Sinus Graft Augmentation

Your experience is one of the primary reasons for obtaining a maxillary CT scan prior to doing a subantral bone augmentation (sinus lift). Had you been aware in advance, you could have planned to refer to an ENT physician, or drain and displace the polyp. Prior knowledge of the purulent polyp could have alerted you to have instruments ready to evacuate/aspirate the purulence before it contaminated the surgical site. In addition you could have placed the patient on 24 hour pre-operative antibiotics which would have given a very good opportunity for the tissues to be well perfused with your antibiotic. In either case, if the site was well debrided and antibiotic coverage maintained, I would say that as long as purulence was never in contact with the graft itself and there aren't other perforations of the membrane, you have a good chance for success.

Dr. Neale,I agree with Gary. A pre-operative CT Scan or cone beam digital CT is critical for diagnosis of sinus anomalies, septum and pathology prior to sinus lift surgery. Most frank sinus infections would show up within two weeks of the procedure. If you are beyond that window the case should work out okay. A subclinical or localized infection might not be noticed immediately but would show up as a radiolucency in the sinus graft.

CT scan or cone beam is the standard of care these days. There's no reason not to have this diagnostic information before you do the procedure. This way you could take the necessary steps ahead of time(ENT consult etc.)I'd wait atleast 8 months before anything is placed.

Everything the others said about 3 dimensional radiographs is correct. You would have seen the lesion in advance and probably recognized it as a likely mucous retention cyst qs opposed to a polyp. The "suppuration" that you observed was in fact mucous and you could just flush with saline. You could also aspirate and drain at the time of surgery but it will probably reform. The cyst can be eliminated via marsupialization, removing about half of it but this may likely wind up as a perforation. If it fills less than 1/3 the volume of the sinus you could likely elevate it without blocking the osteum.

In general, I agree with the above mentioned tx, however, CT scans are not standard of care. They are certainly helpful and in some cases necessary. Standard of care implies that if not used, malpractice has been possible been committed. Just because a modality makes treatment easier or more predictable does not entitle it to being a "standard of practice". If so, one could argue all dentistry should be done through a microscope, using a headlamp, loops, etc., Should all extractions require a CT scan? In an era of increasing health care costs, decisions regarding proper care for individual patients should be left in the professional decisions of the provider. When we label things as "Standard of Care", it only gives ammunition to the ill intentioned and less informed. By the way, why not a referral to your friendly oral surgeon vs. the ENT?

Just to remind you that a head CT scan is equivalent to 2 mSv of radiation. That is about the quantity allowed in a year for an aerage adult.

Good panoramic views can shows big polyps and careful examination of the xrays anyway your polyp seems small careful of the membrane. it often tears because you use long fissure bur to make the window so better use round big diamond bur on straight hand piece and start elevating the membrane from the bottom and the sides If no problems after 21 days you are OK. please monitor properly your post-op advices and medecines careful while doing your implant surgery do it with an osteotome technique

What if you did the CT scan? You will see a polyp and what did you do? The only reason to do a CT Scan for me is if you have doubts about tabication of the sinus. I used to sent pacients to nasal surgery when there was not a good permiability of the nasal cavity and the sinus. And i have some cases that in the surgery and the pre-operative CT scans have purulense in the sinus cavity, i talk with specialists and i came to the reason, some times we have mucous some time we don´t in a days of diference. So it is not necessary. If we have polyp we can do a pre operative surgery to remove it or not. Conclusion, in the sinus lift it is a possibility that we can or can not do the lifting, if we have patology we may have to remove it and also the schneider membrane, and wait 6 month to do the lifting. We have always to informe our pacients and there is one very important factor - The "decomplicator" factor for our success.

I was in your position at one time. I absolutely recommend a CT scan prior to sinus grafting. Yoou need to know if you have a patent osteum or if something goes wrong you are screwed. The best thing i did was to take Mike Pikos course on sinus and ridge grafting. It teaches you how to handle the what ifs. The sinus lining will not reform if you close and wait. You have to know how to repair or rebuild it. I wish i had donehis course right after my residency.

we do sinus elevations on a routine basis, and I truly believe the Ct scan doesnt have to be part of the standard of care for that procedure. It wouldnt really change the way we would conduct ourself clinically most of the time. of course we use Ct scans regularly but for other reasons. we are almost away from practicing lateral windows, we have developed some strategies for internal sinus manipulation and are being very succesful, some have been presented at the AO annual meeting (look in the clinical abstracts). What happen to you can happen, it is wise to do some type of AB prophylaxis to the patient 2 - 3 days before the surgery and even have an ENT consultation when you suspect of any possible situation, usually you pick that up at the time of evaluation, panorex some times show shadows that give you an idea of a possible situation in the sinuses, then you get the ENT and decide togheter. when i have had complications and anyone that have done enough of these have had some, its usually about two weeks to a month, usually a month since the AB use delay the on set of the infection. That case you are describing, it will be a miracle that it works if you really had supuration, but I have seen miracles happen a lot in implant dentistry since the enviroment in friendlier than we usually think and in reality we tend to be careful. next time, irrigate with saline until you run out of it and if you see a polyp and it is at your reach, get a sample and send it to pathology, patients usually understand and appreciate that.

Hi, I have enjoyed reading the comments posted. I am recovering from a horrific implant "gone wrong" I will share with you in hopes that my situtation can be avoided to other patients. I was given a 5 minute consult from a periodontist. I went in because a endodontist wanted a bone and gum specialist to look at what was going on in the bone area of # 11-14. I told Dr. that I was just finishing up on a antibotic for a sinus infection. He felt it was necessary to remove the fractured tooth #11 and place a bone graft, and when the bone looks healthly, then place an implant, approx. in two months. I agreed. When I woke up from the extraction and bone graft, I was informed by his staff that an implant was placed. I asked about the condition of my bone, they said, it looked Okay. I was sent home with antibotic, pain rx, peridex, and home instructions. Since I have worked in the dental field for 7 years, I felt I had some knowledge of what goes on in a dental chair. Within 2 days, I had a raging fever, eye pain, lower jaw pain, sinus pain, I knew something was not right. I told Dr. who placed implant. He said it was normal. After 5 days, I started to hemmorage out my nose, I called Dr. and he said to stop the bleeding or go the the ER. I stopped the bleeding to avoid a midnight ER visit. Luckily, I had an appt. with my ENT 24 hours later. My ENT did a CAT scan and saw that I was totally infected from my mandiable to my ethnoids. Surgery would need to be done to clean out infection. That night I woke up to blood on my pillow and out my nose, and there was the implant. I took the CAT scan to my Dentist and he refused to look at the CAT scan. His arrogence offended me. I am now recovering from an awful sinus surgery. My wonderful ENT said the infection was massive and at a dangerous and critical point. A few weeks longer, and I could have died. I still have not heard from the Dentist who placed the implant. However,I have notified his office at all points of my surgery and recovery. Its also scary to think that the periodontist that I went to has been pursering me to work for him for over one and one half years. I am thinking about going legal, he did follow standard of care, however, once I was under IV sedation, he changed the tx. plan. Never was a through medical history discussed before the surgery, and he has abandoned me since my ENT has taken over my care for now. I would suggest to ALL people having an implant, have a CAT scan, make sure you demand to discuss everything with peridontist or surgern. Your life is at stake with every time you are under IV, take all precauctions, regardless of their resurrance that you'll be Okay. This has been 2 months out of my life I will never get back, not to mention the cost and untold pain. And I have worked with the best dentists in Utah, Dr. Gorden Christensen and his deceased son in law were my employers. There are no guarantees, please be careful.And I still don't have an answer why the bone looked abnormal, my orgional reason for the consulation, there are no notes in my chart regarding the bone. How's that for service? Thanks for listening.

where could I get the best sinus lift augmentation course in usa, I heard of Dr Mike Pikos . anybody knows about him and does he give training still. thanks

Dear Kathy: I am currenty in agonizing pain after having two dental implants placed in my upper right maxillary area. One tooth had a root canal and fractured leaving me with implant as my only option. The periodontist I was referred to by my General Dentist extracted the tooth and immediately placed implant. He also convinced me to place a second implant in vacant area next to implant. After surgery, I was not given any antibiotics. I also began to experience heavy salivation. Since everything seemed o.k. I never even thought of what was causing this sudden salivation. To make matters worse, a root canal was done one month prior to dental implant in same area which was to be used as a bridge and never capped due to my General Dentist's concern that it would impact scheduled implant for following month. Well in about a year I started to have severe pain and numbness in area. I am in constant pain and am now trying to determine through all wonderful medical professionals a definitive cause. I hope that there is no permanent nerve damage but I must say it does not look good. My question is why on earth would the periodontist place an implant knowing that the root canal might go bad and possibly compromise the implant. It also turns out that the implant has broken h 2 mm. through the bone. Please people be careful. The pain is horrific and the medications are awful. If I had known the dangers and they were explained to me, I never would have gone through with the surgery. Not only will I not enjoy the implants and bridge but I will be in probably be in pain for the rest of my life. Take care and good luck to you.

Janice, I am sorry that you are having so much pain. For the life of me, I don't understand what your surgeon did or didn't do to cause this. I have place over 700 implants and I have never had to prescribe Tylenol #3. Advil and Decadron ( a steroid) suffice. You should not be in this much pain nor should you be experiencing any numbness in the maxillary area. We don't usually see parasthesia in the upper jaw. I know you won't like the sound of this but I would place you on Antibiotics and Decadron right away. I would then remove the implants and all the infected tissue ( if any). I would close the area and wait 4 weeks before re-entering to graft the site and fill all the perforations. Sometimes it is necessary to start over when things are going bad. Your situation is an exception. I have two implants in my mouth and I placed nine implants in my mother's mouth. No pain other than mild discomfort for 2-3 days. Please don't be turned off of implants. They are a terrific treatment modality. Good Luck to you.

Hello, 19 days ago I had two upper molar dental implants with a bone growth factor protein and a sinus lift in my upper jaw. I was given 5 days of antibotics after the surgery. 7 days later I woke up with horrible head ache and sinus pain. My general Dr. gave me amoxicillin for the next 10 days my blood pressure was really high. When I went back to the Dentist/Surgeon he told me gums look angry we will watch and see. I'm scared I will lose the implants. This has also affected my thinking, pretty fussy and painful still. I hope this is worth it. Should I have more aggressive antibotics or what? cici

Will internal sinus lift gives a better result in the present of Polyp? Once you sent a pat. to ENT, what isthe normal protocol for the ENT doc? and how long do you have to wait if you're planning to do the lift (internal or Lateral) Appreciate for any response.