I am planning on clearing the upper dentition and placing 4 implants (laterals and angled 4's). We will load immediately with CUD on locators on the 4 implants so long as they torque out.  The Final prosthesis will be a fixed hybrid. The alveloplasty will be 5mm across the anterior and blend into the posterior. The patients opposing dentition is natural.

My concern is the ability to graft the sinuses with the direct lateral approach.

I am placing the 4s on an angle just in case I have a problem grafting the sinuses and hence placing implants in the 6 position.

My issue is mainly the left side where there appears to be pretty severe sinus disease and the patient is otherwise healthy with no meds but does suffer from chronic sinusitis and post nasal drip even when laying back in the dental chair.

The OMC does not appear to be patent on either side on the CT.

My questions are:

1. The 25 appears to be in the sinus, how much of this sinus disease can be caused by the 25 if at all. In other words would removing the teeth help clear up the sinus.

2. If it is primarily a sinus issue should I also remove all teeth and place 4 implants to ensure I have no sinus exposures, as I dont want to perform bilateral grafts and have an oral/antral communication from extraction sockets (both 7's and the 25 potentially) and complicate matters

3.Once everything is healed if the sinus disease still exists is this a case I should refer? I know the Schnederian membrane can be quite friable.

****Picture 3 shows 25 cross section, pictures 4,5,6,7,8,9 show implants cross sections from left to right

A little guidance here please.

Thanks

Chad