Beta tricalcium Phosphate particles inside sinus?

I removed a failed implant at the maxillary first molar site. After removal of the implant, I placed Beta Tricalcium Phosphate (bTCP) into the implant site and sutured the buccal and palatal flaps closed. It has remained closed and looks normal 4 days post-op, but the patient complains of severe pain and drainage from the sinus. My guess is that some bone graft particles (200 to 500 microns in size) perforated the membrane and went into the sinus. The patient is on 500mg azithromycin twice daily and yet he is not seeing any remission. Should I change his antibiotic regimen or should I open up and remove graft particles – although in this case I would have to close an obvious oroantral communication.  Please advise.

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3 thoughts on “Beta tricalcium Phosphate particles inside sinus?

  1. JD says:

    Sutured the buccal and palatial flaps closed?! Without elevation of buccal mucosa and sliding for primary closure, there is just no way! And pushing material into and through the sinus floor without careful anatomical data–i.e. CBCT–is foolish. With such pain there is likely an OA fistula, acute maxillary sinusitis, and disruption of the membrane now with foreign body sinus contamination–i.e. an infection that is difficult to treat and a hole tougher to close! Those who choose to fiddle in areas where they have no training–antral disease–do so at their peril. As this may be far more than meets the dental eye, refer this patient to those with appropriate training and experience like an OMS.

  2. Bülent Zeytinoğlu says:

    Dear Dr.
    Lets start from the begining what was the reason of the implant removal was there an infection or a prosthetic problem.I think there was infection of the surrounding tissues in that case the region sould be evaluated before the operation and the relation of the implant to the sinus should be seen .Ithink these procedures are all forgotten and missed.So first thing to do is to see the localization of the implant localization of the graft material and evaluation of the sinus and the sinus mucosa.As you have mentioned drainage from the sinus can never be treated by antibiotics so changing the AB will be of no use and by reentering the region and cleaning the graft material will no help healing but just enlarge the oroantral fistula which is one of the most difficult cases to treat.The radical treatment is done by Cald well luck operation in which all the infected sinus mucosa is taken out through an entry from fossa canina and communicating the antrum to the nasal cavity by hiatus sinus maxillaris enabling the healing and later airation of the important cavity.İf you have the skill to do the operation please do it if not send the patient to a OMS.
    Good Luck

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