Establish Correct Implant Position and Trajectory and Avoid Sinus Membrane Perforation

A 5x8.5 mm Hiossen implant is placed at the site of #3 (Fig.1) with crestal sinus lift (Fig.2).  In addition to distal and apical placement, there is sign of postop sinus infection.  One-week postop X-ray shows that the bone graft appears to be dispersed in the sinus (Fig.3).

To prevent these complications, establish initial osteotomy (Fig.4), take PA and correct the position and trajectory of the osteotomy as early as possible if needed.  Lift the sinus floor for ~ 2 mm (Fig.5) and place a small amount of bone graft gently (Fig.6 red circles) before insertion of an implant slightly subcrestal (Fig.6 green).  Take PA and adjust implant placement level if necessary.  If there is sinus membrane perforation, place collagen dressing or PRF prior to bone grafting.  It is preferable to place a tap drill or dummy implant to confirm placement depth.

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Xin Wei, DDS, PhD, MS 1st edition 01/08/2017, last revision 01/08/2017