Magic Sinus Lifter Should Have Been Used

When the tooth #15 is extracted, the socket floor looks shiny and hard for osteotomes.  Instead starter drill is used for initial osteotomy.  The sinus membrane perforates.  In fact the socket floor is the sinus floor.  Tatum tapered round osteotomes 2-5 mm are used for osteotomy.  The sinus membrane perforation increases.  The sinus floor is approximately 1 mm.  If Magic Sinus Lift were used, the sinus membrane perforation could be avoided.  A 4x9 mm IBS dummy implant is placed with stability (Fig.1, no bone immediately around the apical portion of the implant).  When a 5x9 mm dummy implant is placed, it is approaching the distal socket wall.  After the last dummy implant is withdrawn, a piece of Osteogen plug is inserted and a 5.5x7 mm implant is placed with less than 20 Ncm (Fig.2).  A 6x4(2) mm abutment is inserted with intention to prevent the implant from dislodging into the sinus in case the implant becomes loose.  Vanilla Graft is used to fill the socket gap (*).  An immediate provisional is fabricated to close the large socket.  The provisional is off 1 month postop, while the abutment is loose and replaced by a healing abutment.  The latter is loose with pain 5 months postop (Fig.3).  If the implant is removed, probe the wall and the roof of the osteotomy.  If the sinus floor remains defective, insert PRF membrane prior to bone graft and implant.  A week later, the healing abutment is removed; the implant is not loose; the mesiobuccal gingiva slightly erythematous (Fig.4).  The implant looks small and short, as compared to those at #2 and 31 (1.5 years post cementation, Fig.5).  The mesial defect appears to remain unfilled with bone (Fig.6).  A healing screw is placed.  The patient returns with pain distal to the implant 6 months later (11 months postop, Fig.7,8).  Since the implant threads are exposed and appears to trap bacteria, the implant is removed with wrench.  The sinus membrane is intact.  After granulation tissue removal, Vanilla graft is placed and held in place with Osteogen plug (Fig.9).  The potential bone height for re-implantation is 6-10 mm (Fig.10).  Two months post implant removal at #15, the patient returns for impression for #18 guide (Fig.11, CT taken on 03/21/2018).

Return to Upper Molar Immediate Implant, Prevent Molar Periimplantitis (Protocols, Table), Trajectory, #2,31 Xin Wei, DDS, PhD, MS 1st edition 10/19/2017, last revision 01/23/2019