Possibility of Lateral sinus lift for implant placement?

What is your plan to remove the displaced implant? Lateral sinus lifting can be done with thickened Schneiderian membranes, but one of the goals should be to simultaneously remove the implant, as it may be contributing to the situation. If you are not comfortable retrieving the implant through the lateral window and dissected membrane, please refer the case to someone who can.

Remove the implant. There was not enough bone to initially place the implant! Yes a lateral sinus graft is in order.

A lateral approach should be done to remove the implant so it does not displace into a deeper inaccessible area. At that time a SFE can be done.

Hopefully the displaced implant won't migrate into the osteum. I think this should be treated by an ENT colleague with a scope. You're in way over your head. Sorry.

I must issue a severe word of caution. From the radiograph you presented this appears to be an extreme case of loss of bony ridge and exaggerated nasal and sinus spaces. Without more details I cannot be definite, but it seems to me that this case will require much more than a sinus lift. I would guess a block graft may be required as well. Mostly certainly I have no hesitation in saying you should get a specialist opinion and preferably get the surgery done by a very experienced surgeon. Presumably this would be an OroMax surgeon but perhaps an ENT surgeon might be consulted. I would expect that a surgeon will adamantly want to remove the misplaced implant and possibly strip at least some of the lining. I would think it silly to suggest that the misplaced implant has not had some influence on the mucosal thickening. Certainly it is not worth the risk (if surgery is to proceed) to leave the implant in the sinus. I wonder if you were the surgeon who placed the implant in the sinus? Here is what worries me most. I wonder why you are asking questions about this? Are you considering doing this surgery yourself and if so why? I would guess that this patient is reasonably old, and I wonder if she is medically compromised? I am wondering why you are not referring this case to a specialist and I am very concerned you may not have experience in this type of case? My sincere suggestion is that this is a complicated case with the potential to go badly wrong if you are not experienced. Thus I recommend you refer this to a well experienced specialist surgeon, and I suspect even they will have some concerns over how to best proceed. I do not mean to be disrespectful and I encourage you to do implant surgery. However I strongly feel this is not a case for the inexperienced.

The implant was a failure before it was ever placed. It never had a chance. I am guessing forces of mastication delivered it to the sinus. No oral antral opening? Looks to me like the other two will fail also. Do yourself, the patient, and dentistry a favor and get them too someone that can help them. I don't think this is a GP implant case. Good Luck

Great case to refer to our trained colleagues the specialist or experienced (diplomat) clinicians some of whom are seasoned teachers and comfortable in treating the patient. Think of how much you can learn from this case ? just by observing the surgeon/diplomat and picking his brains. Usually they will gladly have you in the operators room , if you are keen to learn and the patient will be so impressed by your caring nature. The specialist is our best friend and remember to treat this individual like it was your own family I would want the best person in my town to remove the implant. I agree, yes, we can all make a lateral window, retrieve the implant , if it in a fixed position, revisit , lateral window ,...augment, and place fixtures. But I would argue how many of these have we done?? and how many of these are we going to get in the future.?? And as learned advisors like Dr Dale and others have stated , suppose if an unforeseen complication occurs here ? ,how will you defend yourself in court? in terms of Credentialing ?qualifications to take on this case. So why not refer to the trained specialist /diplomat doctor and learn from this case . Surely, my friend, you will get his respect, the patients respect , possibly more referrals from the patient and surgeon and the knowledge of seeing this case being treated properly till the end ! Thank you for posting the case . it’s not that the surgeon is smarter then us , but they are intensely trained to solve these types of issues during their education and leaning on them for help is so wise.

I would refer patient to ORL specialist for endoscopic implant removal first.. After a month I would do another CBCT and if there is a significant shrinckage of the sinus membrane I would do the lateral sinus lift. The underwater rocks are the other two implants in there though. Need more slices and more "shots" to evaluate that one.

Have your friendly neighborhood ENT or OMFS remove the implant and deal with the potential sinusitis then proceed if you are qualified or refer and scrub in if you are not. Less problems that way.

I had an implant get in the sinus. Told the patient it was my error and apologized for her inconvenience . Did a lateral window and grabbed the implant with a cotton plier. The damn thing popped out of the pliers. It when distally to the point I could no longer see it. Long story short, my good friend a dual degree ENT /dentist removed it for me. You should be good friends with all of your referral people. He used his scope and said it wasn't an easy one. Anyway,I post this because maybe some else will be smarter than me and use a suction tip or a more secure instrument to remove it with should they attempt removal.. I still see the patient and she kids me about it. Oh yes I got too pay the fee. Lesson learned.

I really really appreciate your most precious opinions from all of you.I attached a mail below from a colleague I referred this patient to.I wonder how much correct the comment is.(should she remove sinus tissue first?) "I am sorry that I could not help you in this case. I perform regularly sinus graft surgery and normally thickened sinus soft tissue is not a problem if it does not fill more than a third of the maxillary sinus volume. In this case the sinus is filled by nearly 90%, that makes it difficult or impossible to lift the soft tissue in order to augment the sinus. Also the failed implant is likely imbedded in the soft tissue. I spoke to Dr Teoh and 2 other colleagues and all three suggested removal of implant and sinus soft tissue and then after 4 months healing to plan augmenting the sinus. Removal of sinus soft tissue and clearing maxillary sinus is not within my clinical skills, this should be performed by maxfacs or oral surgeon. You should receive the CD by tomorrow. Keep me update Dear Scot Thank you for your email. I consulted a specialist oral surgeon regarding this issue and he saw the CBCT scan too. He said that the displaced implant and the thickened lainis soft tissue need to be removed, and probably UR4-5 if they are not osteointegrated. The challenging part is to anaesthetise the patient as the procedure would be very painful. This should either be done under IV sedation or infraorbital block anaesthesia. However sinus graft is not possible at the same appointment. After healing period, sinus graft surgery then can be planned. The oral surgeon is able and to do that. If you want I can pass his details to you to contact him.

Your CBCT views show: a) Hugely overpneumatised antra bilaterally with eggshell thin bony antral floors. There are 2 dehiscences in the right antral floor. b) The small image in the bottom right hand corner appears to show a coronal view of the R antrum almost completely obliterated with mucopolypoid mucosa. The ostiomeatal complex is not seen but the antral ostium is almost certainly blocked. There is no way of knowing whether this is a pansinusitis as the ethmoids, nasal cavity, etc are not shown c) There is a displaced implant lying against the medial wall of the right antrum, floating in polypoid mucosa. d) The implants at UR5,4 appear to have minimal bony coverage and I would hesitate to load the UR5 fixture. e) The upper left implant retained bridge looks extremely doubtful with almost no bony coverage of either fixture. I am surprised the patient has no history of sinonasal disease. I would definitely pass it on to an ENT trained maxfac surgeon. There are plenty in the UK but I suspect they are thin on the ground in the US. a) If your patient is definitely symptom free a policy of masterly inactivity may be the best option. b) If he/she has symptoms he/she will need a trans-oral antrostomy, clearance of the infected polypoid mucosa and the displaced implant, and a transantral inferior meatal nasal antrostomy. c) Avoid any more implant work until everything has settled down. Then maybe zygomatic implants? Frankly this is a mess. It has all the ingredients for a medicolegal negligence claim, and is certainly not a case for even a reasonably experienced implant dentist to undertake in a dental surgery.