With placement of Osteogen plug (presumably for repair of the perforation) and limited amount of Vanilla at the osteotomy, a 5x7.3 mm IS implant with SLA surface treatment is placed (Fig.2, ~ 40 Ncm).  When the implant is further seated (Fig.3 arrow with bone graft coronally *)), its trajectory is within the normal limit (Fig.4 blue line).  If the implant fails again, it must be due to the mild sinus infection.  Bone graft should have been done first.  Mild tenderness exists with use of Water Pik 7 months post 2nd placement (Fig.5).  Uncover shows that the implant is stable.  A 6x3 mm healing abutment is placed.  Next appointment a temporary crown will be fabricated for progressive loading.

Re-Placement with Sinus Membrane Perforation Last Next Xin Wei, DDS, PhD, MS 1st edition 06/01/2018, last revision 01/03/2020