Case report
A healthy 48-years-old non-smoker male patient with no related systemic condition was referred to our department by his oral and maxillofacial surgeon in order to take a cone-beam computed tomography (CBCT) radiograph of an intruded implant into his right maxillary sinus. Six months ago, the patient had undergone open (window) sinus floor elevation surgery at the site of lost teeth 3,4, and 5 in order to rehabilitate the posterior free-end edentulous area. The dentist placed three implant fixtures on the corresponding sites three months later. The implants of teeth 3 and 5 were successfully placed with proper primary stability, but the implant of region 4 (maxillary second premolar) was displaced into the maxillary sinus because of the dentist’s miscue and improper insertion. Afterward, the dentist sutured over the region of intruded implant, informed the patient, and referred him to an oral and maxillofacial surgeon to remove the implant from his sinus. Whereas the dentist strongly recommended the patient to visit the oral and maxillofacial surgeon, the patient recoursed the oral and maxillofacial surgeon with a delay of three months and was instructed to take a new CBCT image of the displaced implant. Then, the patient was referred to our oral and maxillofacial radiology department to take a CBCT scan to inform the surgeon about the location of the migrated fixture.
No extra-oral or intra-oral signs or symptoms such as fever, discomfort, edema, erythema, or suppuration were observed in the clinical examination. 3D radiographic evaluation, revealed that the implant has migrated to the nasal cavity through the ostium of maxillary sinus and is trapped under the middle nasal concha in the middle meatus (Figs. 1&2). No further opacity or thickening of the sinus lining was observed in the right maxillary sinus (Fig. 3). The patient was informed of his situation and was referred to an otorhinolaryngologist for further interventions.
After complete infiltration of the nasal mucosa with local anesthetic solution, the ENT surgeon removed the migrated implant gently under endoscopy by nasal bayonet forceps and Iterson nasal hook through the right nostril. The patient had some nasal bleeding after surgery but no additional issues. The patient was given an antibiotic therapy of amoxicillin-clavulanate for seven days, as well as analgesics and nasal irrigation. Desired healing was observed at the two-week follow-up session, and the patient had no discomfort.
A writtent consent for publication of radiographic and demographic information of patinet has been obtained.