Septum Shorter Than Expected

Based on CT taken several years (not on the most recently taken PA in Fig.1), initial osteotomy in the septum of the site of #15 with 1.6 mm drill for 7 mm leads to sinus floor perforation (Fig.2).  A 5x9 mm dummy implant is placed with <50 Ncm post sequential osteotomy until 4.8 mm Magic Drill (Fig.3).  The sinus membrane remains intact; after sinus lift with Vera allograft mixed with autogenous bone, a 5x11 mm IBS implant is placed with < 40 Ncm (Fig.4,5).  With collagen plug placed in the apical portion of the palatal socket, more allograft (Fig.6 (BW) *) is placed around the implant and a 6x5.7(3) mm abutment. With more collagen plug placed over the graft, an immediate provisional is fabricated.  The implant is loose nearly 2 months postop.  After removal of the immediate provisional and abutment, the implant is re-torqued <15 Ncm (implant is placed ~ 1 mm deeper), as compared to >20 Ncm at #14 (without change in depth (3 months postop), Fig.7).  The previous mesiobuccal and distobuccal sockets (Fig.7 *) have apparently disappeared.  The implant is found to be loose with infection 9 months postop.  There is pain when water pik is being used.  The implant is removed with abundant granulation tissue; Vanilla/Osteogen graft is placed 10.5 months postop (Fig.8 *).  Failure factors include severe preexisting infection, poor oral hygiene and implant surface treatment.  Socket preservation should have been done.

Return to Upper Molar Immediate Implant, Prevent Molar Periimplantitis (Protocols, Table), #3,14,28, 31

Xin Wei, DDS, PhD, MS 1st edition 10/02/2017, last revision 08/20/2019