Implant Failure with Sinus Lift

Not long postop, the patient called saying that #2 provisional had dislodged.  Due to his busy schedule and coronavirus outbreak, he returns nearly 4 months postop.  The abutment is distalized and loose with the underlying implant (5x9 mm).  The latter is removed before local anesthesia (Fig.1 distal defect). After initial debridement, a 2.2x13 mm drill is used with a guide of 12 mm offset, followed by insertion of a 4.5x11 mm dummy implant with barely stability (Fig.2).  A 5.5x9 mm is placed free hand initially, followed by guide with stability.  But the implant has uncovered threads distolingual.  Thorough debridement reveals that the sinus membrane has a small perforation.  After placement of a piece of Osteogen plug, cortical chip and Vanilla hydrated with .25 cc of GEM21S is packed into the site with a condenser (Fig.3,4).  The graft is fixed in place with Perio glue, followed by a piece of GEM Cap with the glue.  Three to 4 months later, take CT for healing confirmation.  Try to place a shorter implant (e.g., 5x7 mm) without getting into the sinus to reduce infection.  In fact the Cap does not stay in place with loss of bone graft (8 days postop).

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Xin Wei, DDS, PhD, MS 1st edition 06/01/2020, last revision 06/09/2020