Sinus Tract Next to Tenting Screw After Bone Graft and Implant Placement: How to Resolve?

After 5 months of uneventful healing of implants in area #8 and #9 with simultaneous Bio-Oss collagen bone graft and titanium reinforced non-resorbable high-density PTFE membrane and covered with a non-cross linked porcine membrane, I now see a small lesion resembling a sinus tract that is present in the immediate vicinity (2mm) of one tenting screw in area of #8. The lesion bleeds very easily and would not heal after I tried to cauterize it with a soft tissue laser. The size of the lesion is about 1.5-2mm. What would you do to resolve this situation since the non-resorbable membrane had to be removed after only 8 months of healing? Please note that area #9 has also received a supporting tenting screw and continues to heal without any problems. Thank you and your help in this matter is greatly appreciated.

8 thoughts on “Sinus Tract Next to Tenting Screw After Bone Graft and Implant Placement: How to Resolve?

  1. Timothy Carter says:

    1st question: Are the tenting screws still in place?
    2nd question: Why use tenting screws in conjunction with Ti reinforced membrane and implant placement?

    If the screws are still in then just remove them. The Ti reinforced membrane should be sufficient to maintain space especially with implants placed. It sounds like a lot of excess treatment/materials were utilized.

  2. Vipul G Shukla says:

    Any X-rays or close up photos of the site that you can share with us?
    Was the particulate graft done over intact corticated bone or did you strip the cortical bone first? Any reason for using both types of barriers? How does the post-8 month CBCT compare with the original?

  3. Dr. Gerald Rudick says:

    After five months, you can simply remove the titanium reinforced PTFE membrane as well as both of the tenting screws. Your graft is not fully mineralized, however it is solid enough to go into the area of the sinus track, scrape out the granulomatous tissue and replant some more grafting material and cover with a collagen membrane…. it is going to heal well, and you can place your implants in three months.

  4. Robert says:

    All excellent and accurate comments and advice
    I would follow the above instructions
    Siunus tracts tell you the there is either a soft tissue communication with an open or soft tissue space or that the body has some foreign object it is trying to eliminate, screws, membrane reinforcement, necrotic graft etc
    Also don’t forget to check the pressure of a partial, if that is the transitional prosthetic, on the screw, a mechanical etiology which may be contributing to the problem
    If the tract stays too long you will loose bone, probably already have, so do not delay


Leave a Comment:

Comment Guidelines: Be Yourself. Be Respectful. Add Value. For more details, read our comment guidelines. Though we require an email to comment, we will NEVER publish your email.
Required fields are marked *

Posted in Clinical Cases, Surgical.
Bookmark Sinus Tract Next to Tenting Screw After Bone Graft and Implant Placement: How to Resolve?

Videos to Watch:

Titanium Mesh for Ridge Augmentation

The use of titanium mesh is a reliable method for ridge augmentation to provide adequate[...]


Watch Now!
Implant Grafting Techniques: Demineralized Sponge Strip and Tunneling

This video reviews several unique grafting and surgical techniques, including the use of demineralized cancellous[...]

Watch Now!
Mandibular Fixed Screw Retained Restoration

This video shows the use of a surgical guide for a mandibular fixed screw retained[...]

1 Comment

Watch Now!
Clinical Tip for Fixation of a Collagen Membrane

This video provides a clinical tip with regards to the fixation of a collagen membrane.[...]

Watch Now!
Lower Molar Extraction with Graft

Video showing lower left first molar extraction, followed by a socket graft, and then immediate[...]


Watch Now!
Maxillary Bone Reconstruction

This video demonstrations Maxillary Bone Reconstruction using Subnasal Floor Elevation and an Osteotome Closed Approach[...]

Watch Now!
Infection of Lower Premolar: Extract and Place Implant

In this video, the lower left 2nd premolar was extracted due to infection, and implants[...]

Watch Now!
Flapless Immediate Implant and Provisional

This video shows a technique showing using the patient's own tooth as a provisional at[...]

Watch Now!
Extraction and Immediate Implant with Luxator LX

Extraction of tooth #8, using Luxator LX, and then an immediate implant and provisional.[...]


Watch Now!
Dealing with the Implant Gap

This short video discusses how to best deal with the gap after immediate implant insertion[...]

1 Comment

Watch Now!
Lower Right Molar Extraction & Immediate Implant Placement Using i-PRF

In this video, the lower right second molar was extracted and grafted with i-PRF and[...]


Watch Now!
Maxillary Implantation with Treatment of Chronic Sinusitis

This video shows two cases where implants were placed following treatment of Sinusitis. [...]


Watch Now!