Implant Protrudes into Maxillary Sinus: How To Manage?

Hi How long ago was the implant placed? Was there a bone graft placed at the time of implant placement? Is the implant devoid of bone in the area that protrudes into the sinus or is there a thin layer of bone on the area. If a graft was done was it mineralized bone or a demineralized matrix that was placed which would not show up in the radiograph? Is there frank suppuration? Has the dentist been advised of the problem? What is he/she suggesting to do at this point? Best Sheldon Lerner

If 10mm of implant is in sinus,obviously dentist did a sinus floor lift.And obviously 10mm of lift does require some kind of bone graft. there is a chance that during manipulation of membrane some particles of graft might have become loose and bocked the meatus. First thing you should do is to check the patancey of meatus. If ihis is a first episode, may be it will be treated with antibioic and /or sinus lavage. If is a chronic problem caused by an implant itself and does not resolve with your ENT treatment, you may have to remove implant but then you have to deal with oroentral communication

Dentists should refrain from statements like "If 10mm of implant is in sinus,obviously dentist did a sinus floor lift.And obviously 10mm of lift does require some kind of bone graft."...if they have NOT seen the case data...the statement is just opinion NOT fact. I have read over 1600 scans from almost all dental CBCT machines...I have seen at least 12-15 implant fixtures in the submandibular space and in the antral space...These were all cases in which CBCT revealed the "true" position, "post placement"...I do not know what imaging modality was used in these cases for pre-surgical evaluation...but my educated guess would be that it was not CT, Cone Beam or otherwise...In my opinion, clincian's must move to CBCT for all implant procedures in potentially risky anatomic locations- the information is more precise and the dose is much less than conventional CT...and we should only use CBCT in my opinion...hope this helps everyone, and I'd love to see the DICOM 3 multiseries to evaluate the placement if appropriate...Dr. C.S. sorry about your mother's problem...I'm sure it will be resolved...Dale Mles

Mr. Miles otolaryngologist is asking "whether to remove implant or not?' That implies that implant is in right position placed by dentist. If it is not, then question does not arise whether to remove or not? If an implant has been slipped in to wrong place and causing problems,then it has to be removed and otolaryngologist know better about it than dentist.Protruding does not have to be necessarilly in wrong place.

Implant should be removed. Operator must be capable of Calwel Luc Lateral Sinus approach. This can be performed by most oral surgeons and periodontists and a selct few GPs. Anyone who cannot perform this procedure has no business getting near a sinus that needs elevation. Hopefully implant can be removed and sinus grfted simultaneously. Replacement implant should be delayed for 4-6 months after the sinus lift implant retrieval.

Sorry for the late response but the implant if causing a difference in air-fluid levels should be removed only if additional treatment by your speciality (ORL) doesn't resolve the situation, I mean drainage through antrostomy or intraoral (intraoral would have to be closed later on). I feel if the implant is osseointegrated n drainage can resolve the situation n this is thefirst episode then why remove.

Was a crown placed on the implant?Is it loose ?Is there an oral-antral fistula?Place a mouth mirror next to the impant and have your mom Valsalva.If it fogs up there's a fistula.

it does not seems to be a sinus elevation, but an error of implantation instead. therefore i will remove the implant, than a very good and long cleansing with an antibiotic like ceftriaxone (roche). last step, a very efficient closing of the dehiscence with fibrin pad in two or three layers. and it's all, almost for me.

I have a similar case like yours. Although, the ENT could not conclusively request us to remove the implant. I have prescribe her the sinus lavage and antibiotic. The implant successfully osseointegrated and the patient does not give me the opportunity to remove the implant unless I guarantee it will solve the problem.

I think 10mm cann,t happened by mistake at the same time if this was sinus augmentation procedure then there is high percentage that the fluid collection happened cos of obestruction of the sinus opning from the grafting material,then the sinus opning has to be cleared & keeping the implantas as long as it is a successful one, so the idea is to solve the cause of sinusitis,but removing the implant or not depened on it is success

Dr.C, If your mother were asymptomatic no treatment would be needed. Since that is not the case there are two options: cutting the implant or removing the implant. Since titanium is a relatively soft metal it is possible to cut the implant down to the level of the antrum floor via a lateral window approach. This would have to be done with copious irrigation to prevent overheating the implant and also leaving gross amounts if titanium filings in the antrum. I must admit I have never tried this approach and am skeptical of it. Thh other option is to NON-SUGICALLY remove the implant by simply unscrewing it. This requires having the correct armamentarium and not being afraid to apply 100-150ncm of force. This non-surgical approach will leave a much smaller defect and oral-antral communication than any surgical technique. How you then handle the communication is up to you. Cheek flap, palatal flap or conservative management via medication and time. I teach these techniques and would love to hear how this one turns out so I can pass it on to my students.

If there is that much of the implant in the sinus with no bone..then how long is the implant...and is it stable...and is it restored...if it is stable and restored and the crown to root ratio is acceptable...a caldwell - luc approach...cut off the implant to the sinus floor and cover the area with some collatape or collacote to prevent any fistula from occuring...if it is not restored, stable, and the crown to root ratio is ok..,.still caldwell - luc, cut it off and the same membrane as above...wait another 3-4 months to restore and re-check stability...if stable or not, and the crown to root ratio is wrong...it must be removed and do things the right way and start over after healing with a sinus augmentation and subsequent placement..anitbiotics of course and lavage of the sinus if you cut the implant..my choice of antibiotics would be Augmentum 500mg and Flagyl 500mg...no doubt there are some anaerobic bugs in there.

If I may offer my opinion, 1. As an ENT, I'm sure you have an OMFS colleague in your community. Have him or her take a look at it. 2. Also, as an ENT I have to acknowledge you know a LOT more about managing sinus infections than anyone offering opinions on this site. 3. Without knowing how long the implant has been in the maxilla, it is a little hard to say definitively how I would go forward, but here is my opinion: If there is no bone overlying the implant on the CT, then you need to assume the implant perforated the sinus and it is not doing your mother any good anyway. Take the implant out (NOT that hard or invasive in this situation), clear the infection with your choice of ABX ...I like Augmentin, but you can culture if needed, and close the fistula if it doesn't close spontaneously. A LOT of these will close spontaneously once the infection clears. If there is bone overlying the implant as a result of a sinus lift, and the implant has been in for a while, then you have to assume that the maxillary osteum has been obstructed at least partially. This could happen from bone migrating out of the original graft as has been previously suggested, but more likely from the osteum being small from the beginning and / or becoming obstructed when they elevated the floor. This is a concern in a sinus lift where the medial side of the maxillary sinus floor is elevated a lot (high enough to get to the maxillary osteum). If this is the case, and you want to keep the implant, I would try a round of ABX and decongestants to see if you can clear the obstruction and resulting infections. If that is not successful, consider establishing patency of the os with a FESS surgery. A nasal antrostomy is an option, but I don't know if I'd do that on my Mom. I had a hard time doing that one on the prisoners I saw in my residency...and they were murderers. In the end, if it needs to come out , then don't hesitate to get an Oral Surgeon buddy to take it out. A lot of the dentists or periodontists on this site are giving you advice based on the idea that you must keep that implant at all costs. In the end, it is not a kidney, it's a tooth (implant). I'm sure I'm going to catch flak for saying that on this website, but anyone who has not seen someone with a pansinusitis or had to consult on someone in the ICU for weeks on end from some raging infection from a seemingly innocuous source might not judge so quickly. Sir, I hope this helps. Please excuse my run on sentences, and let me know if I can help. Good luck with your mom.

Hello! I am placing this question here: I hope it is the right topic. IIn March, 2008, my left central maxillary incisor was extracted, the area debrided (the tooth spotted was blue and green), and a bone graft performed in preparation for the implant. In July, the implant was placed. As I recovered from the implantation, I started to experience discomfort along the left side of my nostril, but my surgeon and dentist said it could not be related to the incisor. I even went to an ENT who performed a CT scan, which revealed nothing. The prosthesis was placed in December, 2008, and from the moment it was put in, it caused me great discomfort. Again, both the surgeon and dentist suggested it would just take some getting used to. Over the weekend, I developed a very nasty boil inside my left nostril, the implant hurts, and I am deeply concerned that somehow, despite the reassurances of the surgeon and dentist, some infection did manage to escape the debridement. I saw my GP this morning. He put me on bactrim, and suggested I wait to see if that solves the boil-issue, but I also put in a call to the surgeon who had suggested weeks ago that a follow up was in order. Does anyone have any general thoughts about the possibility that the nasal boil and the extraction/implant right below it might be related? Thanks!

And one more detail: I have discovered a granuloma - I think that is the right word, on the inside of my upper lip, adjacent, again, to the implant site. I am seeing the oral surgeon Tuesday at 12:30!