Integrated Implant but failed sinus lift: what would you do?

Last Updated: Sep 09, 2018

This implant was placed 6 months ago with an internal sinus lift, but as can be seen, the bone placed as part of the sinus lift has resorbed (probably a sinus perforation that wasn’t noticed). The patient is a large person, with strong masticatory forces, and with a previously failed implant in the same position that occurred within 1 year of loading.

It is a Nobel Active 5.5x10mm implant.

What would you do?
– Restore as is?
– Try to do a sinus lift and add bone around the implant?
– any other thoughts?

6 Comments on Integrated Implant but failed sinus lift: what would you do?

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Gregory A Kammeyer

09/10/2018

Take a CBCT to evaluate the molar MB root. It appears to have a lesion. With the implant if it doesn't have any apical bone loss around the floor of the sinus, nor any symptoms of sinusitis then I would restore it....provisionally if you like. Wait 3-6 months and finalize it,

Tim

09/10/2018

Your second molar implant looks great. Keep going with it. The first molar has infection around the MB root. Whether or not it is symptomatic that must be addressed for your implant in the second molar to be successful. You know your options for that. Good luck.

Brian

09/11/2018

Thank you Tim and Gregory for your comments. The root canal on the molar was done only a month or two before the film that you are looking at, so the lesion should be resolving. There are no sinus symptoms, and while there is also no crestal bone loss, my concern is that only about 50 or 60% of the surface area of the implant appears to be in contact with bone. The implant was placed to 70 Ncm, and on an average patient I wouldn't be as concerned. But this patient has fractured multiple molars, and I would love to be able to add bone around the implant. I just have never heard of anyone doing a sinus lift and lifting the membrane off of an implant. Have you?

Benjamin

09/12/2018

Brian, I would second Tim and Greg's recommendations (watch to ensure that the first molar does stay the course with the lesion resolving). I would recommend NOT trying to add bone around the implant. 1) You should confirm that you do infact have a pnematized sinus around that implant with a CBCT. often times you may actually just have lack of density due to the sinus being dropped on either side not unlike when a palatal root looks like its "in the sinus". 2) "one often meets their destiny when they're on the road they took to avoid it" --> its well documented that force on the implants is caried at the crestal 1/2 of the implant, and little/no force is concentrated at the end you are concerned with. IF the membrane is laying ontop of a sharp, rough implant you are much more likely to tear it and cause a problem then "letting sleeping dogs lie". Just my $0.02

Timothy Hacker, DDS, FAAI

09/12/2018

Ok, watch the lesion on the molar root. I'm not convinced that the diffuse lesion will not eventually be problematic. It has that, "I'm as bad as hemorrhoids" look, you know, it goes away for awhile but always keeps on coming back to bother you at the most inconvenient time. Adding bone to the apex of your implant will not improve the prognosis and may introduce pathogens into the sinus....don't bother it. You can mitigate the forces on your implant by ensuring no off axial interferences and a narrow occlusal table. Make a good mesial contact for no food impaction, in other words, use prudent design principles for longevity and you cover your bases. Good luck.

oralsurgeryjj

09/19/2018

If the blah-blah blasted surface of the implant is meeting with more than 4 milimeters of bone, there will be no problem in proper loading, but if the implant has machined surface on top and you happened to submerge the implant, chance is high that it will plunge into ocean of hollow sinus. So, ITI type implant? Re try......T.T Internal submerged type implant? Check out with CBCT.

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