🌱 Spring, mistakes, and redemption — an implant that insisted on teaching

“We don’t notice the moment we make the wrong decision — only the moment it comes back to teach us.”

Good morning everyone,

I’m here at the Olivais field in Moscavide, ready to watch the big Palmense vs Olivais derby — with Henrique playing.

First day of spring, March 21st. It’s still raining a bit… but you can feel the sun is coming. It’s going to be a great day.

And maybe that’s exactly it:

spring doesn’t start when the weather changes — it starts when we learn.

🧠

A difficult week… and an even more difficult case

This week wasn’t easy too many surgeries the clinic isn’t finished and we are build the post graduation course with Margarida and Joao afonso

But Friday brought one of those cases that reminds us why we do this — and more importantly, how we fail.

It was the last case of the day after we had the oportunity to do a big graft n the anterior maxilla of a very well know politician !

Mrs. Silvina. Long-time patient. Several implants already placed.

But a couple of month ago Tooth 26 fractured. She came and we did a very nice treatment plan !

Plan:

Extraction + immediate implant in what looked like a good septum an anatomical healing abutment and that’s it case closed !!

I placed a Tissue Level 3.75 x 6 mm implant in the septum.

Surgery went well. Healing seemed perfect.

And then… the sequence began.

⚠️

Mistake #1 — timing changes everything (almost seems a bob dylan song !!)

The appointment was scheduled 6 weeks later. (WTF ???)

I walk into the room, unaware of that detail.

I unscrew the healing abutment…

👉 …and the implant comes out with it.

That moment of silence. That feeling of:

“damn… what now?” I reinserted the implant.

👉 Mistake #1. 🔁

Persistence… or stubbornness?

Two weeks later:

The implant… gone. “ hello Dr chen is think my implant is fine !! I don’t feel nothing !! Panoramic xray and bang …. No implant !!

We waited. Reassessed.

After 3 month We had around 5 mm → decision:

👉 New 6 mm implant, slightly engaging the sinus

Three weeks later:

👉 Failed again : “ Dr chen my implant fell …. “

We waited 2 more month and we did a Third attempt:

👉 More mesial anchorage, above the premolar root

👉 3.5 x 6 mm blx

👉 Good primary stability yesssss we made it !!

One week later…

👉 Failed again : Dr chen I think the implant came out again ….

⚖️

The decision we were avoiding

And here comes the interesting part.

We finally did what we had been trying to avoid:

👉 Sinus lift — lateral window, by the book

No shortcuts. No rushing. No ego.

🔬

And this is where biology speaks

Yesterday I went back to the case after 6 month

And there are moments when the radiograph almost speaks to you.

👉 Regenerated bone

👉 Consistent volume

👉 And most importantly:

Vital bone in the apical sinus area

This is not just graft.

This is functional biology.

I placed:

👉 Implant 4.5 x 11.5 mm (Biomet 3I)

👉 Good stability (ISQ ~50)

👉 Now we wait 2 months for osseointegration

And honestly?

👉 A 17 mm implant would probably fit so much was the bone …. But I heard a joke saying …. Let’s see if this stay Dr chen ……

🧩

Reflection — technique vs shortcuts

This case makes one thing very clear:

Everybody makes bad decisions …. Not because you don’t know but because sometimes the easyest technique is not the best for some patients

Control you’re shitty decisions by controlling the patient , always explain what you are aiming to do , and you will be fine !!

👉 A lateral window sinus lift is not comparable to osteotomes.

Why?

• We elevate the medial wall

• We preserve true blood supply

• We create a real regenerative environment

• We increase the % of vital bone-to-implant contact

👉 And that changes everything.

💭

The hard part to admit

All the initial decisions…

👉 Felt right at the time.

And this is the key point:

We don’t fail because we are careless.

We fail because we are convinced.

But surgery — and biology — don’t forgive prolonged shortcuts.

🌱

Clinical spring

Today spring begins.

And interestingly…

this case reminded me of something simple:

👉 Growth is uncomfortable

👉 Growth sometimes costs implants

But if we learn…

👉 then it wasn’t failure. It was evolution.

Anyway great sinus thow….

Spring is coming.

All the best,

André