Implant in Sinus Slope

A 55-year-old man has subgingival crown fracture (Fig.1).  High magnification shows that the apex of the tooth (Fig.2 *) is higher than the sinus floor (^). When the tooth is extracted (socket treated as control), it is evident that the distal wall of the socket (Fig.3 >) is shorter than the mesial one.  If the osteotomy is initiated in the middle of the socket, an implant may be deviated to the least resistant area, not ending up in the middle of the socket (Fig.7).  To compensate for the potential deviation, the osteotomy is intentionally initiated in the mesial wall of the socket (Fig.4).  Once the lamina dura of the mesial wall is penetrated, the trajectory is changed with deepening the osteotomy (Fig.5).  As the osteotomy is being enlarged (Fig.6 red solid arrow), it should be unavoidably being shifted distally (white open arrow).

Return to Upper Premolar Immediate Implant

Xin Wei, DDS, PhD, MS 1st edition 12/21/2015, last revision 01/05/2019