Implants in maxilla: Depth and orientation?

I placed these 2 implants in the maxilla.  They extend into the maxillary sinus.  Do you think the depth and orientation is okay?  Are there any problems that I should anticipate?

12 thoughts on: Implants in maxilla: Depth and orientation?

  1. Craig Smith DDS says:

    My only other suggestion would be to do something about that mandibular bridge before restoring the maxillary implants. It looks like it was made to fit an extruded maxillary molar. I would cut the bridge, place an implant in the site of number 19, and restore them together for a more ideal occlusal plane. Love the root on number 29.

    • Jari Laitinen says:

      Highly recommended proposal to rehabilitate the occlusal plane! Afterwards it`s more expensive to restore the ideal occlusal plane, and it will be difficult to explain to patient why it would be beneficial make new crowns also to maxillary implants.

  2. Perioperry says:

    The sinus floor appears to be well above the apices of both implants. I agree with Craig Smith’s advice regarding the opposing occlusal plane.

  3. Maximiliano Hespanhol says:

    To answer your question, it would be necessary to have a CT scan.
    The panoramic X-Ray is very limited in precision and is quite impossible to comment on depth; too much anatomical overlay.

    All the best!

  4. matthew DMD says:

    Ditto to other comments. Don’t see that you are in sinus at all. Guess a CBCT would be a help and only way to judge. Good luck with case.

  5. Perioperry says:

    Can see clearly the maxillary sinus floor. The pano film here is sufficient confirmation that both implants are below the sinus.

  6. Dipika says:

    Great job. Agree with others. Little better spacing to allow better access for restoration, may be( difficult to say without seeing 3 D if possible or not)may be little longer for #15 to engage sinus floor for better retention and slightly better orientation to make them parallel to contact areas? Surgical guide -with 3 D dicomndata and impression or scanning with stml and merging those- I find it very helpful.

  7. OA says:

    Based on Panoramic no one can tell if orientation is good or bad. Orientation must be looked from four eagles B,L,M,D . Also B&L bone width must be taken into account. 2D image don’t give much info.
    I am sorry to say that and I know we all make mistakes, and nobody perfect, but do you know where the sinus is? You saying implants inside the sinus.
    If you not sure where the sinus is then I would recommend to take a course, this my professional advise. I am not trying criticize, just want to give you personal advise.

  8. Sean Rayment, DMD, DSc says:

    Hard to say based on the image but it looks like vertically they are well within bone. It would have been nice to push them more distal. I also would have considered removing the over-retained deciduous canine before restoring this area. Once that goes you will have a space issue that may not be fixed by rotating the adult canine (#11). Interesting case from a restorative perspective……

    • Tony says:

      Agree with all comments – two important points are as OA advises – you
      should try to look at more X-rays to familiarize yourself with anatomical structures if you are going to place implants – there are several no go areas in both jaws that you need to be aware of.
      Also google you tube presentations by Ziv Simon on the optimal angulations of implants on insertion. You will learn a lot .
      Implantology is great fun and gives a new dimension to your practice.
      Good luck

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