Despite best planning and implementation complications can happen during a procedure. The surgeon has to react flexible and prudential. Appl. Prof. Dr. Christian Mehl, Munich/Germany, shows his approach towards two incidences during the implantation of multiple post in an edentulous maxilla which was augmented before. An insertion of six implants in the maxilla is planned. Four months ago the jaw has been augmented with bone substitute.

The drilling template designed according to the wax up is inserted and the drilling positions are marked on the soft tissue. The bleeding points are connected by the cutting guide then. A full thickness flap is prepared and a free connective tissue graft is harvested to thicken the soft tissue. During this procedure and the final suction the A. palatina is injured. Initial haemostasis is done by an electrotome followed by a sling suture to compress the wound. By means of the drilling template the implant sockets are drilled.

The correct axis is of high importance here. While drilling Dr. Mehl has to realize the external sinus lift done before was not successfull. Although there is a higher risk of loosing the implant he repeats the sinus lift from the crestal side this time. With the osteotome the implant sockets are prepared. This procedure is a very loud one for the patient so he has to be informed prior to this. The implants are inserted then and the full lap is readapted.