Not exactly the most ideal immediate case. No a lot of native bone past the socket. This patient had lost #13 so I utilized the bone and planned for an internal sinus lift positioning the implant right at the floor and planned to lift the membrane up with the implant. I knew I would not have the lateral stability for the expanders.
Extracted #12 while the Guide was fabricated:
Through the series of Implant Direct Drills, this is the Nobel Replace Straight Sirona Key kit. Drilled up to the sinus floor. Could feel membrane but not very thick so no graft ahead of the implant.
In the implant went. The plan had the implant crestal as I wanted the drill to stop at the membrane, but in the end we want to be 2-3mm sub “socket” in an immediate:
Implant placed. Note the angulation in the plan to take advantage of the bone is the former #13 spot:
Implant placed. Note the socket is mainly on the mesial. Placed DirectGen MFDBA graft and a little membrane over it. I did not love the fact that I had such a large Gap distance even though I had 35Ncm of torque so I placed a cover screw/healing collar and sutured over in a two stage surgical approach.