Implant Protrudes into Maxillary Sinus: How To Manage?

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Dr. C. S. asks:

I am an Otolaryngologist. My mother went to the dentist and had a root-form dental implant placed in her left posterior upper jaw. She later developed a chronic left maxillary sinusitis from the dental implant. A Cone Beam Volumetric CT scan showed that the dental implant protrudes about 10mm into the maxillary sinus. There is significant air fluid level in the affected sinus. How should I manage this situation? Should the implant be removed? What can I as a physician do?

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12 Responses to “ Implant Protrudes into Maxillary Sinus: How To Manage? ”

  • Sheldon Lerner December 3rd, 2007

    Hi

    How long ago was the implant placed? Was there a bone graft placed at the time of implant placement? Is the implant devoid of bone in the area that protrudes into the sinus or is there a thin layer of bone on the area. If a graft was done was it mineralized bone or a demineralized matrix that was placed which would not show up in the radiograph? Is there frank suppuration? Has the dentist been advised of the problem? What is he/she suggesting to do at this point?

    Best
    Sheldon Lerner

  • satish joshi December 4th, 2007

    If 10mm of implant is in sinus,obviously dentist did a sinus floor lift.And obviously 10mm of lift does require some kind of bone graft.
    there is a chance that during manipulation of membrane some particles of graft might have become loose and bocked the meatus.
    First thing you should do is to check the patancey of meatus.
    If ihis is a first episode, may be it will be treated with antibioic and /or sinus lavage.
    If is a chronic problem caused by an implant itself and does not resolve with your ENT treatment, you may have to remove implant but then you have to deal with oroentral communication

  • Dale Miles December 4th, 2007

    Dentists should refrain from statements like “If 10mm of implant is in sinus,obviously dentist did a sinus floor lift.And obviously 10mm of lift does require some kind of bone graft.”…if they have NOT seen the case data…the statement is just opinion NOT fact.

    I have read over 1600 scans from almost all dental CBCT machines…I have seen at least 12-15 implant fixtures in the submandibular space and in the antral space…These were all cases in which CBCT revealed the “true” position, “post placement”…I do not know what imaging modality was used in these cases for pre-surgical evaluation…but my educated guess would be that it was not CT, Cone Beam or otherwise…In my opinion, clincian’s must move to CBCT for all implant procedures in potentially risky anatomic locations- the information is more precise and the dose is much less than conventional CT…and we should only use CBCT in my opinion…hope this helps everyone, and I’d love to see the DICOM 3 multiseries to evaluate the placement if appropriate…Dr. C.S. sorry about your mother’s problem…I’m sure it will be resolved…Dale Mles

  • satish joshi December 4th, 2007

    Mr. Miles
    otolaryngologist is asking “whether to remove implant or not?’
    That implies that implant is in right position placed by dentist.
    If it is not, then question does not arise whether to remove or not?
    If an implant has been slipped in to wrong place and causing problems,then it has to be removed and otolaryngologist know better about it than dentist.Protruding does not have to be necessarilly in wrong place.

  • DCSmiles December 4th, 2007

    Implant should be removed. Operator must be capable of Calwel Luc Lateral Sinus approach. This can be performed by most oral surgeons and periodontists and a selct few GPs. Anyone who cannot perform this procedure has no business getting near a sinus that needs elevation. Hopefully implant can be removed and sinus grfted simultaneously. Replacement implant should be delayed for 4-6 months after the sinus lift implant retrieval.

  • Yazad Gandhi December 5th, 2007

    Sorry for the late response but the implant if causing a difference in air-fluid levels should be removed only if additional treatment by your speciality (ORL) doesn’t resolve the situation, I mean drainage through antrostomy or intraoral (intraoral would have to be closed later on).
    I feel if the implant is osseointegrated n drainage can resolve the situation n this is thefirst episode then why remove.

  • Bill Pace DDS December 6th, 2007

    Was a crown placed on the implant?Is it loose ?Is there an oral-antral fistula?Place a mouth mirror next to the impant and have your mom Valsalva.If it fogs up there’s a fistula.

  • dr.med.,dr med dent Alessandro ROMANO December 6th, 2007

    it does not seems to be a sinus elevation, but an error of implantation instead. therefore i will remove the implant, than a very good and long cleansing with an antibiotic like ceftriaxone (roche).

    last step, a very efficient closing of the dehiscence with fibrin pad in two or three layers. and it’s all, almost for me.

  • Dinh X. Bui December 11th, 2007

    I have a similar case like yours. Although, the ENT could not conclusively request us to remove the implant. I have prescribe her the sinus lavage and antibiotic. The implant successfully osseointegrated and the patient does not give me the opportunity to remove the implant unless I guarantee it will solve the problem.

  • prof.Dr.Dr.Hossam Barghash December 19th, 2007

    I think 10mm cann,t happened by mistake at the same time if this was sinus augmentation procedure then there is high percentage that the fluid collection happened cos of obestruction of the sinus opning from the grafting material,then the sinus opning has to be cleared & keeping the implantas as long as it is a successful one, so the idea is to solve the cause of sinusitis,but removing the implant or not depened on it is success

  • David Levitt December 27th, 2007

    Dr.C,
    If your mother were asymptomatic no treatment would be needed. Since that is not the case there are two options: cutting the implant or removing the implant. Since titanium is a relatively soft metal it is possible to cut the implant down to the level of the antrum floor via a lateral window approach. This would have to be done with copious irrigation to prevent overheating the implant and also leaving gross amounts if titanium filings in the antrum. I must admit I have never tried this approach and am skeptical of it. Thh other option is to NON-SUGICALLY remove the implant by simply unscrewing it. This requires having the correct armamentarium and not being afraid to apply 100-150ncm of force. This non-surgical approach will leave a much smaller defect and oral-antral communication than any surgical technique. How you then handle the communication is up to you. Cheek flap, palatal flap or conservative management via medication and time. I teach these techniques and would love to hear how this one turns out so I can pass it on to my students.

  • Larry Duffy January 30th, 2008

    If there is that much of the implant in the sinus with no bone..then how long is the implant…and is it stable…and is it restored…if it is stable and restored and the crown to root ratio is acceptable…a caldwell - luc approach…cut off the implant to the sinus floor and cover the area with some collatape or collacote to prevent any fistula from occuring…if it is not restored, stable, and the crown to root ratio is ok..,.still caldwell - luc, cut it off and the same membrane as above…wait another 3-4 months to restore and re-check stability…if stable or not, and the crown to root ratio is wrong…it must be removed and do things the right way and start over after healing with a sinus augmentation and subsequent placement..anitbiotics of course and lavage of the sinus if you cut the implant..my choice of antibiotics would be Augmentum 500mg and Flagyl 500mg…no doubt there are some anaerobic bugs in there.

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