Complications after sinus lift and implant: recommendations?

1_There might be slight injury of the sensory nerve supplying the affected area during reflection of the flap or local aneasthesia 2_Endo problims of the premolars 2_

Wait for more weeks and see if the numbness disappered.before doing any thing

The paresthesia started after 1 week for few days nothing was soposed to happen. I supose it will be a healing pressure of the bone graft that presses some nerve for a few days and ir will resolve soon.

The distance is because of a bone anomalia presented after making the flap that was in my eyes not worth risking the implant and making also another vestibular bone graft. It was like a small hole going more than 5mm deep and to small for grafting but to dangerous braking the vestibular part of the arch during implant insertion with apropriate torque. Thanks for your opinion.

Rule nr 1: always strive for an ideal outcome whenever and wherever possible. In this case, this means that if the patient has antagonist occlusion in that area, you should have planned for two implants. The way this implant is placed will make it very difficult to restore two molars, unless you cantilever a distal one, which is not advisable here. As it is, the distance of this implant from tooth 25 is great enough that you have already created a mesial cantilever point and therefore a fulcrum, jeopardizing the implant’s long term success. Your case planning was off from the start. You should have been able to deal quite easily with that small vestibular defect. You should have grafted it appropriately, placed a membrane over it, and burried the implant for 6 months. That way, you would have been able to place the required second implant at the appropriate distance for a truly proper prosthetic outcome. And you should have (and indeed could have) done this all in one surgical stage, so as not to subject the patient to two surgeries. I mean, you were doing a sinus lift here, so why not do it all properly, in one stage? Nothing difficult here, unless you are trying to rush — or unless you were looking for the easy way out — expecting primary stability and early restoration, which is always a mistake. I know that many patients want everything “yesterday”, but it is up to us to educate them that this is implant surgery and not just screwing screws into a piece of wood! It is also up to us to educate them as to the desired/needed outcome and its benefits. This implant is placed too distally! And remember: one poorly positioned implant (in a case like this) can be a lot worse than waiting a little longer for healing but being able to restore properly. You should always try to visualize the final restoration! ALWAYS!