Implant perforating sinus floor: prognosis?

Not the first and will not be the last time that this has happened ( bi-cotical fixation )..... should be OK . Regards Peter

this will work fine but your patient has sub calculus everywhere, which you can see on a dpt (so it must be sizeable amounts). You really should get them cleaned up before implant placement because your implant will not tolerate not being cleaned properly!!!!!

Dear dr , we should emphasize on that the Xray is 2d not 3d (superimposition will obscure many informations ) Inside the sinus less than 2 mm is not big problem good luck

You mean you didn't do the internal sinus lift on purpose?! (: Implant is solid, patient is doing well. So far so good, I say!

Thankyou for sharing your case, it has prompted me into throwing in my 2cents worth! I am curious about the treatment plan. When did the right quadrant fail? You have no plans for distal to your implant? To look at a close-up view of your implant perforating the cortical floor as Peter states should be fine in a healthy antrum, but how did it get there in the first place? With a CBCT beforehand you will know the site dimensions to work to and you presumably you verified the osteotomy prior to placing your implant, noticing that there was an abscence of apical bone or did you place it without any scan imaging? I can't be too diagnostic but does he have untreated perio. present? and is there apical radiolucency on adjacent #4 (15). Special precautions, hmm, I would be more likely thinking about the patient and the teeth longer term. Your question begs the reply that there are several good courses experienced colleagues would recommend before treating posterior Mx and why not ask for some mentoring with new territories. Could be playing into the lawyers grasping hands- be careful, we all suffer! Good wishes for your case.

Zygomatic Implants have been placed for at least 15 years. Essentially every Zygomatic Implant perforates the Maxillary Sinus. In the absence of symptoms your implant should be successful.

Since most of the peri implant bone is native bone then the perforation will not be a factor regarding integration. If you had started with 4 mm of native bone, did a sinus lift and penetrated, then the prognosis for achieving and maintaining integration would be poor since bp m e will not grow in the perforated space. In your case, mucosa will grow over the apex of the implant in a short time. Perforations can be avoided my obtaining an accurate reading of bone height with cbct or at least an x ray taken with a grid. The use of drill stops will also prevent the drill from progressing deeper than intended. I use 3i hubbed drills and the 3i stops.

my concern, to add to the other observations, is what will be the crown height above the platform? My rule of thumb ( because one of the gurus told it to me ) is over 15mm platform to occl table you are in danger of generating force strong enough to cause screw/abutment failure. everyone gets a night guard

This looks like a well aligned implant. Chances are some bone will grow up the implant. You have bicortical stabilization, which is good. The odds are the implant will yield uneventful and reliable service. You can place one in the second molar site. If so, try an uplift.

In similar cases, a single implant insertion does not lead to significant cosmetic and functional improvement, but the procedure itself presents a big risk. Moreover, the adjacent premolar has at least 1/2 bone atrophy and may be an issue soon.

I don't expect any problem with implant,but my concern is #5. It need to be taken care asap

Yes it will be ok.But at the time of exposure try removing your cover screw very gently & not pushing it hard towards the sinus.As in an unexpected failure your implant doesn't lodges into the sinus. Good luck !

The two dimensional nature of the xray obviously limits assessment but this could be superimposition of the sinus. Unless its an artefact, apical to the implant is a radiolucency that is unlikely to have formed in the air-filled sinus cavity. Was there a any blood from the nose post surgically?

You should be fine. As long as patient is asymptomatic...

My main concern would rather be not the prognosis of the case , which will be favorable, but the fact that you penetrated the sinus floor (or not?) and this was not noticed during surgery. You should have control over this during surgery and perform a closed lift if necessary.

You could also have the patient perform a valsalva maneuver prior to implant placement to see if there is patency between the oral cavity and maxillary sinus. This would tell you if you have membrane continuity.

The valsalva maneuver is an excellent suggestion and so easy to do. What I've found to be a very effective and predictable solution if the finding is positive and assuming minor as a major perforation and tear should not be an issue with the minimum in planning prior to placement, is simply placing a section of collagen plug ahead of the implant. No grafting material necessary. I may place a bit of the patient's harvested after the plug and before the implant but even that is not necessary.

i wouldn't lose any sleep over that implant, Like Dr. Hughes said you will get many years of good service from that implant. I would be very concern about the periapical lesions on the adjacent bicuspids and the large amount of calculus present in the area. Posterior to the implant you can place short implants of course I would recommend quantum since I am part of the company. Your other choice is Bicon. Raul Mena

I often do this intentionally. Drilling to the floor of the sinus but not into the sinus, and with the implant placement itself or an osteotome pushing through the floor of the sinus. This allows a longer implant to be placed. If the drill goes deeper into the sinus when doing the osteotomy a shorter implant could be placed to stay within the boney envelope.

Good and useful discussion. I also had such case with with 24 Implant placement found perforation in sinus. First 3 days there's was swelling on that side but after that,everything is found ok