Complications: Schneiderian membrane perforation + lack of buccal bone plate

A 60-year-old patient with no relevant medical history was referred to us for fixed rehabilitation based on dental implants in the second quadrant.
She presented a bone deficit in the left maxillary sinus as well as an internal reabsorption of tooth 25, for which we decided on the following treatment plan: extraction of tooth 25 and post-extraction implant in this position, and sinus lift with Cadwell-Luc access and immediate implant in position 26.
Two complications arose during the surgery: one was the lack of buccal bone plate on tooth 25, which we resolved by placing an implant with apical-palatine stability and performing a bone regeneration with autologous bone, fixing this bone with titanium mesh and osteosynthesis screws.

The second complication was a perforation of the Schneiderian membrane, which precluded continuation of the lift. To resolve a perforation, if it is small in size then normally it is sufficient to fold the membrane back on itself and place a collagen structure as a dressing, as it can be a membrane. In the case of large perforations, as with this surgery, what we did was to suture the perforated Schneiderian membrane to the maxilla by means of some small holes we made, which allowed us to retrieve the Valsalva.
We placed the implant in position 26, grafted the lift with autologous bone taken from tuberosity, and we closed the Cadwell-Luc with titanium mesh and osteosynthesis screws to prevent the extrusion of the material.
Below you can view photographs of the surgery.