This document summarizes several dental implant cases performed by Dr. Brian Lee. It describes 37 cases in detail, noting techniques used, challenges encountered, and lessons learned. Key points include: attempting various sinus lift approaches and recognizing when perforation occurs; emphasizing the importance of bone quality and grafting techniques for immediate placements; noting the risk of buccal plate perforation, especially in the maxilla; and emphasizing care when placing implants near the mental nerve or in furcation areas. The document serves as a reflective case log to help improve the doctor's skills and knowledge over time.

1. Dental
Implantology
brian lee dds

2. Case 0: My Very First Implant Case
No training
I saw.
I placed.
I prayed...

3. Case 1: F-71.6/6/14 My 1st Max Case
Sinus Lift 13-14-15 Lateral Window Approach
w/ Piezo-surgery (Silfradent)
No bone graft - CGF spacer only.

4. Case 1: 6 month-post minimal bone f

5. Case1: Completion.

6. Case 2: M-40-6/24/14 #195*10Smoker
Deeply Concern: Bone resorb. Smoker.
Overagulation. Should be wider &shorter
implant. Placed deeper. Possibly a 5*8.5

7. Case 3: F-59-6/27/14 14(4*10) 3(5*8.5) 4(4*10) 5(3.5*12)

8. Case 3: Completed. No comps so far

9. Case 3: Continued… Reasoning
A learning exp: Sinus lift attempted. Failed. perf. I failed on the lateral window attempt. Bone was thick.
In this case a 3D shot is necessary to see exactly how thick the window bone is. I tried crestal and
immediately could feel when I perfed into the sinus cavity. You lose all torque and can tell. Buccal on
#5 was exposed. Tx was continued with placement, due to patient desire to finish case. I placed CGF
in sinus. and also buccal grafted the #5 area. I was able to achieve 25-30N torque but I was
concerned for a myriad of factors. Not just osseointegration but sinus infection as well. I placed patient
on augmentin. She did not report any complications.
I realize that the sinus membrane is of epithelial origin thus heals rather quickly. And if you have
atleast 5mm of crestal bone from the sinus floor accd to Misch, you have fair chance of osseointg even
without bone grafting. It is when you place allo-material such as collagen mem or allograft that you exp
nonosseointeg and more importantly infection. This is where CGF comes into play. I do not believe in
placing foreign materials in sinus if all avoidable. The immune system will react ->inflammation
&infection- >kills osseointg. Obviously if there is <5mm of crestal bone from sinus floor you have no
choice but to cut a window and allograft the lifted site.

10. Case 5: F-1/11/53 #4 (5*10)
Be careful of M-D length. Encroach on adj.

11. Case 6:M-55-5/15/14 #19 (5*12)
Furcation is difficult. Place in MB root never D

12. Case 6: 10/16/14 No Osseointegration
Why did it fail?
Implant brand Cowell
no good?
Immediate Placement?
I originally placed in distal
canal then removed and
placed in mesial canal? multiple placements?

13. Case 6: Replace After 1 months

14. Case 7: F-55 6/3/14Immed #29 4.5x12
Straight to healing
abutment.
● Interestingly good
bone regen.
● Bone growth filled
socket site. No
graft. No loss.
● I belive healing
abutment helped.

15. Case 11: F-56. 10/8/14 #19 5x10
My first smooth case? Hopefully no lingual perf.
Fast and clean.
Near nerve.

16. Case 13: M-79- #19-(4.5*10)
● Make sure to
debride
● One of my
accurate
placements.
● Careful for lingual
concavity.

17. Case 16: Male - 72 . 9/9/14
Implant retained Overdenture - Maxillary
Placement easy. Pros-Hard. Find good lab.

18. Case 17:F-77.9/16/14 Immed#25 3.5
Ext. Immed placement. Temporized.
Be careful of buccal.
Really press on lingual.
Perfed.Had to graft.
First temporized case.
Use temp as healing abut.

19. Case 20: F- 83-10/1/14
#14 vert fract. Ext - immed placement ETIII
5*10mm.Difficult placement. Aimed for furc. Ended in MB
root. CGF + allograft.

20. Case 21:M-70-10/7/14
Immed Placement - Buccal Perf- Grafted defect. Mental Nerve Damage?
Only use torque wrench for immed placement. Be careful of buccal wall. Press
toward Lingual.
Immed placement requires force. Ur Fighting the canal. Follow canal and Fail.
Fight the Canal-blaze your own path- and win.

21. Case 22: F-74 10/13/14 #21 4.5*10
Immed placement w healing abut. I find that
placing healing abut same day if you have good
torque is the way to go. Reason: You don’t have
to lay a “tension-less” flap for primary closure. -
thus-less bone loss occurs. Bone loss occurs
with tension-heavy flaps.

22. Case 24: F #12 Immed Bone Density

23. Case 25. M-71 Locators MandDent
Locators on canines and 2nd premolars. 4x12 & 5x10

24. Case 25. M-71 Locators MandDent

25. CASE 26: IMMED MAX
I like to always place healing abutment. But if
site requires grafting then do not go to healing
abutment.
Cover primary w/
cover screw.

26. Case 27: 80 y Female. C-4 Bone Den
Piezo sawed off top 3-4mm. Torque <20N Porous Bone.

27. Case 28: #28 - Ext Immed Place

28. Case 31: Buccal Perf Max Fail

29. Case 31: Buccal Perf Max Fail
Be very careful for Max Buccal wall.
Clean extraction but look at how thin wall was on buccal root.
I placed implant atleast 2 mm from buccal wall and thought I grafted enough.
Was not enough. - Need to place a membrane.
Fistula had formed and enveloped the implant faster than bone could osseointegrate.
Luckily I went straight to healing abutment so we were able to catch this error early.
NOTE: MAX BONE HAS NO CORTIAL PLATE. SO RESORBPTION WILL OCCUR . MANDIBLE IS
OKAY DUE TO CORTICAL. MAX YOU MUST BE EXTRA PROTECTIVE.

30. Case 32, 33, 34, 35, 36, 37
gets routine after
Case #30