Sins Lift Master Kit
When the patient returns for #14 implant placement (scheduled), he wants to do implant placement on the right side first (Fig.1: #3,5 for bridge (fixed partial denture, FPD)). It appears that the bone height at #3 is limited (Fig.2 measurements). To avoid premature implant loosening and loss, Sinus Lift Master Kit is used. The beauty is its drill stoppers. The osteotomy depth is tightly controlled (Fig.3,4). A 6x11 mm implant is placed with sinus lift (Fig.5 *) at #3; a 4.5x17 mm implant without bone graft at #5. Both implants have achieved primary stability (>60 Ncm). Abutments are placed immediately to keep periodontal dressing in place. Arrowheads in Fig.3,4 indicate change in trajectory for the next steps, for example, to try to avoid contacting a residual root (Fig.1 *).
Progressive loading should be provided before final restoration because of limited bone height at #3. The patient seems to be a bruxer with partial edentulism. Fabricate provisional FPD with light occlusal contact 2-3 months postop for 1-2 months before normal occlusal contact. Ask the patient whether there is pain when he masticates. Before premature implant loss, there is pain.
The patient is doing well 1 week postop, except partial dislodgement of periodontal dressing (Fig.6). When the latter is removed, the wound seems to be healing (Fig.7).
When the patient returns for impression 3 months postop, PA is taken (Fig.8). The restoration is cemented 4 months postop (Fig.9). More implants are needed, including the one opposing the tooth #2. The mesial of the tooth #2 has mild probing pain 14 months post cementation (Fig.10). The residual cement persists after Cavitron (Fig.10,11 *). It appears difficult to remove cement after setting for long time. Take BW or PA immediately after crown/FPD cementation if they are unable to be removed for cement removal (for Tatum or Magicore). Even just set cement is difficult to remove.
Upper Molar Immediate Implant,
Xin Wei, DDS, PhD, MS 1st edition 07/07/2016, last revision 01/21/2018