Implants and Maxillary Sinus Case: How Should I Manage This?

Last Updated: May 15, 2011

Dr. S asks:

I would like to present a complicated case and ask for advice on how to manage the case. I extracted #3 [maxillary right first molar;16] which had a periapical lesion around the palatal root. I waited 2.5 months for healing to occur at the extraction site and installed an implant fixture. While I was drilling I felt that I had perforated the maxillary sinus and I decided to place a shorter implant (9mm). Postoperatively I took an OPG [orthopantomogram] and I saw that implant protruded into the sinus 2 to 3 mm. I took a CBCT and realized that the implant was under the sinus mucosa and the palatal part of the implant seems to be surrounded by bone. I would appreciate if you could offer some advice on how I should manage this situation.

Should I remove this implant? The patient does not have any problems. Patient does not have any sinusitis, pain or infection. Systemically patient does not have any problem. I am going to place implants in the #5 [maxillary right first premolar; 14] and #4 [maxillary right second premolar;15] sites next week.

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8 Comments on Implants and Maxillary Sinus Case: How Should I Manage This?

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Perio

05/15/2011

You probably should have performed an osteotome sinus lift (Summer's technique), however it appears that you did not perforate the Schneiderian membrane which is good. If that's the case you will likely see bone formation along the apical part of your implant. Perforating the sinus floor per se is not necessarily a complication. Think of zygomatic implants, they perforate the sinus floor and the membrane and sit quietly without causing any long term complications.

ttmillerjr

05/16/2011

No action required. A wider and longer implant would have made me feel better though. I'd be a bit concerned about this single, short, and narrow implant in the softest bone in the mouth.

DavidFurnari

05/17/2011

You seem to be ok here with new bone formation around the apex of the implant. Next time this occurs you should do a Localized management of the sinus floor( osteotome lift) . You can place in some collatape and Bio-Oss. this will protect the schniderian membrane and provide mineral scaffold for new bone formation. Perhaps in the future you may want to do more site development prior to implant placement. This would allow use of a wider and or longer implant.

Dr. S

05/18/2011

Thank you all for your comments. I placed 2 implants on 14 and 15. (3.8X12 and 3.8X10.5) Iam going to fixed the implant together. Answer for ttmillerjr ; First implant which protruded to sinus is not a narrow implant (4.6X9) But I agree with you about quality of bone at this site of jaw. At first planning I was going to place 2 implants and going to make a bridge. After the sinus penetration I changed my plan and decided to place 3 implant.

naser

05/18/2011

for me its considered a perfect implant as its tip has just penetrated the sinus floor which is formed of cortical bone hence giving it a good primary stabilty

Dr. Dan

05/20/2011

looks good to me.

CRS

05/24/2011

Let me give you a little tip, the sinus will very easily tolerate 2-3mm of implant, the membrane will heal over without complications. If you have enough length and stability you don't need a sinus lift. These procedures are to allow placement of a longer implant vs repairing a small perforation. You can place the patient on sinus meds as for a oroantral communication. Good Luck!

david g

05/24/2011

implant is fine. There are many case studies that show one can create a sinus augmentation by just elevating the membrane and allowing blood to fill the space.(ie no graft material). I agree a wider implant would have been nicer, but this one should work just fine so why beat yourself up.

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