Implant in the sinus, removal and closure: recommendations?

Remove implant. Wait a few weeks. Let site heal. Then simultaneous sinus lift and graft the socket. Wait about six months. Place implant.

the width of the implant is narrow so I think you can counter rotate it out and then do a crestal lift then place a wider fixture and close with primary closure

Hi there, Take it out, clean it, wait for 3-4m, than place the bicon implant All the best,

PROCEED VERY CAUTIOUSLY...... THE IMPLANT IS NOT STABLE AND WHEN YOU ENGAGE THE HEALING COLLAR WITH YOUR SCREW DRIVER....THERE IS A GOOD CHANCE YOU WILL FORCE IT INTO THE SINUS........ ADVICE....BEFORE ENGAGING YOUR SCREW DRIVER, LASSOO THE IMPLANT WITH A PIECE OF DENTAL FLOSS, SO IN CASE IT MOVES, YOU CAN HOLD IT AND PREVENT IT FROM SLIPPING INTO THE SINUS. Once out, let the soft tissue close over, and wait about a month before going back and grafting......best to use a PRF membrane to line and cushion the sinus membrane before placing the particulate graft material.

What was the dentist hoping to achieve with this single implant? There are no natural teeth present. Was it intended to carry a locator for an overdenture? If so wouldn't it be possible to remove this implant - which appears to be a no-hoper in any case - and place a new fixture further mesially at the same time? This would avoid the need for sinus lifts and so forth. It's not really possible to formulate a treatment plan without more clinical information, a panoramic x-ray, photos, etc.

Previous dentist had hoped to do a FMR, i removed the implants on the other sides as they were all failing, Patient had very thin ridge, they were all placed too far facial. I plan do a bilateral sinus lift once this all heals. ( Ex dentist had taken "live" patient course overseas and was "ready" to full arch.

I would place patient on Augmentin 875 mg for 10 days. (Assuming not allergic to Pen/Amox). Take off cover screw and back out implant all the way out. Place resorbable membrane Cytoplast on superior, mesial and distal walls of sinus like an umbrella against sinus with mfdb allograft soaked in flagyl (assuming Pt not allergic). Make sure not to push bone into sinus. Gently place bone graft. Place non-resorbable Cytoplast Membrane over mfdba and suture with ptfe sutures (try to get primary closure). Place glue stich and make sure patient does not blow nose for 10 days.. Place of nasal steroid nasonex and Claritin d for10 days. I have done several of these with great success and be able to go back in 4 mo later and place new implant. I would agree though in this case move implant more mesially so no risk to already compromised site. Good luck and keep us updated.

Sorry David, but I fundamentally disagree with your treatment plan. All Dr Patel needs to do is remove the implant and pop in a stitch. The explantation site will heal in the same way as an extraction socket. A 10 day course of high dose Augmentin would be appropriate for the management of life threatening pneumonia but not for a failing dental implant the size of a small wood screw! This indiscriminate chucking about of antibiotics is wholly irresponsible. Intranasal steroids and antihistamine are unnecessary and there is no need to graft the socket - which is only about 3mm in diameter at it's widest point. It really worries me when I read some of the hugely complex treatments proposed for simple problems.

Wow, What a great opportunity to learn from the maesters. I will be seeing her tomorrow and will keep you guys posted. Thanks again for being an invisible mentors.....

David Please don't get me wrong, I'm not aiming my concerns at you alone but at the general tendency for this discussion site to overcomplicate what should be fairly simple surgery. With regard to your choice of antibiotic I suggest you should not be asking "Which antibiotic?" but "Do I need to prescribe an antibiotic at all?" If you're prescribing it as a surgical prophylactic you should also be asking "How long?" There is plenty of evidence that a single pre-operative dose and a single post-op dose is all that is necessary. With regard to the "best" antibiotic why not just give amoxicillin or perhaps co-amoxiclav. There's no evidence that azythromycin is more active against the common oral and respiratory pathogens (although if your patient also has chlamydia Zithromax would kill two birds with one stone!). There's not a lot to choose between the two with regard to side effects - amoxicillin has a higher incidence of rashes but azithromycin has a 12% minor side effect rate and about a 1% incidence of significant side effects such as jaundice, palpitations and chest pain. Azithromycin also has an increase in cardiovascular deaths , usually due to arrhythmias, compared with amoxil. As for cost you folks in the USA are always ripped off by the drug companies anyway. In the UK a 7 day course of amoxicillin 250mg costs 95p ( about $1.10) whereas a 4 capsule pack of azithromycin will set you back £9.64 (about $12). I know a zippy name like Zithromax Z-Pak sounds as though it must be doing you good but you don't want to believe everything the drug salesmen tell you.

Great advice on this thread. I would carefully remove the implant using Dr. Rudicks protocol then graft the sinus via the old osteotomy. Expect some graft material to enter the sinus. Wait 5 months for healing then place another fixture. I wider implant at time of removal will not work due to lack of bony support apically and distal (due to pneumatization of the sinus floor)

OK so the implant was intergrated rather nicely, I still removed it as there was a defect on the buccal. I curetted the area, placed an osteogen plug on the sinus perforation, secured with suture. Checked the patient for healing last week and everything is well so far.