Implant displaces into sinus: best line of treatment?

It depends on the location of the implant in the sinus. You need a CT to determine this. A trans-nasal approach is out of your field of practice and should be handled by an ENT. A lateral window is the preferred intraoral approach.

I agree with Dr Boudet. It sounds like you haven't done a lateral window sinus graft, so I would recommend you refer the patient to an OMFS or someone else that is very comfortable with implant removal. As your experience level grows, it is better to have alot of training in a new area and then move into it slowly. That way you have fewer mistakes to correct, and your growth momentum is sustained.

Do you have any imaging on this case?

It is a question frequently asked in Boards . I am unable to choose the best answer . According to what I have gathered , it should be removed at any cost . However if the situation calls for a later removal prescribing antibiotics is recommended ( fear of sinusitis ) Let us discuss doctors Thanks in advance

Ct scan, anti-biotics, refer to OS, with lateral window access, to remove implant from sinus - it is usually not a very difficult procedure.

In my 52 years of practicing dentistry, I have had five such occurances…. a dental implant placed under sterile conditions is not an infected natural tooth.I have not done anything, just left them in place, take occasional panorex films over the years, and watch them move around like a silent ship...in one case, the patient called me years later to say that he coughed something out...and sent me the implant with a healing collar on it......this patient lived in another city, and when he did come to see me, he was not well enough to walk down to the floor below where our panorex machine is....so I do not have the xray, and sadly he passed away...... they are harmless, and perhaps more harm may be done by re-entering the sinus to fish them out....leave it alone....

I would suggest that there is probably only 1 correct answer. However it depends on the circumstances. So prescribe antibiotics and observe (and take another CT scan) would be the preferred option. I would add 2 more possible options. • Refer to an appropriate specialist (if the practitioner has no experience with sinus operations or if the implant is in a difficult position) • Open sinus via lateral window and remove implant. I consider doing nothing is not reasonable and would increase the chance of a negligence claim if something went wrong over time. A trans crestal approach may be appropriate but I think in most cases would make an easy corrective procedure much harder (but it depends on the situation). Similarly a trans nasal approach seems a difficult way to go, unless there is some reason we are not aware of – obviously we do not have a history or enough information to make a fully informed decision.

It needs to be removed. In a rare occurrence the patient could manage to aspirate the implant into a bronchiole which could have a devastating outcome. In the age of short implants and crestal sinus augmentation this has become more common to see. I remove about one implant from a sinus a week. All of them are referred by outside GP’s who are pushing the envelope of good practice. Most often they are first molar immediate implants. My advice is refer it to a local OMFS and let them make the call on how to remove. Most often it is by a Caldwell Luc approach.

Dr G is correct. I’ve had this happen three times. Make a lateral window, violating the sinus and remove with the surgical suction tip. Place a collagen membrane, close. Revisit at a later date. Antibiotic coverage is useful. If you leave the implant, the patient could aspirate (it will dump into the nasal cavity). It only takes a few minutes to remove.

?n any condition find out the place of the implant by a radiologic method and then try a lateral window but never ever keep it in the sinus.?n case the patient may have a cardiac battery or a femur implant in the years to come the untouched implant may cause bigger complications. Good luck

Tips and pearls for removing implant.....is.... 0. Check if the membrane is thin and uninfected, if the sinus is swollen with sinusitis, it will be hind and seek without vision. Refer to OMFS when the sinus is already infected state. 1. Make a large wall on crestal or laterally. The membrane is already damaged state with the implant..... Dont bother messing up the membrane. Make it fast and not to mess up PSAN or arterioles. 2. Insert suction tip to the deepest bottom, that will sometimes carry the fixture with vacuum power. Never irrigate the sinus in the position, that will make the patient in panic, since all the saline will drain into nasal cavity and that will make the patient hard to breathe. 3. If it fails, quickly lift the patient on sitting position and wish your luck with gravity. Flush the sinus with saline in order to float the fixture and drain to the window.