Sinus Perforation: Shorter Implant

After using 4.5x5.3 mm and 3.5x7.3 mm drill at #14 with guide, the sinus floor is not perforated.  When a 4.5x11 mm dummy implant is placed to the 2nd line (12 mm offset), the sinus membrane is perforated (Fig.1).  A piece of PRF membrane and sticky bone are pushed into the sinus in an attempt for repair.  A shorter implant is placed (5x7.3 (instead of 8.5) mm, Fig.2,3,5, as compared to Fig.3) to reduce postop sinus infection.  In fact incision reveals palatal bony concavity.  When the implant is placed, there is mild palatal thread exposure.  With incision instead of tissue punch, it is easy to place bone graft over the small defect (Fig.3 *).  The wound dehisces and heals 2 weeks postop (Fig.6).  There is bone loss 6.5 months postop (Fig.7 *), corresponding to palatal thread exposure.  After decortication and periosteal underscoring, cortical allograft mixed with ~.25 cc GEM21S is placed (Fig.8 *).

Return to No Deviation GEM21S
Xin Wei, DDS, PhD, MS 1st edition 06/05/2020, last revision 01/30/2021