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Ask UsPenetrating the Maxillary Sinus
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Dr. Chin asks:
I recently placed 4 dental implants in the maxillary jaw. The panoramic
radiographs I took before the procedure showed a 13mm vertical bone
height in the left premolar area. I was planning to place 11.5mm length
implants there.
The panoramic radiographs I took after the procedure show that 1 dental implant I placed penetrated the maxillary sinus by about 3mm. Primary stability is very good for all 4 dental implants. Will I have to trephine out the dental implant and replace it with a shorter implant? Or can I leave them all as is and have a delayed loading? I am planning to restore the case with an overdenture. How long should I wait to load the dental implants?
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14 Responses to “ Penetrating the Maxillary Sinus ”
According to your case describtion , you over exceeded your planed length by 4.5 mm which is not logical comparing to your measurments of pre op panorex for (13 mm)unless you placed the implant 5 mm subcrestally. I would suggest to redo the pan with the exact head position and I think you will find your implant in the right place,
But supposingly you really missed your correct pre op measurments and the implant is really 3 mm inside the sinus , according to my experience I have seen more than 50 implants which have a 2-3 mm inside the sinus with no symtoms at all and no reaction on x rays ,and surviving more than 5 years.
just give 4 months time to heal and proceed with your planned prostho, good luck
Leave it as it is. Results should be great.
Remember that all Branemark;s early implants penetrated into the sinus - bicortical stabilization it was called.
CR
Leave it alone and it should be just fine. Many do an “internal” lift with around 3mm apically wihtout any exogenous grafting done and it works quite well. You should have really felt the dense sinus floor before you penetrated it though. I’d take another radiograph either way to confirm what you have and just let them heal a bit longer.
Good luck,
Jackson
Dont be paranoid, they will work just fine.
Wait atleast 6 to 8 months for healing.What’s the rush? It should be just fine but if there are any issues I’d prefer to find out before the restorative phase is completed.You have nothing to lose by waiting.
Good Luck
No reason to wait any longer than usual. 3-4 months. If you had excellent stability, you did everything right. I’ll take bicortical stability over a short implant any day!
2 issues. Sinus penetration will not propose a problem. Wait 3-4 months and go forward. Panorex has 25% distortion so the fact that your measurements are off do not surprise me. Take a periapical to ckeck your actual placement.
Shouldn’t necessarily be a major problem. In the future when you take panoramic x-rays, use a metal ball in or near the edentulous space to calibrate just how much magnification has occured.
I would be happy to explain this formula for you, but it may be easier to find it in a text-book.
There is a great example of how to do this on the STRAUMANN website, a short video that shows use of such a ball and how to calculate your actual distances.
Good luck
This shouldn’t be a problem. However, I have had one case where the implant penetrated the sinus. After it being submerged for six months it had failed at stage II surgery. We then had an oral-antral communication to close and a sinusitis had developed. In your case I would leave it, just be aware of potential complications.
Are you sure that the implant is in the sinus? You can not decide the implant’s tip is in the sinus looking at the panoramic X ray only, you should get the tomographic radiograph to understand this. Usually I use the bone which is behind of sinus on the palatal side and after taking x-ray, it seems the implant’s tip in the sinus because of superposition.
As in your case it appears you have done an indirect sinus lift procedure (sinus floor elevation) from the osteotomy site , without bone graft.It is a well accepted procedure recently. If there is no tear in the schneider membrane & there is adequate primary stability i feel u can go ahead with your normal protocol for loading. Does’nt need extra time.
Leave it alone. I think it was Andre Saadoun (France) who have shown some nice work on that few years ago. It should heal WNL. I would rather worry about the gap in measurements you expected and what you ended up with!
Dear Dr Chin
Unintended Implant penetration of the maxillary sinus occur more often than we think. Usually you would be aware of this as you get a sudden ’sinking feeling’ of the drill during surgery. Most times it will be fine and you should proceed as you normally would. But do remember that having the implant sticking into air in the sinus has no advantage. So we want to be more accurate.
Panoramic images are magnified by as much as 25% and the distortion and magnification may not be consistent in different part of the jaw in the same film. A known dimension ball bearing marker placed close to the surgical site will be a great help.
ussualy it appears a lot of granulation tissue around the apex of the implant
/ the cause for avoidig the perforation of the schneiderien membrane
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