Braz. j. . vol.80 número4

BrazJOtorhinolaryngol.2014;80(4):359---361

Brazilian

Journal

of

OTORHINOLARYNGOLOGY

www.bjorl.org

CASE

REPORT

Late

displacement

of

a

dental

implant

into

maxillary

sinus

夽

Deslocamento

tardio

de

um

implante

dentário

para

o

seio

maxilar

Rodrigo

Nunes

Tavares

_,

_Alexandre

_Simões

_Nogueira

,

Marcelo

Bonifácio

da

Silva

Sampieri

,

Marcelo

Ferraro

Bezerra

,

Eduardo

Sanches

Gonc

¸ales

a_{FaculdadedeFarmácia,OdontologiaeEnfermagem,UniversidadeFederaldoCeará(UFC),Sobral,CE,Brazil} b_{FaculdadedeOdontologiadeBauru,UniversidadedeSãoPaulo(FOB-USP),SãoPaulo,SP,Brazil}

Received17July2012;accepted24November2012 Availableonline23May2014

Introduction

Dental implants can be accidentally introduced into the maxillarysinus bothduring andaftersurgical installation. Bothsituationsareuncommon andusuallyinducesinusitis orothersimportantcomplications.1_{Theaimofthepresent}

study was to report a rare clinical case of late displace-mentofadentalimplantintothemaxillarysinus,inwhich aCaldwell-Luc(CL)approachwasperformed, followedby thereconstructionoftheanteriormaxillarysinuswallusing atitaniummesh.

Case

presentation

A49-year-oldwomanwastreatedsixmonthspreviouslywith dental implants, and received three in the left posterior

夽 _{Pleasecitethisarticleas:TavaresRN,NogueiraAS,SampieriMB,}

BezerraMF,Gonc¸alesES.Latedisplacementofadentalimplantinto maxillarysinus.BrazJOtorhinolaryngol.2014;80:359---61.

∗_{Correspondingauthor.}

E-mail:marsampieri@hotmail.com(M.B.S.Sampieri).

maxilla. She was referred to this clinic since one of the threeimplantsdisappearedduringcasting.CTscanshowed whatappeared tobeadentalimplant locatedposteriorly andinferiorlyinsideofthemaxillarysinus(Fig.1A---C).The mucosafromthesinusdemonstratedimportantalterations; itsdensitywascompatiblewithacutesinusitis, corroborat-ingtheclinicalfindings,whichincludedairwayobstruction andmoderate facialpain. Therewas noevidence of oro-antralfistula. After antibiotic therapy for acutesinusitis, the dental implant was removed through a CL approach. Underlocalanesthesia, asmallsurgicalincisionwasmade onthebuccalsulcus.Theanteriorbonywallofthesinuswas exposed,andanaccesswasmadewithacarbideroundbur (Fig.1D).Thesinusmucosaaroundthedentalimplantwas resected,followedbyintensecleaning.Finally,theanterior wallofmaxillarysinuswasreconstructedusingatitanium mesh,whichwasfixatedbymonocorticalscrews(Fig.1E). Thepatient hasbeen followed upfor 32months, withno complications.

Discussion

Poor bone quality and quantity of the posterior max-illa,inadditiontoalveolar pneumatizationfrommaxillary

http://dx.doi.org/10.1016/j.bjorl.2012.11.001

360 TavaresRNetal.

Figure1 (A)TCaxial,(B)TCcoronal,(C)TCsagittal,(D)Calwell-Lucapproachand(E)reconstructionofthesinusanteriorwall withatitaniummesh.

sinus,arepredisposingfactorsforthedisplacementof den-tal implants.The majorrisk factor is inadequatesurgical technique, which includes overtreatment of the implant preparation,sinusfloorperforation,andpoorprimary sta-bility.Latedisplacementisrareandusuallyhappensduring thefirstsixmonthsafterimplantation.2_{Inthepresentcase,}

thedisplacementoccurredaftersixmonths,during manip-ulationoftheimplantforprostheticrehabilitation.

Thereareseveralmethods toremoveadentalimplant from the maxillary sinus, such as suction through bone alveolar defect, CL approach, functional endoscopy sinus surgery(FESS),andtransoralendoscopyapproachviacanine fossa.3,4_{Inthepast fewdecades,FESShasbeen replacing}

theCLapproachforthetreatmentofparanasalpathologies, since it has been more effective. Besides all its advan-tages, isolated FESS is not effective in removing larger materials,especiallythoselocatedintheposteriorand infe-rioraspectsofthesinus.5,6_{Thepresenceofanoral---antral}

communication,inflammatoryalterationsofsinusmucosa, and ostium patency also must be taken into account to choose the correct plan of treatment. The anterior max-illarysinus wallreconstructionbecomesimportant due to potentialcomplicationsfromtheCLapproach,suchas per-sistentbonedefectandretractionsofthesofttissuesofthe cheek.5,6_{Bonegrafts,guidedtissueregeneration,and}

buc-calfatpadhavebeenusedtodecreaseCLfailure.1_Forthis

purpose,atitaniummeshwasusedinthepresentcase.

Final

remarks

TheCLapproachisstillindicatedtoremoveobjectslocated posteriorly/inferiorly inside of the maxillary sinus, with additional care to reconstruct the bone defect created. Endoscopy procedures isolated or in association with the CL approacharealso proven tobe effective. The profes-sionalmusttake accountthesethreealternativesinorder tochoosethemostsuitableprocedure.

Conflicts

of

interest

Theauthorsdeclarenoconflictsofinterest.

References

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Latedisplacementofadentalimplantintomaxillarysinus 361

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4.ChiapascoM,FelisatiG,MaccariA,BorloniR,GattiF,DiLeoF. Themanagementofcomplicationsfollowingdisplacementoforal implantsintheparanasalsinuses:amulticenterclinicalreport and proposedtreatmentprotocols. IntJOralMaxillofacSurg. 2009;38:1273---8.

5.NakamuraN,MitsuyasuT,OhishiM.Endoscopicremovalofa den-talimplantdisplacedintothemaxillarysinus:technicalnote.Int JOralMaxillofacSurg.2004;33:195---7.