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Implant in sinus: possibilities of complications from experience?

Last Updated: Aug 10, 2016

The patient is a 55-year old female with many missing posterior teeth. I decided to do an indirect sinus lift (with graft) on the right side with simultaneous implant placement, and direct sinus lift and graft placement on the left. However, the patient agreed to only the right side for now.

The osteotomy was done without encroaching into the sinus (and confirmed with a radiograph), the floor of the maxillary sinus was fractured with an osteotome (or so I thought), the socket was partially filled with graft and the implant torqued in. I hoped the implant would push the graft to lift the sinus up sufficiently enough for the decided length of the implant.

The pan taken after closure can be seen below.

It has been 2 weeks now, the patient is fine (I prescribed antihistamines and augmentin for 5 days). Should I expect her to have problems in the future?

(Note: Residual bone in the relevant area was 7mm, implant placed was 4.2 x 10mm)

9 Comments on Implant in sinus: possibilities of complications from experience?

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greg steiner

8/10/2016

In my opinion it would be easy and simple to remove the implant now and I am sure the patient would have no problem understanding the need to regraft. We all have failures and this is an easy fix now and you don't want the patient to develop a problem after restoration and have some other dentist tell her you did inferior work. Greg Steiner Steiner Biotechnology

SSB

8/11/2016

Thank you. It has already been explained to her that the implant is intruding into the sinus, and she understands that we may have to redo the implant. However, since the primary stability was satisfactory and the patient a friend, we have decided to wait it out. I just hope it doesn't prove to be a costly mistake.

John Kong

8/11/2016

I would leave it. BTW, what was the bone graft used?

SSB

8/12/2016

Thank you. Graft used was irradiated cadaveric, rocky mountain. Perhaps the gritty consistency of the same helped in perforating the lining.

Matthew Watson,DMD

8/16/2016

Actually looks like you have graft around the 2 implants that are in sinus. If you have stability and no side effects then leave it. Add some large cortical chips next time so graft will show better. Good luck

bob walton dds

8/16/2016

I see no problem, leave and monitor. I am sure all will be we'll.

8/17/2016

dr wait and watch, but the implant placed on the premolar is on the periapical lesion of canine which has to be adressed immediately.

Irbad Chowdhury DMD, FICO

8/18/2016

Monitor the patient. Implant and patient should be fine. However, >4mm sinus perforations tend to remain exposed in the sinus with no epithelial lining. Due to their treated surfaces, they tend to collect debris which can lead to sinus infections.

George Yzaguirre

10/5/2016

As always it is easy question your treatment after the fact. First thing, why do you not have a CT to show. Pa is ok but to really see the best picture, we should see a cross section. On the most distal implant, could have used a wider shorter implant. In general, the more we protrude up into the sinus, the better chance of perforation. Use PRF as much as possible when doing these procedures. It sometimes helps tough situations like this.

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