Implant lost in sinus at uncovery: best options?

Refer to trusted omfs immediately Protect the patient and protect yourself The incident is defendable in the eyes of the law, Failure to recognise and properly refer a complication is not defendable.

Sb oms says it all , just curious how it happened , when you did the sinus lift a year ago was a lateral window or a crestal approach ? You would need to remove via lateral window or if the implant has drifted to the Ostium then an ENT can remove it via the nose . But ubless you are comfortable with these procedures as Sb oms said refer Peter

The implant did not osteointegrate hence you were able to push it into the sinus. Peter has a good point was it a crestal or lateral approach. Did you take n X-ray to see if had integrated prior to uncovering? In retrieving the implant it could be under the membrane or in the sinus proper. A Ct scan will locate it so that either an approach by an ENT thru the nose or an OMS via a Caudwell Luc can be done. It will eventually need to be removed. Most importantly fess up to your patient, do the right thing and advise him what happened. These things happen it is part of medicine. I think the nasal approach is probably less invasive, I would confer with my trusted ENT colleague or OMS colleague.

Due to gravity the implant will be laying on the floor of the sinus with the patient upright. But also due to gravity you will need to remove it with the patient in the upright position. If you have a ct scan done outside the office the implant will likely be in a different position when you do your surgery. Take a periapical with the patient in an upright position as possible for your surgery and do not move the patient so the implant stays in place. Do a lateral wall and remove the implant. No need to be concerned about the sinus membrane but cover the osteotomy to prevent an oral antral fistula. The sinus is just a big hole and the safest place in the body to do surgery. Greg Steiner Steiner Laboratories

Actually that's not exactly true, the implant will adhere to the membrane it just doesn't roll around according to gravity. If there is any inflammation or hematoma the implant will adhere to it and it may even be under the membrane and not easily visualized from entering the sinus laterally. If this happens in the chair, yes immediately retrieval can be attempted my rule of thumb is if I can visualize it I will remove it immediately, you need a fiber optic light, headlight to shine in there to see it. Sometimes irrigation and good suction will also work. But I am assuming since you posted this the patient has gone home and probably slept in the same position as he would in a CT machine you won't be faulted for appropriate referral and I would not attempt this without a good panorex or even better a CT. Also bear in mind that their is an abundant blood supply in the walls of the sinus so you need to know where the implant is nd be able to manage hemorrhage. I suggest referral to more experienced hands. Good Luck!

I agree CRS again , it depends on the length of time after the "accident" as to the position and the congestive state of the sinus. The action of the cilliated epithelium can move even an implant to the Ostium .I have seen a case of an Ankylos with the carrier attached blocking the ostium , which was removed by an ENT through the nose. As I said before we have removed Implants through a lateral window and placed another Implant at the same time grafting directly onto the Implant through the window using materials that set. The lining then heals over the material , no pain the following day and a new Implant is already in place to be loaded in 4 months . Do not do this without a bit of experience . Peter

In the two cases where I removed implants from the sinus there was also a significant oral antral fistula in the area of the implant placement. In these cases due to the opening of the sinus into the oral cavity there was excellent drainage and no congestion. The implant moved every time I moved the patients head. If there is congestion I agree with CRS and Peter that implant movement will be less of a problem. Greg Steiner Steiner Laboratories

The first time a dentist has this unfortunate incident happen is a real shocker, and the patient should be informed and reassured that this is a harmless event.... but have no fear, it does happen more often than you think, and is not that uncommon these days with dental implantologists trying to replace missing posterior upper teeth into poor quality and reduced edentulous alveolar bone. Unlike an infected root of a tooth that could cause a health problem, the dental implant was placed in the bone under sterile conditions, and can stay in the sinus indefinitely....even if it is floating around...it is perfectly harmless, and does not have to be removed except if it blocks the Ostium..... and at the point an ENT can remove it through the nose. Over the years, I have had this happen in my practice about six times; and on one occasion the patient who lived in another city, called to tell me that he thinks he broke off part of a crown that was placed years ago, and sent me the piece that he found in his mouth...... he coughed up the implant....it went from the sinus through the ostium to the back of his throat and into his mouth.........unfortunately this patient was in the midst of terminal pancreatic cancer and was not able to come in for a panorex film to show that it had worked itself out. We have other patients with "sinus floaters", who have had further grafting, and eventual successful implants, and their panorex films always draw attention...but they are fine..... So in my opinion, removal can be done by either an ENT atraumatically under general anaesthesia or through the lateral wall of the sinus.... but it is really not necessary to put the patient through the added stress of a surgical procedure . Gerald Rudick dds Montreal, Canada Assoc Fellow AAID, Fellow, Diplomate, Masters Prosthodontics ICOI

I had this exact thing happen 24 years ago. It was one of my early implants and back in the day we used press fit implants so this happened more often than these days. It was simple enough to create a Caldwell Luc acess and remove the implant. After that we went back redid the sinus lift and 5 months later replaced the implant. As said before this is a legit surgical failure and the main goal is dont make things worse. Find the appropriate specialist to help you out and move forward from there.