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Maxillary sinus augmentation is a well-established surgical procedure for dental implant placement in the posterior maxilla when the residual alveolar bone height is insufficient. Traditionally, the lateral approach has been preferred in cases with less than 4 mm of bone; however, the crestal approach has emerged as a less invasive alternative, particularly with the advent of advanced techniques and tools such as hydraulic pressure systems and dedicated osteotomy kits. Case Presentation: This case report presents the clinical management of a 68-year-old female patient requiring rehabilitation of the right maxillary molars, where the residual bone height measured only 3.6 mm (in position 1.6) and 2.5 mm (in position 1.7). Using the CAS kit system with rounded drills and hydraulic pressure, a controlled crestal sinus elevation was performed, followed by simultaneous implant placement. Despite the extremely limited bone height, a final insertion torque of 30 Ncm was achieved for both implants, likely due to favorable sinus floor anatomy, under-preparation of the implant sites, and the use of tapered, macro-textured implants. Postoperative follow-up over three years showed stable bone levels and successful prosthetic rehabilitation with single crowns. Conclusions: This case report highlights the potential of the crestal approach in anatomically challenging scenarios. Proper planning, technique, and implant selection are mandatory to achieve predictable and long-lasting outcomes, even in cases previously considered contraindicated for this method. Further randomized controlled trials are needed to confirm this preliminary result.<\/jats:p>","DOI":"10.3390\/reports8040228","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T09:14:45Z","timestamp":1762506885000},"page":"228","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Safe Crestal Sinus Elevation Below 3 mm Residual Bone with Tissue-Level Implant Placement: A Case Report"],"prefix":"10.3390","volume":"8","author":[{"given":"Carola","family":"Di Frischia","sequence":"first","affiliation":[{"name":"Independent Researcher, 00146 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Tallarico","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Gargari","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Via Montpellier, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edoardo","family":"Magnifico","sequence":"additional","affiliation":[{"name":"Independent Researcher, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Cecchetti","sequence":"additional","affiliation":[{"name":"National Institute for Health, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco Mattia","family":"Ceruso","sequence":"additional","affiliation":[{"name":"Department of Dentistry \u201cFra G. B. Orsenigo-Ospedale San Pietro F.B.F.\u201d, 00189 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,7]]},"reference":[{"key":"ref_1","first-page":"117","article-title":"Clinical and radiographic evaluation of sinus floor augmentation using a crestal approach with osteotomes and various grafting materials","volume":"22","author":"Chen","year":"2007","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_2","first-page":"7","article-title":"Effectiveness of sinus lift procedures for dental implant rehabilitation: A Cochrane systematic review","volume":"3","author":"Esposito","year":"2010","journal-title":"Eur. J. Oral Implantol."},{"key":"ref_3","unstructured":"Jensen, O.T. (1999). 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