Felt drop of resistance during osteotomy but no perforation: prognosis?

I was installing a 4.2x10mm implant in the maxilla in #13 site [maxillary left second premolar] adjacent to the maxillary sinus. During my drilling of the osteotomy I felt a sudden drop in resistance, I did the valsalva maneuver to check for any perforation and there was no perforation, I then installed the implant. What is the prognosis?


![]image](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2014/04/image-e1398976522597.jpg)

11 Comments on Felt drop of resistance during osteotomy but no perforation: prognosis?

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CRS
5/1/2014
Did you do the maneuver or the patient? It should be fine ;)
Rishabh
5/1/2014
@ CRS, haha, sir i asked the patient to perform the maneuver :-) thanks
Sboms
5/2/2014
You probably perforated the sinus floor with one of your smaller diameter drills. Drill stops for beginners are a must. Should be just fine. Implant shoulder looks very deep- look at shoulder of implant compared to cej of bicuspid. Any reason why you placed it that deep? It's at least 3mm sub- crestal.
Rishabh
5/2/2014
Thanks for the suggestion sir, i ll surely keep the drill stop thing in mind.... As for the implant below the crestal level, sir clinically it was at the crestal level only and not submerged, may be bcoz i have place the implant slightly palatally and the angulation of the IOPA x-ray its looking like dat... Thanks and regards
naser
5/3/2014
once the implant is integrated its fine , here the tip of the implant engaging the cortical plate of the floor of the sinus gives it good primary stability ,and resistance .even if you perforated the sinus and 2 mm of the implant in the sinus it will tolerate .good job
Gianmarco
5/3/2014
According to me during your drilling osteotomy you probably perforeted the buccal plate at the apex but this will not compromise the final result. Good luck
Dr. Robert Wolanski
5/7/2014
I suspect that it will just work fine. It could be any of the above.but to acertain thie issue you wculd take a CT. While not normal post op prorocol it is acceptable to ct the implant if your concerns are grave enough. I assume you had a ct to start with.
myonphu yip
5/10/2014
Accoding to my personal experience, once the primary stability is adequate and patient follow your advice without strenuous exercise, the outcome will be definitely predictable.
Dean Licenblat
5/14/2014
If primary stability is good and it is placed crestally. You should be fine, it will integrate without concern
KurtOMFS
5/14/2014
I have seen this also in cases where the marrow space has been replaced to a large extent by fatty or fibro fatty tissue. Once the cortical plate has been widened sufficiently there is a loss of resistance as you enter into the mush. You can practically suck it out with a small suction. Usually seen with older patients and those with systemic diseases such as IDDM, CRF and other long standing chronic diseases but not always. Some folks just seem to have it. The bone is a very poor quality and integration may or may not happen. It doesn't really look like poor bone on your x-ray but I try really hard not to make my diagnosis about the bone quality until I am actually looking at it ;)
amir
5/19/2014
Hi,it is not critical,dont worry,

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