Surgical Strategy For Removal And Sinus Bone Graft With Simultaneous Implant Placement
A 63-year-old man who complained of pain on the left cheek area was referred from local dental clinic for removal of a displaced dental implant which was placed 3 years ago. Panoramic radiograph, cone beam computed tomography scans disclosed a dental implant in the left maxillary sinus with mucosal thickening maxillary sinusitis . The operation was done under local anesthesia. The surgical intervention began with elevation of full-thickness mucoperiosteal flap. After exposure of lateral wall of the maxillary sinus, the bony window was marked by ditching with a round bur. The size of bony window was vertically wider than usual bony window in maxillary sinus elevation. The upper portion is for removal of the displaced implant, while the lower portion is for lifting of the maxillary sinus membrane . Following exposure of the sinus membrane and removal of the bony window, a horizontal incision is placed at the upper portion of the bony window. Through this opening, the implant is removed using dental suction. Then, the sinus membrane is lifted, starting from the lower edge of the bony window. The perforated sinus membrane is covered with absorbable collagen membrane, and the new implant is placed simultaneously with sinus bone grafting using a mixture of graft from the maxillary tuberosity and allograft .
Fig. 1
Sinus Lift Recovery Time
Immediately after your surgery you may experience swelling in the area and bleeding from your mouth or nose. You’ll probably feel uncomfortable for a few days afterwards, but most patients don’t experience major discomfort. If any bleeding continues for more than two days, or pain and swelling get worse, you should contact your dentist immediately.
There is a risk of the sinuses becoming infected, but your dentist will give you medication to protect against this. You’ll have to be careful not to sneeze or blow your nose heavily since this can move the bone graft material or dislodge your stitches. If you are prone to allergies, your surgery will probably be scheduled for a time of year when these won’t flare up.
After 7-10 days you’ll return to your dentist so he can check the progress of your healing and remove your stitches, if they haven’t dissolved by themselves. You’ll have several more visits during the healing process to check everything is going as planned.
You need to take care to protect the area that has undergone surgery. The sinuses are particularly susceptible to damage while you recover. The following tips will aid healing from a sinus lift:
There are also some everyday actions and activities you should avoid:
Dr Eyad Tariq
In the video below, Dr. John Thousand IV describes what you should do after sinus lift surgery, and what you can expect during your sinus lift recovery experience.
Overloading Of Dental Implants
What: Overloading is the term given to dental implant failure caused by undue pressure, or forces placed on the protruding abutment and/or crown. These forces can easily disrupt the osseointegration process.
How: Your dentist may sometimes decide to perform immediate loading during a dental implant procedure. Immediate loading is a one-stage treatment method where the crown and abutment are placed on the dental implant right after the implant is surgically inserted .
This is an acceptable treatment plan in certain cases, as long as the biting forces are properly managed. When applied in the wrong situations however, this can lead to the failure of dental implants.
Causes: Patients who suffer from bruxism can cause overloading on dental implants.
How to prevent: It’s common for your dentist to recommend loading the implant with a crown 3 – 6 months after the implant surgery is done, to ensure that the healing is complete. This avoids subjecting your dental implant to the stress of biting and chewing.
Your dentist may also recommend wearing a mouthguard at night to minimise excessive grinding forces on the dental implants.
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Late Symptoms Of Dental Implant Failure
While some dental implant failures present symptoms in the first few months, other problems can appear several years down the line. If you experience any of the symptoms mentioned above as well as the symptoms mentioned below, its important to contact your oral surgeon.
Nerve or Tissue Damage
When an implant is placed too close to a nerve, you might feel a tingling or numb sensation in your face, tongue, lips, and gums. This can impact your ability to eat and drink normally and should never be ignored.
Foreign Body Rejection
Sometimes, the body rejects foreign objectsincluding things like organ transplants, prostheses, and replacement teeth. If you experience pain, inflammation, chills, or fever even years after your dental implant surgery, your body might be rejecting the titanium alloy implant.
Protruding Implant
A trauma, poor planning, or changes to your facial structure can lead to a dental implant that protrudes into the sinus cavity. This can usually be resolved with a sinus bone graft and a new implant that is placed after a long gap for healing.
Facial Injury
Trauma to the mouth or face can knock artificial teeth loose just as they can knock out your natural teeth. See your surgeon immediately after the accident to find out whether the tooth replacement can be saved and to replace any newly missing teeth.
Consider A Second Opinion
After you speak with your dentist, we suggest that you consider scheduling an appointment for a second opinion. A dentist with advanced training and experience in implantology, an oral surgeon, or a periodontist can review your x-rays, and examine your implant site to determine the issues involved and recommend treatment.
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Facts About Dental Implants And Sinus Perforation
November 30, 2018 by AllSmiles
Dental implants can be a lifelong solution for replacing missing teeth. But care must be taken to ensure precise placement and adequate bone support. Sometimes sinus perforation occurs during dental implant surgery. What can be done to prevent it? And what should you consider if its already happened to you?
How To Prevent Discomfort In Your Dental Implants
Dental implants require regular cleanings, dental checks, and careful home care to prolong their lifespan. Brushing lightly around your dental implants may stop an infection from occurring. Your dentist may recommend using an interdental toothbrush to clean hard-to-reach areas around your teeth, gums, and implants.
Regular dental checkups help ensure the long-term stability and function of your health. Getting professional dental cleanings can help remove bacteria from below the gum line and prevent infection.
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Dental Implant Surgery Standard Of Care
Dental implants need enough bone to fuse to and remain stable.
High-quality implant surgery requires the surgeon to take x-rays. Most successful oral surgeons use three-dimensional x-rays to ensure there is enough bone density to support dental implants and maintain stability.
3D x-rays will also reveal your facial structure, nerves, and sinus cavities and assist in performing surgery with precision. 3D x-rays help anticipate the need for sinus lift, or sinus floor elevation, and bone grafting before dental implants are placed. A 2010 article in the Journal of Oral implantology reports that in one study of patients who received minimally invasive sinus lift surgery, there was a 97% implant success rate.
No Room Too Tight For Implants
Sometimes there is just not any room for dental implants. I have placed thousands of implants so I can certainly tell you that there are times that having an implant would create more problems. That being said, dental implants are still the absolute best replacement for a missing tooth or teeth when done correctly.
When there is no room for an implant it is usually because the roots of the teeth have tilted into the space. Sometimes the top part, we called the crown of the tooth has tilted in as well. To have a successful single tooth implant or even multiple the other teeth need to be mostly upright. If there is no space than you create some of the space for implants to be properly inserted into the bone.
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Perforating The Maxillary Sinus With An Implant: Comments
Dr. Z. asks:
I have a question which may be rather naive for the experienced implant surgeons. What is wrong with perforating the floor of the maxillary sinus with an implant? The implant will engage two cortical plates which should provide greater initial primary stability. This should be especially helpful in Type IV bone. Will bone grow up from the floor of the maxillary sinus to eventually cover the implant? I have attended lectures where plastic surgeons have demonstrated procedures where they perforate the maxillary sinus with screws when doing reconstructions. They do not seem to be as concerned as we are about the problems that perforations might cause. Any comments?
Taking Care Of Implants
The best way to ensure the success of a dental implant is to follow the aftercare advice the surgeon provides.
After undergoing DIS, a person should avoid hot food and drinks while numb and stick to a soft food diet for at least a few days. It is also important to avoid strenuous exercise for 23 days to prevent increased blood flow and associated swelling of the area.
As with a persons natural teeth, an implant and the tissues surrounding it require regular cleaning. A person should floss the area at least after the gums have healed and use interdental brushes to access areas that are more difficult to reach.
People should also schedule regular dental check-ups and appointments for cleaning areas below the gum line.
People who smoke may wish to consider quitting, as this will reduce the risk of complications from DIS.
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When To See A Doctor Or Dentist
Following DIS, a dentist may prescribe antibiotics to help prevent infection. A person may also require an over-the-counter or prescription pain reliever to help alleviate any pain.
Any swelling or bruising should subside within a few days of the surgery. However, if pain and swelling persist beyond a week, the person should book a follow-up dental appointment.
The process of initial healing takes a few weeks, and full osseointegration can take months. A person should seek medical attention if their dental implants begin to move slightly or continue to hurt after a few weeks. Addressing the problem quickly is crucial to preventing complications.
Simple DIS usually only requires local anesthetics, so most people tend to have a relatively short recovery time.
However, some people may experience the following symptoms after DIS:
- pain at the site of the dental implant
- minor bleeding
- bruising of the gums or skin
- swelling of the gums or face
A dentist or oral surgeon will advise that the person gets plenty of rest following the procedure. They may also recommend a temporary diet of soft foods and the application of an ice pack to the affected part of the face to help alleviate inflammation and swelling.
Discomfort levels may vary from person to person and depending on the number of implants the surgeon placed. However, taking acetaminophen or ibuprofen should be sufficient to alleviate any pain. Pain medications are usually necessary for 23 days after the procedure.
Nasal And Maxillary Sinuses
Clinical findings
None of the patients showed any signs or symptoms of rhinitis or sinusitis during follow-up. All patients maintained good oral hygiene without pain or implant-related exudates.
Radiographic findings
Comparison of the radiographs obtained at 6, 12, and 18 months with those obtained at baseline did not reveal any inflammatory reactions at or around the implants, signs of osteolytic reactions, polyps or granulation around the implants inside the sinuses, lost implants, or implant fractures. All implants showed newly regenerated bone surrounding the threads, indicating an increase in the bone-to-implant contact despite the different penetration depths .3]. For those implants that merely penetrated or disrupted the sinus membrane, it was found that the membrane had healed and tended to cover the implant tips .b]. When the implant penetrated the maxillary sinus deeply, there was still an increase in bone contact around the implant in these cases, the membrane healed around the tip of the implant but did not cover it .
Cone-beam computed tomography scans showing an implant that just barely made contact with the Schneiderian membrane. Immediately after implant insertion. At the 18-month follow-up visit. There are no inflammatory reactions at or around the implant, no signs of an osteolytic reaction, no polyps, and no granulation around the implant inside the sinuses. The implant shows an increase in boneimplant contact
Peri-implant soft tissue
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Sinus Lift Surgery For Teeth Implants: Procedure Costs And More
Being told you need a sinus lift before getting tooth implants may seem daunting, but there is no need to worry. It’s a relatively common restorative surgical procedure that can make it possible for you to have implants even after suffering bone loss.
Here you can read all about what a sinus lift for implants involves, what sinus surgery costs in the US, and what to expect afterward. Don’t miss our tips for reducing the cost of the procedure it’s possible to save hundreds if you know how!
What Is A Sinus Lift
A type of sinus surgery known as a sinus lift is often performed before a person gets dental implants. A sinus lift is a form of bone grafting that is designed to strengthen the jaw. As its name suggests, the dentist lifts the sinus tissue away during the surgery so that there is space for them to insert the bone graft.
A bone graft can come from your own body, a donor, or it can even be synthetic. In our practice, the use of growth factors from the patients own plasma is routine in all sinus lift surgeries to enhance the rate of healing as well as the end result. How much bone a dentist places in the area depends on how thick the bone is to begin with, but usually a few millimeters of bone is positioned in the area.
Theres usually a waiting period between a sinus lift surgery and the positioning of dental implants, although a significant number of cases can be done simultaneously. The waiting period gives the grafted bone time to fully mesh with the existing bone. This helps bond both the tissue and jaw.
Although there are often several months between the sinus lift surgery and the implant, in some cases it is possible for a person to have both at the same time. In those cases, a patient needs to already have a sufficient amount of bone in the jaw to support an implant while the grafted bone fuses in place.
Augmenting the sinus is frequently necessary for dental implants. This type of surgery is used for people of all ages and is not affected by oral hygiene.
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Complications Associated With Dental Implant Displacement Into The Maxillary Sinus
Dental implant displacement into the maxillary sinus may be an intraoperative or postoperative complication. The displaced implant can disturb the anatomy around the maxillary sinus and inhibit mucociliary clearance by the cilia in the sinus membrane . Furthermore, mucosal thickening may occur, and scattered bone graft material may obstruct maxillary ostium to result in maxillary sinusitis and congestion .
In the event of maxillary sinusitis and blockage of the ostium, an oroantral fistula can develop . Alberto et al. described that accidentally displaced implants can also migrate from the maxillary sinus to the upper structures such as the paranasal sinuses, orbital floor, or cranial fossa through mucociliary clearance against the force of gravity, changes in the air pressure of the nasal cavity, a foreign body reaction, and local tissue necrosis .
Some studies have described that implants displaced into the maxillary sinus may not result in maxillary sinusitis . Galindo-Moreno et al. reported two cases of antral implant migration. The migrated implant that had been left behind on request of the patient showed no signs of clinical complications at 4-year follow-up visit . On the other hand, Regev et al. and Raghoebar et al. suggested that the displaced dental implants in the maxillary sinus result in chronic maxillary sinusitis because of a foreign body reaction and need to be eliminated through surgical intervention, even if the patient is asymptomatic .
How Common Are Sinus Problems After Dental Work
Sinus problems rarely occur after dental work. Bone grafts used before an implant are a successful way to minimize the likelihood of infections and inflammation. Complications can arise if post-care instructions are not followed, but this is largely preventable.
In the case of a problematic implant, removing the implant allows a dentist to start fresh with the patient. It might be that not enough bone was grafted into place before the first implant surgery.
After removing the affected implant, a dentist can perform a bone graft or sinus lift. Once the grafted bone is firmly in place, a new implant can be positioned. This should solve the patients problems. Preventing sinus problems is often easier than fixing them after the fact. If youre missing a tooth in your upper arch and are concerned about how the placement of an implant would affect your sinuses, contact Dr. John Paul Gallardo in Miami, Florida. Our dental specialists can walk you through all the options to help you decide which course of action is best for you. Our dental professionals expertise can not only restore your smile but also provide long-lasting and comfortable results. To schedule an appointment, call 305-547-8687 today.
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