2 Stage

The longest (12 mm) bone trimmer seems not to work over the guide at #15.  When osteotomy finishes, the guide is removed.  The sinus floor happens to have been removed, whereas the sinus membrane remains intact.  After partial insertion of a piece of PRF membrane (due to hemorrhage) and Vanilla graft for sinus lift, a 5x10 mm implant is placed with 15 Ncm.  The implant appears to be short and placed deep (Fig.1,2).  When an implant is not too large, it can be placed ~ 1 mm subcrestal (vs. 2-3 mm for this case) in spite of the palatal wall defect.  A cover screw is used, followed by allograft (Fig.1 *).  The latter is covered with another piece of PRF membrane, collagen membrane (Fig.3) and periodontal dressing.  There is no nasal hemorrhage postop.  PRF membrane and collagen membrane dislodge a few days postop, although the bone graft remain coronal to the implant.  The healed socket appears to have been shrunken buccopalatally 3 months postop (Fig.4), probably due to the absence of an abutment and a provisional.  The mechanics (abutment and provisional) seems to be more important than the chemical (membrane).

Return to Upper Molar Immediate Implant, Prevent Molar Periimplantitis (Protocols, Table), Trajectory, Guided Surgery Xin Wei, DDS, PhD, MS 1st edition 09/28/2018, last revision 12/22/2018