The History Of Materials Health And Social Care Essay

12: The

patient had a history of an acute sinusitis attack 6

weeks ago. Maxillary sinus floor was augmented by means

of internal technique in the first molar region

on the left side using 0.5 gr xenograft (BioOss®,

Geistlich Sons Ltd) and an implant in a diameter

of 4.1x12 mm (ITI®, Straumann) was placed

(Figure 2). No complications occurred during the

surgical procedure. Four weeks after the surgery,

the patient had pain on the region of the implant

inserted with the internal lifting procedure. Clinical

examination showed postnasal drip, swelling and

hyperemia on the operated side. Full opaque appearance of left maxillary

sinus on the panoramic radiograph confirmed the

acute maxillary sinusitis

Finally, the implant was extracted and a purulant

fluid was drained from the implant socket. A

new implant in a diameter of 4.1x12 mm (ITI®,

Straumann) was inserted to the canine region


1. The

patient was treated with an autogenous onlay corticocancellous bone graft, harvested

from the iliac crest, affixed to the anterior maxilla, and placed through a labial

vestibular incision. Six months later, three Brånemark implants (Nobelpharma AB,

Gothenburg, Sweden) were placed in the anterior maxilla. Two months after implant placement, one of

the implants had been expelled through the nose upon sneezing. A panoramic

radiograph revealed that only one of the three implants remained in the surgical site.

In addition to the expelled implant, another implant had been dislodged into the right

maxillary sinus

2. A 67-year-old woman presented to the OMFS Clinic requesting a consultation

regarding failure of maxillary implants previously placed by her private dentist.

Approximately 1 year prior to her presentation, she had undergone placement of two

implants on each side of the posterior maxilla. Immediately after implant placement,

pain in the right maxillary area developed. The right maxillary implants were

removed, along with a significant amount of bone, resulting in an oroantral fistula,

which was surgically closed. The extent of the defects in the bony floor and the

lateral wall of the right maxillary sinus precluded the possibility for further bone


13. Eight patient histories illustrating maxillary sinus– related complications, such as

pain, infection, implant migration, and bone loss associated with maxillary

endosseous implant reconstruction, are reported herein

The patient was treated with bilateral sinus-lift procedures with autogenous iliac-crest bone grafts in preparation for subsequent endosseous implant placement. Six months later, endosseous implants were placed in the maxilla bilaterally, and

in the left mandible (Fig 3b). Following placement of the implants, the patient

developed pain and swelling in the right maxilla. Radiographic evaluation revealed

that the implants appeared to have a bony interface with no evidence of bone

resorption. The local vestibular swelling responded to antibiotic therapy; however,

the patient developed persistent pain and tenderness with signs of chronic infection.

Consultation with an otolaryngologist was obtained. In an exploratory Caldwell-Luc

surgical procedure, the implants appeared covered by bone and were clinically

osseointegrated. A 1.5-cm, sphere-shaped foreign-body mass composed of a black

material was curetted from the maxillary sinus. The inflamed contiguous mucosal

lining was removed as well.

The pathology and microbiology reports of the removed material were consistent

with aspergillosis (Fig 3c), which is sensitive to amphotericin B. The patient was

JOMI on CD-ROM, 1995 Apr (451-461 ): Maxillary Sinus Complications Related to End… Copyrights © 1997 Quinte…

initially treated intravenously with amphotericin B and then orally with itraconazol

100 mg per day for 6 weeks. To date, the pain and discomfort have not resolved, and

the patient has had two more exploratory surgical procedures demonstrating no signs

of acute infection. The implants are stable and appear to be covered with bone and

osseointegrated, clinically and radiographically. A bone scan (technetium –99

diphosphate) revealed an area of increased activity in the right maxilla. However, a

white blood cell gallium scan (Ga67) indicated a noninflammatory process in the

right maxilla. At the request of other consulting physicians, the right maxillary

implants were removed. The pain has not been resolved and it has been diagnosed as

being neurogenic in origin.

4 ,5….. as like other cases.

6. A 66-year-old woman with a history of fibromyositis and muscle amplification

syndrome, for which she was taking prednisone 5 mg every other day, had 10- and

7-mm Brånemark screw-type implants placed in the left posterior atrophic maxilla (

Fig 6). Six months after implant placement, only the more anterior implant had

integrated, while the posterior implant required removal. Three months later, another

implant, 10 mm in length, was placed more anterior to the failed implant. This

implant had penetrated the floor of the maxillary sinus but did not produce any sinus

symptomatology. Six months later, this implant was uncovered, and during the

attempt at abutment connection, the implant was dislodged into the maxillary sinus.

The implant was retrieved through the implant-preparation site and did not require a

Caldwell-Luc approach for retrieval. The wound was closed primarily and healed


7….nothing special

8. bilateral

maxillary sinus-elevation surgery was performed with augmentation using an

autogenous tibial bone graft (Fig 8b). Suppurative drainage 3 weeks postoperatively

was detected in the maxillary ridge. The culture report revealed Escherichia coli.

Treatment with oral amoxicillin with clavulanate potassium was initiated, but the infection persisted. Surgical debridement and removal of the bone graft from the left

maxillary sinus was required

15.. Four grams of bone graft

material (irradiated cancellous particulate

allograft bone; Rocky Mountain

Tissue Bank) was placed into the sinus lift

cavity. A collagen membrane (Conform,

Ace Surgical Supply, Brockton, MA)

was placed over the lateral aspect of the

bone window. The flap was replaced,

and 4.0 nonresorbable suture material

(Cytoplast PTFE; Osteogenics Biomedical,

Lubbock, TX) was used to stabilize

the flap. This patient was prescribed 150

mg clindamycin four times per day for

10 days and 0.75 mg dexamethasone

four times per day for 6 days. The

patient started these medications one

day before surgery. 2 weeks after the

surgery, the patient reported pain and

discomfort, with drainage from his nasal

cavity on the operative side. Yellow mucus discharge from the

right nostril was cultured in standard

transport media. A mixture of aerobic

and anaerobic bacteria was noted. The

patient was prescribed clindamycin

300 mg along with metronidazole 250

mg to reduce the possibility of having

anaerobic bacterial infection. The patient

showed no improvement, and he

was then prescribed tetracycline 500

mg, for 10 days. On the second day of

taking tetracycline (21 days after the

surgery), the patient reported swelling

in the right maxillary sinus area. There

was also pain on palpation, malaise,

and fever.

After several weeks, the intraoral

soft tissue stoma had closed. Under

local anesthesia, a full-thickness flap

was reflected over the right maxillary

sinus wall, and access was made

through the previous lateral window.

Findings included showed frank pus

accumulation and unattached bone

grafting material. The area was curetted

and irrigated with saline. Suturing

was done using a 3.0 PTFE with interrupted


The otolaryngologist performed an

endoscopic examination under general

anesthesia (Fig. 3). Findings were consistent

with stenosis of the right maxillary

sinus ostium (Fig. 4). Balloon catheterization

and widening of the ostium were

completed (Fig. 5). Cultures were taken

during the surgery, and the sinus was

examined using a fiberoptic probe.

These cultures had shown presence of

Prevotella species and were identified

as Prevotella melaninogenica. The base

of the Schneiderian membrane on the

other hand appeared intact. No other abnormalities

were noted.

The patient did improve after the

procedure and was less symptomatic.

Two months later, the patient developed

copious clear mucus discharge

from the right nasal cavity and also

noted tenderness of the right maxillary

sinus. In addition, he reported intermittent

blockage of the right nasal airway

and difficulty with air flow

through the right nasal passage. Under

local anesthesia, the oral and maxillofacial

surgeon elevated a fullthickness

mucoperiosteal flap over the

right lateral aspect of the maxilla. The

previous lateral window was used to

gain access into the base of the sinus.

The window was enlarged, and a thorough

curettage of the graft material

was done. Multiple sinus polyps and

grafts material attached to the thickened

Schneiderian membrane were

removed (Fig. 6). The sinus was thoroughly

irrigated, The

patient showed remarkable improvement

(Fig. 7) and was symptom free on a

1-year follow-up.

16. Discussion

17. literature review…discussion

18. discussion with ENT prospect….clinical study..very good….

Have to do correction on cases reported for failure

19. Twenty-six of the total 34 implants inserted

failed, of which 7 were displaced into the sinus. All patients had maxillary sinusitis, and 2 also had an inflammation of

other paranasal sinuses. Ten patients presented with an oroantral fistula. Review of the files of the referring practitioner

revealed the preoperative presence of chronic maxillary sinusitis in 4 patients and an odontogenic cyst in 1. Caldwell-

Luc operation served as the definitive surgical treatment.

20 n 21. normal article

22. The implants placed in the augmented sinus were clinically

healthy and the implant-supported restorations had been

functioning successfully at 17 months after initial loading.

Unexpectedly, the patient visited the dental clinic with the

chief complaints of pain on biting in the upper right 2nd premolar

(#15) since he had eaten hard food 3 days earlier. The

#15 tooth was diagnosed as cracked and endodontic therapy

was required. During endodontic therapy, a CT scan was taken

to locate the buccal canal of the tooth. Peri-implant radiolucency

in the apical portion of the implant placed in the augmented

maxillary sinus was found by accident in the CT scan

although a conventional (panoramic) radiograph revealed no

signs of peri-implant radiolucency (Fig. 9). This was after a

healing period of 32 months since sinus augmentation. The

fortuitously discovered radiolucent portion can be described

as incomplete bone formation or bone cavity in the augmented

maxillary sinus. Nevertheless, the dental implants that were placed in the grafted sinus had been functioning well

after prosthetic loading for more than 60 months and no enlargement

of the bone cavity was found in follow-up radiographic

views (Fig. 10). The patient has had no subjective

symptoms such as discomfort or pain in the #16i and 17i area

and has been receiving follow-up care on a regular basis.

24. A 43-year-old white man came to our private

practice office with a chief complaint of a

mucosal trauma on the left posterior maxillary

region caused by the prosthetic rehabilitation

of movable overstructure, placed and

loaded on dental implants 8 years ago. A

careful clinical examination showed the

disappearance of an abutment on the

posterior left side of the maxilla and the

absence of the implant from the same area,

though the housing on the overdenture was

clearly seen. The conventional panoramic

and Water’s radiograph revealed migration

of the dental implant into the left maxillary


After the raise of an atraumatic buccal full-thickness flap and the the implant was

detected under direct vision and removed

with forceps through the osseous window of

the osteotomy

The histologic examination showed no

inflammatory signs connected to the migrated

implant. The pathogenesis of migration of an implant

into the maxillary sinus is difficult to explain,

but 3 probable mechanisms include the

changes in intrasinal and nasal air pressure,

an autoimmune reaction to the implant

causing peri-implant bone destruction and

compromising the osseointegration, and a

bone resorption produced by an incorrect

distribution of occlusal forces

Treatment modalities for removal of a

migrated dental implant initially included the

conventional Caldwell-Luc (C-L) procedure,16

27. A 52-year-old woman was referred to us with a displaced

dental implant in her left maxillary sinus. The left cheek had started to swell and serous discharge

had developed from the implant site a month before.


presented with pain in the cheek and a postnasal drip. Computed

tomography (CT) of the paranasal sinuses showed a

1 cm metallic foreign body, which was thought to be the dental

implant (Fig. 1). Under local anaesthesia we approached it

endoscopically through the middle meatus of the nasal cavity.

28. A 45-year-old systemically healthy female

patient was referred to us with a displaced

oral implant in her spheno-ethmoidal recess.

The patient had undergone an implant

placement procedure 15 days back for

the substitution of the left upper first molar

with a screw-type oral implant. Despite the absence of

symptoms, it was decided to remove the

implant, to prevent potential obstruction

or infectious complications of the sphenoid

sinus. Under general anesthesia with orotracheal

intubation, the patient underwent

endoscopic removal of the displaced

implant via a transnasal approach

29. A 44-year-old female presented with a two day history of unilateral

facial pain and a puffy left malar region. Two weeks

before she had three osseointegrated implants screwed into the

left upper alveolus by her dentist for future use with a permanent

dental plate as described by Branemark et al. (1977). Her

upper alveolus had remained tender since insertion of the

implants and on examination was erythematous and swollen

with no sign of the implants. There was pus filling her left nasal

cavity. Occipito-mental and lateral sinus X-rays (Figs. 1, 2)

showed an opaque left maxillary antrum containing two dislodged

implants. An orthopantomogram (Fig. 3) showed the

third implant in place but complete loss of upper alveolar bone

laterally where the other two implants had been inserted. The

three implants were removed via a sublabial antrostomy with

an extended buccal mucosal flap, the infected bone of the

upper alveolus was curetted and an intranasal antrostomy was

fashioned. A mixed culture of Haemolytic Streptococci group F

and mixed anaerobes was grown from the aspirated pus;

30. 26 patients presented with displaced

implants in the maxillary sinuses. 1

patient presented with an implant that

was originally displaced in the maxillary

sinus, but due to delay in treatment,

underwent spontaneous migration toward

the sphenoid sinus and penetrated its