This document discusses the treatment of dental implant displacement into the maxillary sinus. It begins with the anatomy and functions of the maxillary sinus. Common factors that can lead to sinus perforation during implant placement are then outlined, such as thin alveolar bone or pneumatization of the sinus. Complications from displacement include sinusitis, infection, and migration of the implant to other areas. Management involves radiographic and surgical evaluation, with the implant typically being immediately removed using a Caldwell-Luc procedure. Antibiotics may be prescribed beforehand, and the patient is followed up with CBCT scans and later implant placement after healing.

1. Treatment of dental implant
displacement into the
maxillary sinus
Dr vikram
MDS prosthodontics
BHU

3. Content
 Anatomy of maxillary sinus
 Function of maxillary sinus
 Factor responsible for sinus perforation
 Complication of implant placement
 Management
 Follow up

4. ANATOMY:
It is the largest Paranasal Sinus.
Communicates with other sinuses through lateral Nasal
Wall.
Shape- Pyramidal
Average Dimensions
Height- 36-45 mm Width- 23-25 mm Length- 38-45 mm
(Anterio-posterior Axis )
Average Volume- 15 mL (9.5-20mL)

5. Boundaries:
 Anterior Wall- Extends from Inferior Orbital Rim to
Maxillary Alveolar Processes.
 Superior Wall- Floor of the Orbit (very thin)
 Posterior Wall- Seperates Maxillary Sinus and Pterygo
palatine Fossa
 Medial Wall- Lateral Wall of Nasal Cavity

6. FUNCTIONS:
 Lightening the weight of the skull.
 Humidification and warming of inspired air.
 Assisting in regulating intranasal pressure.
 Lightening the skull to maintain proper head balance.
 Imparting resonance to the voice.
 Absorption of shocks to the head.
 Filtration of the inspired air.

7. Factor responsible for sinus
perforation
 Severe maxillary sinus pneumatization
 Thin residual alveolar bone .
 Biting forces on the implant prosthesis
 Displacement can occur more often in patients who
undergo simultaneous implant placement
 Bone grafting after sinus elevation
 Sinus elevetion technique

8.  Galindo et al. stated that differences in the air pressure
between the maxillary sinus and nasal cavity and an
autoimmune reaction to dental implants, which causes
bone resorption due to peri-implantitis, can also result
sinus perforation

9.  Other influencing factors include the
 lack of the primary stability,
 the surgeon’s lack of experience,
 temporary denture usage without relief
 Overostetomy
 Force

10. Complication of sinus lift
 Surgical complication like bleeding ,pain ,tenderness etc
 Mucosal thickening may occur,
 Scattered bone graft material may obstruct maxillary
ostium to result in maxillary sinusitis and congestion
 Oroantral fistula can develop .
 Maxillary sinusitis
 The bone graft is a dead space prone to infection
systemic antibiotic drugs do not enter the area until
revascularization

11.  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
a foreign body reaction, and local tissue necrosis

12. Management
 Radiographic evaluation
 Surgical evaluation

13. Radiographic

14. Treatment
 the basic principle for treatment is immediate removal of
the displaced implant
 If delay, amoxicillin with clavulanate and nonsteroidal
anti-inflammatory drugs need to be prescribed with
pseudopehpedrine hydrochloride for 1 week before
surgery
 ,CaldwellLuc procedure and conservative observation in
the absence of signs or symptoms

15. surgical intervention
 elevation of full-thickness mucoperiosteal flap
exposure of lateral wall of the maxillary sinus,
window by ditching with a round bur(divided in upper
and lower portion)
 The upper portion is for removal of the displaced implant,
 the lower portion is for lifting of the maxillary sinus
membrane

17. Follow up
 CBCT taken after 3-4 months later .
 The secondary surgery was done 6 months later after
implant placement.
 Prosthetic restoration of the implants was done in 2
months later.

18. 
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