Sinus Lift Sinus Tract Case: What Should I Do?

Possible sinus infection or infected graft. Did you have a membrane tear during sinus lift? Did patient have an Rx for antibiotics and sinus decongestants and nasal spray? I would Rx a broad spectrum antibiotic (Augmentin if no Pen allergy), sinus decongestants. May need long term abx if a sinus infection. The graft looks pretty good on the radiograph. Do you have a clinical photo? How is the ext site between the implants healing? Looks like it was grafted and there is a lucency apical to the graft at this ext site, may be another source of infection if it was not curretted well.

Or the simpler answer is the graft simply did not take and it's impeding the normal healing process.

Problem just a localised area of infection along surgical wound margins. If all else is well prescibe amox and metronidazole -MH allowing- and review again 7-10 days.

A basic premise of oral surgery, in regards to infection, is to establish drainage. I recommend I&D (meaning incise into the sinus tract, irrigate with saline and leave it at that...no sutures or drain is usually needed). Tell the patient to massage the area (extraorally), rx augmentin or clindamycin if allergic and afrin nose spray.

Place gutta percha point into tract to trace source of infection first. Decide if the problem is in the graft, implant, extraction site or sinus. Then treat that area specifically.

Disagree here. Dont make incision in the area of the tract so short after lateral window sinuslift. In case of reopning, incisionline should be at the previous incision line, midcrestal normally. In this case, if no abscess, first try broad spec. Antibiotika and folllow up. If no improvement, reacess and curettage, maybe necesarry to remove graft and wait 3 months for regrafting.

YOu state that your did a sinus lift 1 month ago. Is that all you did at that time. Did you cover your lateral wienow with the removed cortical plate or any membrane?

Draining (ie: Productive) sinus tract.......Infected. If antibiotics dont work. Open and clean or it will get messy.

Irrigate the fistula with an aqueous antibiotic, or mix powdered Ab in with sterile water or saline every two -three days. Cover with Augmentin, Biaxin, Levaquin, or Zithromax together with Metronidazole. I've had this happen before, and that's what I did. Little by little, the sinus tract closed, until it finally sealed itself off. I later placed three implants, which lasted over nine years until the patient died.

Fully agree with Dr. Theodore M. Grossman, D.M.D.! 1 mounth is enough term to avoid primary infmalatory complication (check the osteogenesis terms) in this cases, so we need to look for secondary problem, which can be the neighbor teeth even. Good antibiotix w/o drenage it 50/50, and we allways will have a time to remove the graft... but first we need to check with gutta percha the directon of trackt. Good Luck

What was the graft material? On the X-Ray it appears to be a granular material -is the X-Ray from day one or a month later. If it is a month old one would possibly expect less definition of the material and if this is the case I dont think the graft is establishing a blood supply. If the infection persists you may end up with a ball of dry granular/chalky material. I think you should open up and assess properly. If there is no blood supply I dont see how all these antibiotics being prescribed will work.Good luck - hope the results are favourable at the end of the day.

A photo would be great as could be just a soft tissue infection from spontaeous exposure. But just a thought that adjacent socket graft may be the issue as the apex looks interesting and in-efficient curretage of the site may have led to an infected graft site here.

If sinus tract heading toward implant platform could be bacterial leakage from inside the implant. I had a case in the past that did just that. Presumably the center of the implant was acting like a petri dish. The cover screw didn't seal it off entirely. If I bury my implants I will irigate the center with peridex to avoid this. just something to think about.

Antiboitics: Z-pack

I forgot, sorry Antibiotics: Z-pack and Metronidazole together. It works great.