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Palatal Sinus Tract Developing After Implant Placement: Thoughts?

Last Updated: Sep 14, 2009

Dr. A. asks:
I placed an immediate implant after extracting the maxillary left first premolar (#12), that had previously received root canal treatment. The tooth was asymptomatic prior to extraction, and there were no signs of infection clinically and radiographically. I prepared an osteotomy, prior to placing the implant, and I probed the osteotomy site to make sure all the walls were intact. I placed the implant, had excellent initial stability, cover screw, sutures,and so on. Everything went beautifully.

Patient called 4 days post-operative saying she has swelling. She came in the next day, and she presented with a palatal swelling with a sinus tract extending almost to the palatal suture. The swelling had decreased by the seventh day. I will see her next week, and if the palatal sinus tract has not resolved, I will flap to see where it directly is coming from.

My question is, I felt for the wall of my osteotomy and they were completely sold and intact, and I even had a look on the palatal side after implant placement, and no perforation seemed to be present. Can a palatal sinus tract develop so quickly after implant placement if a perforation did occur? Can it be something else? Can I do anything else other then taking the implant out, socket graft, and return at a later date?

7 Comments on Palatal Sinus Tract Developing After Implant Placement: Thoughts?

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tipo khan dds

9/15/2009

i would recommend waiting and not to do any thing ,it should resolve it self.

Dr G.

9/15/2009

Instead of flapping, did you try placing a gutta percha point, and see where the fistula is comming from?,It seems so early for fistula development, I would prescribe antibiotics, and see if it resolves under normal course.

Dr. Peter Domagala

9/15/2009

It maybe helpful to take a post treatment CT scan, do you work with any specialists that may have one in your area?

Jean Paul Demajo(Malta)

9/16/2009

I am having the same problem with a patient whom I placed the implant in a 21region. I perfomed an all-on-6 after 6-8wks of clearing the top teeth. Since the sinus appeared after 2wks I didn't want to remove the provisonal bridge and disturb the healing implant. So I left it, prescribed antibiotics and reviewed it again. Sinus still there. With GP it directs adjacent to implant. After removing the bridge and assessing possible mobility of the implant the implant was rigid. It could possibly be dead bone fragments in the osteotomy site causing this as in your case.

Bruce G Knecht

9/16/2009

It could be necrotic bone. I had this happen using a Pezosurgery device to remove a tooth and clean the socket. Be prepared to remove the implant if it does not get better and use a medrol dose pack. Teh bone sequella may pushout.

dobs OMFS

9/19/2009

If the tooth was assymptomatic and not infected, why was it removed? A palatal fistula is a signe of infection. It could be caused by necrotic bone, infected soft tissue or a failing implant. If te situation does not improve with conservative treatment then the palate needs to be explored and the cause of the problem sorted out.

dr.s

11/22/2009

it happened to me once i placed 4 implants for denture support maxilla, one presented exactly ad you described yours and i place the patient on antibiotics and the implant failed after 1 week of pain and swelling. The WEIRD THING IS the implant was 80% solid, so i thought it was gonna work. the 3 others are still doing great. so you may have to take it out!

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