Sinus Lift with Magic Expanders

After placement of a 4.5x8.5 mm implant at #13, a vertical anchor pin is used, which is helpful for #14 osteotomy (Fig.1-3).  One hand is free.  Sinus lift with 2.8 mm reamer is not efficient, since it is difficult to feel stopper.  A 5x7.3 mm implant has to be removed from the site of #14 for use of Magic Expanders from 3.0 to 4.3 mm at the depth of 13 mm (gingival level).  Autogenous bone harvested from osteotomy is used for sinus lift.  It appears that the implants are placed deep; healing abutments with 5 mm cuff are placed (Fig.4 (extraoral bitewing)).

The patient returns 10 days postop with chief complaint of light UL, LL pain.  There is plaque over the healing abutments; the gingiva sligtly erythematous and tender.  She feels better after plaque removal.  Amoxicillin is prescribed 1 more week.

Six days later, "pain is less".  Percussion of #13 healing abutment causes headache.  There is no mobility at #13 or 14.  The buccal gingiva is severely erythematous and edematous at #14.  Chlorhexidine irrigation is conducted.  After removal of the slightly subgingival healing abutment without pain, a 6x7 mm one is placed with severe pain.  After local anesthesia, the implant seems to be mobile.  The new abutment is advanced ~ 1 mm (Fig.5).  Augmentin is prescribed.  One week later there is no sign or symptom of infection.  It appears that Augmentin should be prescribed after sinus surgery.  The implant at #14 is removed with bone graft 1 month post placement.  The graft appears to heal 4 months post implant placement (Fig.6,7 (5 months post placement at #13)).

The existing guide will be reused to start osteotomy with point drill with 2 O-rings and 2.2x7.3 mm drill with 3 O-ring, followed by 5x5 cm CT with a parallel pin from Bicon kit. Bone expanders #3 and 4 (1.7/3.1 and 2.4/3.7) will be used slowly with depth control.  Dummy implants (4.0 and 4.5x10 mm) will be placed for further expansion before placement of bone graft and a 5x7.3 mm definitive implant.

Return to Upper Molar Immediate Implant, Armaments Xin Wei, DDS, PhD, MS 1st edition 08/30/2018, last revision 02/12/2019