Rehabilitation of edentulous jaws with implant-supported prosthesis has become a common practice among oral surgeons and dentists in the last three decades [
The resorption of the alveolar ridges in the posterior maxilla and/or the maxillary sinus pneumatization often limits the available bone for positioning dental implants. To overcome these problems, the use of short implants or maxillary sinus floor lifting in association with dental implants is well documented and proved as successful procedures [
Implant displacement/migration in the paranasal sinuses, resulting from wrong planning or surgical inexperience, have been reported sporadically in the literature [
Implant migration into the sinuses may be followed by no relevant signs and symptoms of infection, but it can be associated with oroantral communication and/or infection that may involve the maxillary sinus and the ethmoidal, frontal, and sphenoid sinuses. These displaced foreign bodies should be removed as soon as possible to prevent such complications [
The major complication due to a foreign body in the maxillary sinus reported in the literature is sinusitis, that may bring more serious conditions such as pansinusitis, panophthalmitis, and orbital cellulitis [
Two main treatment modalities have been proposed for the removal of displaced implants in the sinuses and to treat the associated infectious complications: an intraoral approach with the creation of a window in the anterior-lateral wall of the maxillary sinus and a transnasal approach with functional endoscopic sinus surgery (FESS) [
A 47-year-old man was referred to our department for treatment of a displaced dental implant, installed by an oral surgeon in a private dental office 30 days before, and migrated immediately after surgery into the maxillary sinus.
The CBCT scans showed a dental implant displaced in the maxillary sinus roof, with no evidence of sinusitis (Figures
CBCT scans showing a dental implant displaced into the maxillary sinus.
CBCT scans showing a dental implant displaced into the maxillary sinus.
An intraoral approach consisting im the elevation of a mucoperiosteal flap and the creation of a bony window pedicled to the Schneiderian membrane was adopted.
The patient was operated under local anesthesia. An oral antibiotic prophylaxis (amoxicillin + clavulanate, 2 g) was administered one hour prior to the start of the procedure.
The surgical intervention began with the elevation of a trapezoidal full-thickness mucoperiosteal flap. The buccal aspect of the flap was then retracted with the aid of Langenbeck’s retractor to improve the access and visibility of the maxillary sinus bony wall. A traditional rotary instrument (low-speed straight handpiece and fissure bur) was used to drill the maxillary bone with four holes (Figure
Four holes are performed after the elevation of a full-thickness flap.
The osteotomy is performed by means of a piezoelectric instrument.
The bony window is left pedicled to the Schneiderian membrane.
The bone lid was then rotated upward; the implant was identified and removed with a surgical aspirator (Figures
The implant is perfectly visible lying on the sinus floor.
The implant is removed with a surgical aspirator.
The bony segment is repositioned and secured with absorbable sutures.
Antibiotic therapy with amoxicillin and clavulanate (1 g) was prescribed in association with nonsteroidal anti-inflammatory drugs. Chlorhexidine mouth-washes were associated to the usual oral hygiene manoeuvres for seven days. Postoperative recovery was uneventful. After seven days, the patient went through an examination and the sutures were removed. At this time, a panoramic X-ray was taken (Figure
Panoramic X-ray after the intervention.
Surgical removal of dental implants from the maxillary sinus is not a very common oral surgery intervention. The approach proposed in this study (intraoral) is limited to the cases that do not need treatment of an obstructed maxillary sinus ostium and concomitant sinusitis of other paranasal sinuses.
Osteotomies for the bony window creation can be performed with traditional rotary instruments, or with piezoelectric instrumentation. The first method is widely used and very well documented, and it allows a fast and effective osteotomic path design. Piezoelectric instruments have been recently introduced, and they use microvibration of the surgical inserts at ultrasonic (27 to 29 kHz) frequencies to perform cutting of the hard tissues. These instruments demonstrated good cutting properties on cortical bone, allowing at the same time the preservation of soft tissues from damage in case of accidental contact [
There are few works reported in the literature about implant migrations into the paranasal sinuses (Table
Treatment options proposed by different authors.
Author | Implants displaced | Anatomic structures involved | Symptomatology | Treatment applied |
---|---|---|---|---|
Kluppel et al., 2010 [ |
2 | Maxillary sinus | Absent | One removal, one followup |
Felisati et al., 2007 [ |
1 | Maxillary and sphenoid sinuses | Absent | Removal (endoscopy) |
Galindo et al., 2005 [ |
2 | Maxillary sinus | Absent | One removal, one followup |
Kitamura, 2007 [ |
1 | Maxillary sinus | Present | Removal (endoscopy) |
Raghoebar and Vissink, 2003 [ |
1 | Maxillary sinus | Absent | Removal + bone graft |
Iida et al., 2000 [ |
1 | Maxillary sinus | Absent | Removal |
Regev et al., 1995 [ |
3 | Maxillary sinus | Absent | Removal |
Regev et al. [
Iida et al. [
Raghoebar and Vissink [
Kitamura [
Galindo et al. [
Kluppel et al. [
In the literature, we can find three possible explanations of the implant migration: bone resorption caused by wrong distribution of occlusal forces; changes in nasal air pressure; inflammatory reaction around the implant (peri-implantitis).
The majority of the authors seem to agree that the removal of a displaced implant from the sinus should be performed to avoid the possibility of development of sinus infections.
The migration of dental implants into the maxillary sinus is rarely reported. Migrated implants should be considered for removal in order to prevent possible sinusal diseases. The removal of displaced implants in the maxillary sinus with a buccal approach by means of a bony window creation proved to be a safe and reliable technique.