Working With What God Gave Me: Difficult Post Sinus lift fully guided CEREC Guide 2/Interactive Case

I don’t do my own sinus lifts and this is a perfect case as to why I don’t.  Patient wanted 2 and 15 implants and just did not have the bone for it, so I sent him out to a very very accomplished surgeon for bilateral lifts.  Should be pretty straightforward right?

 

The right side turned out great, while the left, well we had issues. The patient developed a huge sinus infection  that would just not go away. I put him on augmentin, sent him back to the surgeon who put him on a few courses, then off to an ENT. long story short we lost most of the graft on the left. The patient was really adamant about not going through anything with his sinuses, and I suggested just living without #15, but he really wanted the tooth which is understandable with what he went through.  Still a lot of opacity in the sinus but no symptoms and his ENT gave the go ahead. I told the patient that the implant may not take and we were both willing to go for it. Obviously we have to go with a 3 by 13mm implant which certainly is not ideal, but sometimes you just have to work with what God gives you.

 

Planning and making the guides were easy enough.  As mentioned in my other cases CEREC Guide 2 is a single unit guide chair side, I could have sent out for a Digital Guide or a lab made CG2 but milled these out to a tune of about $110.

As always these fit great, my big issue will be getting all the way back with my long Implant Direct drills.

Used the Medium Guide sleeve on the right and a Small on the left. Fully guided interactive implants a 3.2 by 13 with a Nobel Conical NP mount on #15 and a 5 by 13 with an RP mount on the right.

#15 is certainly more distal than what I want, but thats where that last finger of bone was.  Its looks like we are close to the DB root of #3 but we are actually really far to the palate, again no ideal but was hurting for bone. Certainly up for suggestions on how you all would handle this.  Again, the patient was not having it when I told him to get another sinus lift and he and I are both on the same page if #15 fails.  Don’t know about you all, but I just either credit or refund the patient.