Implant Lost in Sinus: What to Do?

Ask the ENT-spec. to take it out with a scope.

You can wait a few weeks, order a CBCT scan, locate its exact location and go in with a caldwell luc. Good luck.

Of course a caldwell luc is less invasive :) (...not)

something similar has happened to me except it was a MB root tip. open the window just like doing the lateral sinus lift, except you are tearing the membrane on purpose. visualize the implant and suction it out with surgical suction tip.

In the future, consider immediate emergent referral to an Oral and Maxillofacial surgeon for a "no charge" retrieval under sedation. (Assuming you have a History or relationship with one.) They are trained and experienced with handling complications such as these and they may not throw you under the bus the way and ENT surgeon may.

You should send the patient for a CT scan in order to locate the position and location of the Implant.Open up a window,make an opening through the membrane and dig out the implant. Good luck

Have the patient sniff in some pepper or real snuff. They should sneeze and the implant will probably fly out. Have them sneeze with their mouth closed. This is not a joke and is a non-invasive technique. The purpose of a sneeze is to clear the sinus of any foreign matter.

Alvin - Not sure of the snuff suggestion!! Have you used this technique successfully yourself? Ziv - If you take a CBCT with the patient erect and then operate with them supine, will the implant not have moved? - it is, (initially at least), freely moving within the sinus. The same is true if they lie down for a CT scan and then stand upright from the scanner. I fully accept that after a few ?days/?weeks the implant MAY become fixed in position by ?scar tissue - but this would not be the case initially. Kind Regards, Bill Schaeffer

Check with your local Thoracic Surgeon. He will tell you that if you can't place a chest tube, don't crack the chest. Take away. If you can't deal with the potential complication, don't do the procedure. There must not be a OMS in the clinic or this question would not be raised. I agree with Empirical Medicine's recommendation. Better yet, start with having a surgeon do the procedure.

Every thread always has the specialist lecturing down to the GP; enuff already

Are you CERTAIN it is IN the sinus and not trapped beneath the membrane? That would be less invasive, plus, you could do a bone graft after retreiving the implant and go back in later with cconfidence you will have adequate bone there. Just a thought. Get a CT to positively locate it. A Sinus instrumentation kit should have the instrument to retreive it. Get one from Salvin. Good luck. Bill

Dr Cheever, Perhaps the surgeons have had "enuff" of the patients and treads where a clearly under prepared dentists do procedures they have no business doing on real people. Dr. N is clearly doing his best and a single maxillary implant is well within the perview of his training(I Hope!) Seeking help is the correct thing to do. However, if he or she regularly worked with an OMFS, this problem could have been resolved that day. Note that I did not tell Dr. N not to do the implant, but is it lecturing to ask that Dr. N make a timely referral for a complication. Is it wrong to even expect that Dr. N. knows who to refer that patient to? If Dr. N follows the initial advice, the ENT surgeon will likely blow the dentist away and another baseless law suite may be hatched. Also, an antral retrieval by an ENT Surgeon may prove problematic due to the size of the implant. Oral Surgeons are used to dealing with implant "complications" and making it all better for the GP. Now for a lecture (Dr Cheever Only): IF YOU CAN'T FIX THE ONE THAT GOES WRONG, YOU HAVE NO BUSINESS DOING THE 99 THAT GO EASY! If it is lecturing when you try to protect people.... I'M GUILTY!

Dr. N.....fret not. You are not the first implantologist to have had this happen, nor will you be the last. A dental implant is not an infected root..... it was put in under sterile conditions and is really of no consequence. Years ago, it was unthinkable to go anywhere near the sinus, but Dr. O'Hilt Tatum changed this for all of us. Since it was an orthodontic implant, it is much smaller than a conventional dental implant. I have had this situation occur with three different patients. The first time it happened, I took the patient to the ENT department and spoke to a medical specialist who told me that he can take it out with his equipment going through the nose......but wait and see. The wait and see was 20 years ago; the site of the lost unstable implant was grafted, and a new implant placed months later, and has been a well anchored fixture for all this time. It is harmless, and will not affect the patient's health in any way...I joke with the patients' who have had this experience and tell them they may never be able to board an aircraft again....because they will fail the metal detector test. All three patients are doing fine, and I have had no legal problems...it is a procedural error of sorts, and the dentist is not at fault...if you need an expert witness....call me, and I'll have my patients act as witnesses for you. Gerald Rudick DDS MOntreal

i compeletly agree Gerald . it is better wait and see the outcome . in my experiance ,also, there is not anything to worry , and you can leave the implant in sinus , and after some month try another one at the same place , ofcoures , now you may need bone graft or may not . good luck

I completely agreee with Gerald Rudick. This is an "accident" that may happen to everyone and I think that an intervention for a sterile implant retrieval in case like this will do more harm, than help.

Open the sinus by way of a sterile technique and remove with a surgical suction. Close, perscribe proper antibiotics, steroids, decongestants amd pain meds. Place a collagen barrier membrane, then close. You can re-enter in about 6 to 8 wks when the sinus membrane regenerates. Keep an eye on this pt.

Read this thread and thought good it has not happened to me since I started in 91. Then yesterday it happened to my initial horror. Told the patient, then opened a lateral window and could see the hole in the lining where the implant had gone through , it was strange then having to destroy the rest of the lining to have better access. Then used a suction as described here and after a bit of manipulation got the implant out...bit of a day.

I see only two options over the case.First,refer the patient to an oral and maxillofacial surgeon to open the sinus and get the fixture out,or (second),have him sniff and sneeze (c'est incroyable!!!).

Well guys...Just came from the office.A patient was referred with an implant that was pushed into the sinus....It happened two days ago. I've sent the patient for a CT verifying where the implant's position.Opened up the sinus and suctioned the implant out.

I can tell you about three cases: 1.- Patient refered with a large calcitec press-fit implant in the sinus (1998). I prescribed a panoramic x-ray and made a clasical caldwell-Luc approach raised the shneiderian membrane later I made an incision in the membrane and with the patients head in an elevated position I took the implant out with a fine suction tip profuse irrigation and an angulated forceps. In the same surgery I stabilized the membrane, placed a colagen membrane and grafted the floor of the sinus. Unevenfull healing and one year later placed a new implant. 2.- A coleague of mine called me telling me he pushed an implant into the sinus(1999). He opened a small window and was looking for the implant but could not find it. The panorex showed the implant was trapped in the upper posterior angle of the sinus close to the orbit floor. I adviced him to enlarge the sinus window, to have the patient seated and to slightly tap the patients head every once in a while. after that he did a new panorex confirming that the implant came off and lied in a lower position where the implant could be easily and safely removed. 3.- Patient refered with a 7mm. long branemark tipe implant in the sinus(2003). I made a panorex and schedullled an apointment in about one week to remove the implant. Patient came to the office three days later with the implant in his hand telling me it came out thru his nose... I had also removed quite a few roots from the sinus and many of them where trapped between the bone and the shneiderian membrane and not inside the sinus. Since your implant is a small orthodontic implant you must also consider this possibility.

I really like the tecnique proposed from Dr Artz. I would like to know how many cases did he treat and which positive relults percentage did he get. I removed 3 implants and 1 third superior molar by opening one lateral window and removing the item with a suction. the final risult was good in all the 4 cases but in lastest one took me more time because the implant was suborbital, and the position was different from the x-ray of the previous day. I think this tecnique would be appropriated if we think to have a risk of bacterical contaminations leaded by and during the surgery. concerning the extraction of the third molar there is an easier possibility of contamination. for what i read so far in this site, I will let sneeze the patient leaving the implant in the sinius site only if i am sure about its sterility. if the patient attitude is not that good, i will think to send him to some very friendly nose hear-throath specialist. thank you for your wonderful web site.

Dont u ever take CT scans with no reason!Its the definition of malpractise.When u do the Caldwell-Luc, itll be easy to find it and suck it.

We as doctors do not always know what constitutes malpractice. It is a violation of the standard of care, with said particular situation. The lawyers are the ones that make the case for malpractice or not.

If you refer pt to an Oral and maxillofacial surgeon for a "NO CHARGE" recovery procedure, be sure and follow that up with a great gift certificate(American Express be my guest, ETC). The surgeon will more likely remember the entire event with a bit of pleasure rather than the awkwardness of the situation.

I wouldn't count on a sharp-tipped and deeply threaded orthodontic implant (TAD) moving from the maxillary sinus into the nasal passages and then out the nostril. The first ostium is quite small. I still wonder how an ortho implant made it INTO the sinus to begin with. Good luck.

I really can not understand how one would believe the oral cavity is an area that can be made sterile!All of the patients I treat have in their oral cavity, resident flora that includes some of the most dangerous bacteria around( go back to 1st year of dental school look at the pathogens found in periodontal pockets)Any naterial or instrument that transits thru this cavity is considered contaminated.The best one can acheive is a CLEAN case never STERILE.The basic are hard to remeber in the space age.I would not want to give any of those bacteria an opportunity to set up home in my sinus

it is nota big thing to remove it through Caldwell op. it is better to be done under local anaesthesia with patient in setting position.u can even ask the the pateint to move his head down,this of course work before any reaction & fibrous tissue formation

I think the sneezing part is not a joke. I actually have one colleague who does mini implants exclusively and he claims that it works most of the time. He also claimed to have left a couple of mini implants in the sinus without any complaints. Looking at the experiences of other practitioners, I think he may be telling the truth. I don't think a standard implant will find its own way out. There are arteries in the sinus membrane. So care must be taken if it needs to be cut. The process of sucking it out can be simple or complex depending on where the implant is lodged. An implant in the sinus is not an emergency, but some patients may not be able to sleep just thinking about it. I don't think I have any patients who would allow me to leave them in there.

Dr. Yee good points. Leaving the implants in the sinus is halfassed at best and is not the standard of care. Again minis have a limited use.

In the States, it's good practice to remove foreign bodies, especially when they're iatrogenically introduced. Removing it is not a big deal for experienced OMFS, but you do want to 1) inform the patient of the incident, 2) make the appropriate specialist referral, 3) and as said previously try to work with a doctor that won't throw you under the bus. In response to the standard of care issue as far a pre-operative imaging before retrieval, you do in fact want some films to 1) confirm the implant's presence, 2) localize the implant's position, 3) reduce the time and trauma needed to retrieve it by having the first two pieces of information. In my opinion, going in blindly with a radiographic survey would be BENEATH the standard of care. Best to all. Dr. R

correction to the above: going in blindly WITHOUT a radiographic survey would be BENEATH the standard of care.

I have had a few cases like this and it has been fairly straightforward to retreive With a pre op panoramic and a couple of gentle smacks around the head :) i have managed several without complication Intresting suggestions regarding the sneezing Where is the implant expected to come out ? Thru the ostium or thru the surgical approach ?

"Gentle smacks around the head." LOL.