Guided Sinus Lift

After osteotomy using bone-level implant guide at #4, the crown and abutment at #3 has to be removed to place a 4x14 mm tissue-level dummy implant because of the narrow space of #4 and implant placement angulation (Fig.1).  Following initial placement of a final 4x17 mm implant and bone graft (Fig.2 *), the crown and abutment of #3 and the guide are reseated for correct implant trajectory.  The guide has to be removed for final depth control.  With the same mode, a 5x17 mm tissue-level tap is used at #2 following bone-level osteotomy with guide.  A 5x14 mm tissue-level implant is placed with >50 Ncm (later placed deeper), while more bone graft is inserted mesial of #4 implant with a 3.5x5 mm abutment (Fig.3 *).  Bone graft is introduced into the sinus using guided sinus lift kit (Fig.4,5 (CT sagittal and coronal sections)) * (D: distal, P: palatal)).  The coronal half of the implant at #4 is covered by bone graft (Fig.6 *) buccal (B) and palatal within the deep socket.  The implants at #2 and 4 seem to have osteointegrated nearly 5.5 months postop (Fig.7,8 (BW)).  A 4.5x5 mm unipost is later placed at #2 with long chamfer margin.  It appears that the abutment at #3 is wide.  The hex is worn.  It changes to a 5.5x7(4) mm one.  After abutment adjustment for parallelism, a provisional FPD is fabricated.  The latter will be adjusted for papilla formation between implants to reduce food impaction.

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Xin Wei, DDS, PhD, MS 1st edition 04/30/2019, last revision 11/17/2019