Implants in maxillary sinus
A 58-year-old man reported to the dental and maxillofacial clinic with complaint of heaviness over the right side of face and nasal discharge for the last 1 month. The history revealed multiple surgical episodes for implant placement at a dentist's clinic 4 months back, following which there was considerable discomfort and swelling over the right side of face which lasted 7-10 days. This was followed by loss of all implants over a period of 3 months.\nThe patient currently wore a complete tissue borne denture in maxillary arch. Intra-oral examination revealed considerable hard and soft tissue loss with lack of good bound-down keratinized tissue. Radiographic investigations by way of an orthopantomograph showed two implants in the right maxillary sinus with one of them close to the floor of the orbit []. A complete maxillary rehabilitation was planned for implant-supported prosthesis with bilateral sinus grafts and anterior maxillary onlay grafts under general anesthesia.\nOn raising a mucoperiosteal flap in the right maxillary sinus region a perforation was seen in lateral wall of the maxilla, the sinus membrane was tense and fluctuant []. The membrane was incised and spontaneous purulent discharge was observed, following which the membrane was curetted out [Figures and ]. Two implants were removed from the sinus encapsulated in granulation tissue.\nFollowing a through lavage, a double-layered cross linked type 1 collagen membrane with a delayed resorption pattern (Biomed, Zimmer Dental) was used to create an artificial membrane to contain the graft []. The membrane was secured by Titanium tacs (Autotac, biohorizons Inc.) on the medial wall of the sinus inferior to the ostium and brought out laterally and fixed with tacs to the lateral wall of the maxilla.\nA 50:50 mixture of autograft and xenograft (Bioss, Geistlich) was used mixed with Plasma Rich Protein to graft the sinus []. A second layer of collagen membrane covered the access opening to the sinus. The anterior maxilla was prepared and block autografts harvested from the symphysis were fixed using four lag screws and covered with a type 1 collagen membrane. Closure was achieved with suture 4,0 Mersilk suture and the patient discharged on antibiotics, analgesics, nasal decongestants, and oral rinses, 8 months later, the implants were inserted, following which patient underwent a waiting period of 4 months. Thereafter, the implants were uncovered and revealed good integration to the grafted bone [Figures and ].