Biohorizon Implant perforated the maxillary sinus: recommendations?

Question: is the most distal right maxillary implant (the only one I mean) supposed to be a 1st molar? Looks like 2 or 3mm subcrestal and too distally placed. Not a proper placement for a proper prosthetic rehab. If "The bone in #3 site turned out to be more porous than I expected" you could simply back the implant out in midst of placement, send it back (most brands I've worked with will allow that) and place a wider one not just sink it down the prep site/into the sinus. Even better you could prep (underprep) a new site more mesial to the original site and simply place the implant there. Not that the 6mm rough titanium WILL make some damage to the sinus but it could. If you remove it now (with now I am assuming the surgery was performed not too long ago) just understand that an oro-antral communication is supposed to be managed somehow either by doing nothing at all, by placing a new implant 2 or 3mm into the sinus with thorough saline sinus irrigation, by placing probably CaSo4 and allowing it to set and occlude the communication or by a lateral approach. Your call. Alternatively you leave it as is and place another implant between the already placed one and the 2nd bicuspid making this a 3rd and 4th bicuspid restoration. Again it's your call. Thanks for sharing

Actually get a CBCT see how much of the implant is actually in the sinus, this will heal, however the quality of the bone is poor. I'd remove, repair with a sinus lift and membrane. The lift most likely needed to be done to provide more base bone, I'm not that concerned about the sinus, the membrane will reform and grow over the implant there is not enough decent bone around the implant in general. You are lucky the implant wasn't pushed into the sinus. 25 ncm is not great. You needed to do the correct procedures for and optimum result. Not sure what the implant in the opposite tuberosity/second molar area is supposed to accomplish, seems that it was cropped out in the photo. Grafting is not an option in implant placement, the result will be compromised can't build a house on sand, don't blame the bone for poor technique.

Hi. Leave the implant where it is. Poor primary stability, it is likely that you will push it into the sinus trying to remove it. You definitely do not need the sinus lift. Keep it simple- more surgery, more complication, more morbidity. Get CBCT, check the ridge with, the high looks v. good in upper right first molar region, I am guessing at least 13 mm long implant should be fine. the bone density in this regions is usually poor, under-preap the osteotomy, I always anchor the top of the implant in the sinus floor for bicortical fixation. Spend more time on planning, less on drilling.

CRS gave you good advice...... it will probably integrate just fine..... wait six months before uncovering it..... as well, since you are aware that the bone is not dense, when uncovering the implant, place an explorer on the body of the implant, and hold firmly when attempting to remove the cover screw......you do not want to send the implant into the sinus........ if the implant feels solid, place a wide healing collar on it, and leave it for a couple of months... it will not have occlusal contact, but will get some stress from the bolus of food on it.........the idea of the wide healing collar, will prevent the implant from lodging in the sinus, just in case it becomes unstable...... I like to give implants a chance rather than just taking them out.

Could you post a radiograph pod this case when it is restored?

You should check the implant is not migrating apically. I would not remove it.

On the expanded view on my phone I was able to see the UR implant. The previous comment seems most efficacious, more planning less drilling. What was the prosthetic plan? A single unit? What the CBCT indicated and what the pan indicates seem contradictory. I would be leary of loading it for the previous reasons and fishing an implant out of a sinus is not fun. I would place 1 or 2 more implants mesially and support the posterior implant as much as possible

Doing less surgery when indicated is not the best, if one cannot perform the indicated procedures then refer to appropriate specialist think long term not what you are comfortable with but what is best for patient. Following the above advice while making you feel better but sweating out a potential complication is not fun, wastes time and is not a great business model. When performed optimally a sinus lift is not a big deal especially when the post op sequela are mitagated with appropriate management. That's why I feel a team approach is best, surgey is not a hobby. If you are working near the sinus knowing how to avoid, retrieve , repair, and manage complications is part of being a good surgeon. This goes for extractions, implants and infections. Sorry but that's how I see it. I feel this post is about giving prudent advice and constructive evaluation not massaging one's feelings. I spoke to you as a professional, thanks for posting good luck!

Sorry about the long post but allow me to share some insight, I see patients often and hear their stories of how their dentists tried something and thought they knew what they were doing. I try to keep what's best for the patient in mind due to this. It happens more often than you think and patient's won't tell you but leave the practice or tell others. We are a reflection of our work, I try to remember that daily, it is humbling and our patients trust us to get the best care.

I agree CRS . I would go a step ahead . If in doubt just remove , graft and restart . In future if this happened possibly even crestal sinus lift would save hassle .

The maxillary sinus is a mucosal lined cavity. The oral cavity is mucosal lined cavity as well. The oral cavity is a lot dirtier. I am wondering why we collectively worry about penetrating the maxillary sinus? It has been shown in studies that zygomatic implants heal uneventfully in the maxillary sinus.

I begin all implant cases with a treatment plan and a model work up that I present to my patients with a cost estimate. Making a model allows me to know where I would need to place the implants. I fabricate a surgical guide on that same model. Using guide during my presurgery pano allows me to know where I need and want to place the implants. It is a low cost effective way I have used to place implants for the last 17 years. It's basic implant planning. For the implant that is in the sinus, I would leave it alone. Take a pano at 3 months and clinically check the site. If after 6 months it is integrated then crown it. Good luck!