Dr. C., an oral surgeon, asks:
Patient has been diagnosed via CT scan with a mucus retention cyst in the right maxillary sinus. Single implant with block bone graft on #8 was done 14 months ago. Patient is indicating dull throbing pain in area above the implant. No response to 2 courses of anitbiotics. ENT indicates no active sinus problems outside of cyst. The patient has returned for post-operative follow-up and is complaining of a dull throbbing pain. I can find no reason for the continued throbbing pain. What do you recommend? Any thoughts?
In my experience pain in integrated dental implants equals infection until proven otherwise. Antibiotics cannot clear infections if the source remains. I do not think the sinus pathology has anything to do with this. If you are an oral surgeon you probably allready new this.
Questions I have for you-
1. have you removed the fixation screws from your bock graft?
2.Are you sure your block graft actually attached to the alveolus, or do you have a fibrous union between the two??
3.Do you have a scan of this area??
I’ll wait for your info before going into further detail. your case intrigues me, I’d love to learn more.
I agree with sb oral surgeon it is not the mucous retention cyst they tend to be asymptomatic. Your problem is the implant or the graft.
Have you taken a detailed history of the pain? Can you exclude TMJ dysfunction as the cause of the pain?
I’m assuming that by #8 you are referring to the upper right central incisor???
TMJ pain referred to the anterior maxilla??
i’m lost
mucus retention cysts do not cause symptoms until they block the sinus ostium and prevent normal drainage.
Impingment of the contents of the incisive canal may be a possibility
The problem may actually be more simple than you realize. If the block has been in place for that length of time and the bone screws are still in place, there may be external resorption of the blocks leaving the screws extending out into the soft tissue volume. The tissue at the midline can be highly mobile and have a frenum pull. The constant internal abrasion of the tissue will result in an inflammatory response and the symptoms you descibe. This is why we try to place implants at 4 months months after grafting.
RJM
How’s the adjacent teeth ? free of pathology?