Implant partially in Sinus: Best solution?

When you were creating the osteotomy did you feel the drill "fall" into the sinus (lose all resistance suddenly)? The sinus is sloped and often you have more bone than it appears. Gotta see a pt, more latter

It is in the anterior wall acceptable placement. Watch the healing should be fine.

If might be just fine. Leave it alone for awhile. If it integrates and remains asymptomatic, then restore the case.

What is your treatment plan for this case? and is the mandible being treated as well? What options did you offer your patient? No doubt your implant at 26 is more at risk with some exposure to the maxillary sinus and if infected we can imagine what the scenarios could be. If you do lose this implant for any reason what would your plan be? I am a little confused with your case description, but am I correct in thinking that the ridge dimension mesial to your 26 implant is only 2-3mm? Sorry for more questions than answers but primary stability (gained here through two cortical plates so should be sound enough) is only one factor innvolved in treatment planning

If patient has no acute and prolonged sinus-related signs/symptoms you can wait and monitor. The implant appears faily long. I guess you could have chosen a shorter implant to avoid this. BTW, is the severe perio problem at lower teeth under control?

What is your prosthetic plan? if this it to be a full arch fixed on these 6 implants you wont be able to extend the right side back very far due to the cantilever will be too long in a high load area. that last implant on right should have been placed further back so it was over the area where the 1st and 2nd molars contact each other.

I don't see any problem. The bone will probably grow up the implant 2-4 mm.

Dear Dr. I think during driling you should aware about perforation of sinus bony structure by sence of falling into a hollow space.In this situation you should check the perforation of sinus floor and schniderian membrane by nose blowing. In case of positive nose blowing test you should change the place of osteotomy to the more safer place.But if there is no sinus membran ( schinderian ) damage and perforation it is a good idea to put your implant with shorter size or the preplaned size moreover in this case it is recommended to use hand instrument for implant placement like rachet instead of using rotary handpice.it helps you to have more tactile sense than machine to stop in optimal length and elevate schniderian membran with minimal damage. Best Regards Dr.Ali hossein Mesgarzadeh Oral and Maxillofacial surgeon Tabriz university of medical sciences Tabriz / Iran

Hi Dr. Leave the implant where it is and just follow it. If: 1- the implant is integrated 2- sinus is asymptomatic 3- your patient knows what happened and has no dispute Go ahead for restoration. Trust me , sinus has incredible nobility. Dr. Mehran Shokri Oral&maxillofacial surgeon Fellowship in advanced implant surgery Iran

Shouldnt be a cbct done for better 3d view than 2d opg. So that a clear idea of sinus perforation can be seen. As per what you said that you didnt feel that fall in sinus.

All great comments. As well as the feel of the drill ,I check the osteotomy for solid bone in all dimentsions, laterally as well as apically and always chart this. You will sleep better at night if you do this routinely. It is much more accurate thatn trying to interperet a two dimensional Panograph.I agree that a CT would be usefull here, and that the sinus is a rather resiliant bit of anatomy. There are many successful implants that are partially in the sinus and functioning just fine. The engagement of the anterior cortical plate can actually be an advantage. The membrane can grow over the implants as long as it is not infected but do not cout on this. It is just a fortunate fact.

Hi Dr K Yoa , i feel that implant is not in the sinus specially you felt resistance during the drilling , actually there is superimposition between the implant ( which is slight bucally located ) and the anterior wall of the sinus ( which is palatally located ) due to the panoramic view is 2D x-ray .

I'm surprised that your response to the treatment plan is that 'it is beyond the scope of this post'. Considering what is going on with the occlusion ,supereruption. and perio on the lower you may have dug a hole that will be expensive to dig out. Any time you place implants the treatment plan must involve the whole system. You have a myriad of problems coming your way if you don't step back and consider the forces you are creating-the bugs that are left to infect the implants, the re-constuction that will occur once you do decide to do the lower. Stop now and get the plan for the lower and save you and your patient energy expenditures. I could be more blunt but you must consider what is going on on the lower. Good Luck