Sinus issues after implant placement: thoughts?

The placement looks fine, there probably was a slight disturbance of the sinus floor. It would have been useful to have the patient on Antibiotics for and following the procedure. At this stage, it is the sinusitis that needs to be treated and you were correct to initiate antibiotics. You might also and truing to enhance drainage by prescribing Claritin and Neo-Synephrine. Then, give it some time. Both you and he should be fine. Don't even think of removing the implant unless it becomes impossible to resolve the situation with the conservative approach.

Sorry : "You might also start trying to enhance drainage"

In a situation like this, I think a CBCT scan should be taken to see where the implant ended up....impossible to tell if the buccal bone has been perforated, and possibly this is the "root" of the problem....check it out...….

Clean perforation in the area of 3 mm heal and the membrane grows over. Only you know how surgical protocol was followed. The choice of antibiotics will be critical and I assume that you are no stranger to pharmacology. Perhaps combination of two antibiotics will be necessary to deal with the spectrum of micro organisms. When the infection subsides the implant should survive.

This is a nice case. Thanks for submitting. The patient needs to be on at least 850mg Augmentin bid and 500mg Metronidazole or 2g Ciprofloxacin and 500mg Metronidazole/day if penicillin allergy. A decongestant nasal spray is a good idea as well. Give this some time.

In addition to treat the sinusitis with antibiotics and decongestant, I would send the patient to an ENT for Sinus treatment. It is most likely not related to implant placement at all. It might be seasonal allergy,adenoids, iatrogenic sinusitis, or common cold.

Hi,I had a lot of cases like this,even deeper into the sinus. after surgery, I gave for at least 10 days a combination of two antibiotics as the colleagues suggested plus cortison. it should heal well,unless,as Dr. Gerald is saying you have a buccal bone perforation. so you'll need to deal with this issue. by the way,what GBR did you do ?

Could the cover screw be not seated? As we don't know the brand of implant, it is impossible to tell. An advantage of an open wound is that the devious cover screw can be viewed and wobbled/rotated/removed and returned. Also given its wide flare, could it have been tightened against the proximal bone rather than the fixture head?

Personally I don’t like my implants impinging into the sinus, but my question is, how about zygomatics that are placed through the sinus and left floating inside the sinus. Just some food for thoughts

I do this everyday- and don’t have problems. The sinus floor is an excellent coritical bone layer to anchor implants into. You really only need 1mm of engagement. That being said, when you drill, you cannot run your burr into the sinus as you introduce bacteria and cause inflammation. It’s a tactile sensation that you just have to learn. I do tell my patients that they might have sinusitis like symptoms for a week or so afterwards. But the maxillary sinus is an incredibly forgiving place. With the GBR, you have an added source of infection risk. Standard of care- a CBCT will show you the condition of the sinus and is very easy to obtain and read. If the sinusitis is just around the area of the implant, it should resolve with no intervention. If the osteum is blocked, you’ll need an ENT consult to help manage. Please send to a trusted OMFS to evaluate. Do not send this patient to an ENT first, as that is professionally a weak move for the entire dental field. If GBR site is tender and inflamed, it is also potentially infected and must be dealt with. If you place implants in the posterior maxilla, you must be able to diagnose and treat complications.

I think Augmentin and mitronidazole for 10 days and follow up should heal fine. Scan is a good idea too. I had the same situation several times, but I start the antibiotic right away, all of them healed fine except in one diabetic patient that had to remove the implant and close the fistula with collatape and suture .

Is someone among you place implants without antibiotics prescription ?