Thick sinus mucosa: best approach?

Hello; how did you know that this is a thick membrane/ ployp? might be a fluid or infected cystic tissue etc. I would refer to an ENT for evaluation and treatment. there will be a high possibility of infection affecting your bone and / or membrane when the inside of the sinus is not known. we all keep in mind that health history and age is very important to determine the success of sinus surgery. good luck.

The tooth behind the region proposed for implant placement seems to be quite severely infected and this may be a factor causing the sinus issues. This needs to be managed before placing an implant in the adjacent region. In terms of the implant proposed, the thickening of the sinus soft tissue complex generally means that it is simpler and safer to raise the soft tissue complex up, but first you have to get through the sinus floor. There are several "internal" approaches to perforating the sinus floor, one of which you have mentioned. The sinus floor, though thin, is excellent for stabilizing an implant. Most of the methods described for perforating the sinus floor do not talk too much about how critical it is to generate the "right" diameter of hole in the floor for the implant. We tend to start with a small perforation produced by an ultrasonic device which is then opened up more with a hand held osteotome gauged to the implant to be placed. As we use a tapered implant we insert the osteotome about 1/rd of the way up so that when the implant is placed it can engage the sides of the perforation, gaining stability in the process. We generally place a small amount of collagen up first of all and then add additional osseous graft. This combination of materials reduces the potential for membrane perforation. We place additional bone graft into the channel before taking the implant slowly and steadily up to the desired position. As this happens, the graft material in the channel gets lifted up and "puffed out" into the sinus region under the soft tissue complex. I hope this helps. Best wishes.

That molar needs to be removed first. The sinus thickening with that amount isn't an issue. You can proceed with your plan once the molar site has had a few weeks to heal.

Peter's and Greg's comments are right on the mark. You keep mentioning techniques to place the implants and handling the membrane, but do not mention how you will handle the infected molar bridge abutment. It is possible that the sinus pathology is caused by the infected molar, but whether of endodontic origin or from some other reason, sinus pathology is present and a referral to an ENT is warranted. Sectioning the bridge at the anterior abutment and removing the infected molar or treating it endodontically if possible needs to be done weeks in advance of implant placement. Good luck!

Chronic CRS and or its derivations have a 25 to 75% odonthogenic origin (depending on the study) so FIRST remove the mollar and the lesion (i think there might be a contact between both membranes), good cleaning and its graftable. after proper healing you can go for the implants. I would recommend DIVA implant system for that , its fast clean and no particulates to be messing around. best of luck

The films provided are not very clear. How long ago were the two implants placed? Obviously the four unit fixed bridge is easily removable, and if adequate time has elapsed, and the implants are well integrated, then remove the molar with the periapical pathology ….. build a plastic provisional three unit implant supported temporary prostheis . It would be advisable for the patient to consult with an ENT Specialist would have a better idea of what is happening to the sinus.

Whenever is sinus lining this thick, there is concern that natural drainage is not that well. Even though second molar pathology has nothing to do with sinus state (but as previously mentioned, 75% chance it DOES), bad drainage makes patient prone to acute sinusitis as complication of sinus floor manipulation. Moreover, bone graft and implant itself could get infected and fail.

I fully agree with Peter Hunt considerations. First of all extract 1.6, very probably the responsible for the mucosa thickening (potential chronic odontogenic sinusitis). After a few weeks post-extraction Schneider's membrane probably will return at its pysiological thickness (<1mm). Moreover the presence of an important infection near an implant during its osteointegration is dangerous. After sinus healing a crestal approach is absolutely indicated and easy, mainly for sinus favorable anatomy (narrow sinus).