Placed Two Hi Tec Plus Implants and Have Issues with Primary Stability: Recommendations?

they have a great chance! The mescal implant may be a little difficult to restore, maybe splint the two and screw retain the prosthesis. These should be stable at 16 weeks. I would uncover at 16 weeks and place healing abutments. Then let it sit for 8 weeks more. I'm not familiar with this brand, but I assume that they have all the prosthetic components you need.

Could have been a nice lateral window case to get some 10 or 12 mm implants in. No Septa nice floor that may have been the best route . If not could have angled the mesial implant to again get a longer implant placed . Peter

Crestal or lateral window sinus lift coupled with long implants would give you a better fighting chance. Vertical gains with GBR is not a good idea.

longer and more upright mesial implant would be more perfect good job

Why lateral sinus lift? Close sinus lift give u good result but u did your job and have to wait 6 months!! I saw a little widening in pdl and think u r case has heavy occlusion and will not a good news for u. If it is possible give us some information about your case? Profile? Occlusion? Any history of braxism or clenching? Any history of chronic sinus problem? After that u will be able to think about prognosis And long term working of your implantation

In my experience, I have had to remove much more short implants than long ones. Do not be afraid to reach and engage the floor of the sinus. In cases like these, it allows you to place longer implants and gives you more stability due to the harder cortical bone. Even if you do not want to do an osteotome lift, a couple of millimeters into the sinus is an option that would benefit your implant case. I believe that any of the more experienced clinicians here will tell you that they prefer to engage the sinus floor with a longer implant than place a short one. As far as the placement is concerned, the anterior implant should have been placed closer (about 3 mm) from the tooth in front. Good luck!

Hi Amir Lateral is easier , faster and safer especially when placing two Implants and yes using fully bio-absorbed synthetic graft materials ready to load safely at months . Can check as I do with Osstell Regards Peter

Soory meant 4 months to load

I would take out the implants and graft. Then come back and place two longer implants with sinus lifts with the correct angulation. It is better to correct this situation before integration and this becomes a bigger problem.

first the implants are parallel but are both tipped mesially which will complicate restoration of these and have off axis loading when in function. Did you use a surgical stent to place these? I agree with the comments remove the implants and graft. these need longer implants and an internal sinus lift (crestal approach) will work well. also in the maxilla under prep the sites and use the implant to osseocompress to improve stability and get denser bone around the implants

I am assuming that it is your intention to splint these implants. If you review the literature you will discover that there are numerous articles that conclude that if you splint two implants which are at different apico-coronal heights, there will be bone loss on the more coronal fixture down to the level of the more apical one. Based on this, I would say that you are wise to remove the mesial fixture. And while you are at it, I would suggest you take the advice offered above and remove both fixtures, do a sinus lift and then place two fixtures of a more appropriate length at the same apico-coronal heights.

good luck with this case. 9.0 x 5.0 should be the shortest implant for this case since you're working in D3 bone..

Some authors say that we should never place implante shorter than 10 mm in posterior maxila. That´s why I always lift the sinus to gain more bone and place a better implant. But, since you placed them already, I´d wait 6 months to place the healing abutments and do the crowns after 4 more weeks. Good luck!

Yuuup, I agree with almost all comments regarding minimal lengths of posterior maxillary implants. For the patient's sake, this is a bit unfortunate. I've seen Cases such as this restored and they are less than ideal. If the patient refused the sinus lift, you could have scanned them and engaged the floor at least. This question, would have served the patient and you, much better, had you posed it before the surgery. Bv

If you are starting off with a comprimised scenario, then every other step, must be perfect. A digital pa film, takes 5 seconds. Use them during your cases, to asses position and post op, to confirm finalization. I have a scanner and 20+ years of experience and still take the intra-op radiograph. Bv

This patient would of been better served with longer implants and sinus lift.