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.