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References

Ding X, Wang Q, Guo X, Yu Y. Displacement of a dental implant into the maxillary sinus after internal sinus floor elevation: report of a case and review of literature. Int J Clin Exp Med. 2015; 8:(4)4826-4836
Kluppel LE, Santos SE, Olate S, Freire Filho FW, Moreira RW, de Moraes M. Implant migration into maxillary sinus: description of two asymptomatic cases. Oral Maxillofac Surg. 2010; 14:(1)63-66
International Team for Implantology. SAC Assessment Tool. https://www.iti.org/?a=1&t=0&y=3001&r=0&n=188&i=&c=25&v=page&o=&s (02/08/2015)

‘Don't bite off more than you can chew’

From Volume 42, Issue 7, September 2015 | Page 688

Authors

Srinivas Sulugodu Ramachandra

Department of Periodontics, Kanti Devi Dental College and Hospital, Mathura, Uttar Pradesh

Articles by Srinivas Sulugodu Ramachandra

Haydar Majeed Mahdey

Faculty of Dentistry, SEGi University, Malaysia

Articles by Haydar Majeed Mahdey

Article

A male patient aged 40 years reported for a routine dental check-up to the Faculty of Dentistry, SEGi University, Malaysia. The patient requested oral prophylaxis and replacement of a missing maxillary left first molar. He reported that a dental implant had been placed three years previously which was ‘hidden in the gums’ around the maxillary left first molar region. An intra-oral peri-apical radiograph was taken around the edentulous maxillary left first molar area (Figure 1) and showed a dental implant in the left maxillary sinus region. Since the implant does not have a cover screw, it can be assumed that the implant was pushed into the maxillary sinus during surgical placement. The patient was informed by an earlier dentist that dental implant treatment had failed and would not cause any problems since the implants were made of biocompatible titanium. Even though the patient was asymptomatic, he was informed about the possibility of the occurrence of maxillary sinusitis and the need to get the implant removed. The patient was referred to an Ear Nose and Throat (ENT) specialist for further evaluation and treatment.

Figure 1. Intra-oral periapical radiograph showing an implant of standard dimension present in the maxillary sinus. The implant does not show any cover screw and minimal height of bone can be seen in the maxillary left first molar region.

There have been cases published in scientific literature wherein dental implants displaced into the maxillary sinus have been removed successfully or even followed for considerable periods of time asymptomatically.1,2 In this particular case, even after accounting for ridge resorption and possible hyperpneumatization of the maxillary sinus, there is simply no bone to place an implant of standard dimensions. The possible reasons during surgical implant placement which led to the current situation in this patient would be highly speculative. However, one thing is clear, that the previous dentist had attempted a case which was probably more complex than he could have handled. Dental implant companies and their vendors over-simplify the complex process of implant case selection. Non-profit organizations, like the International Team for Implantology(ITI), have clear-cut guidelines and assessment tools which can be used freely online to identify the degree of complexity and the potential risk involved in individual cases.3 Cases can be categorized into straight forward, advanced and complex (SAC) categories after assessing the surgical and restorative areas using the SAC assessment tool.3 Usage of this assessment tool will clearly demarcate cases into SAC categories so that dentists can operate on cases which match their skills and level of experience.