Odontogenic sinusitis is dental in origin. It can be caused by infections and trauma of the maxillary dentition, as well as from iatrogenic injury. Endodontic infections and chronic periodontitis can disrupt and inflame the sinus lining, leading to mucosal inflammation of the maxillary sinus. Between 10-40% of all sinusitis cases are believed to have dental causes, though it appears that only around a third of these patients experience dental pain. Treatment can require medical and/or dental intervention, depending on the nature of the underlying pathology.[i]
Dental implants
Acute sinusitis (ARS) and chronic rhinosinusitis (CRS) are potential, though infrequent, complications that can arise following dental implant and sinus lift procedures.[ii], [iii], [iv], [v] Odontogenic sinusitis symptoms generally occur within 3 months of the procedure.[vi]
In rare instances, dental implants can be displaced into the maxillary sinus directly, during or after placement. This occurs more frequently in patients who have minimal alveolar bone available (particularly where it is less than 4mm), severe maxillary sinus pneumatisation, or who require bone grafting. Surgical skill and experience is a noted influence on the likelihood of implant displacement, particularly regarding over-drilling and excessive force.[vii] Where the implant penetrates into the sinus cavity less than 2mm, covering of the implants with sinus mucosa could occur; it is not unknown for new bone growth to cover over them. More than 2mm of extension, however, prevents healing and could lead to debris accumulating on the exposed implant.[viii]
On the other hand, the Summer’s technique of closed sinus lift has been shown to be a highly successful treatment when carried out expertly in suitable patients where the residual bone height below the maxillary sinus is reduced.
It is usually recommended that displaced implants are immediately removed, though where a delay occurs, the sinus infection should be treated with antibiotics and/or endoscopic surgery. Once the offending implant is removed, implant replacement and grafting may be performed in stages.[ix]
With knowledge and precision, the risk of iatrogenic infections or collateral surgical damage is reduced. Of crucial importance is to carry out a thorough clinical examination with appropriate 3D diagnostic imaging to evaluate the anatomy, identify existing pathology and to avoid collateral damage occurring to the maxillary sinuses and the adjacent vital structures. Ucer Education offers courses providing clinical training, mentoring and support in all aspects of implant dentistry. Ucer Education’s PG Cert in Implant Dentistry will empower you with the training you need to confidently provide implants to the highest standard, while more advanced sinus lift and bone grafting courses offer experienced clinicians an opportunity to further refine their skills.
While there is a small risk that patients may develop sinusitis as a consequence of dental implant surgery, it should not be a deterrent to receiving the best treatment for edentulism. With knowledge and experience, the risks are minimised. Furthermore, alternative techniques such as graftless, extra-maxillary zygomatic ZAGA implants or the innovative technique of 3D printed customised subperiosteal implants could be considered with the advantages of less traumatic surgery and immediate loading. These techniques are routinely available at Professor Ucer’s Centre for Oral-Maxillofacial and Dental Implant Reconstruction, and taught during his straightforward or advanced surgical courses.
Please contact Professor Ucer at:
Centre for Oral-Maxillofacial and Dental Implant Reconstruction,
Manchester Postgraduate Dental Institute & ICE Hospital, Salford Quays, Manchester
Professor Ucer at ice@ucer.uk or Mel Hay at mel@mdic.co
Tel: 01612 371842
[i] Little R., Long C., Loehri T., Poetker D. Odontogenic sinusitis: a review of the current literature. Laryngoscope Investigative Otolaryngology. 2018; 3(2): 110-114. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915825/ December 12, 2019.
[ii] Chirilä L., Rotaru C., Filipov I., Sändulescu M. Management of acute maxillary sinusitis after sinus bone grafting procedures with simultaneous dental implants placement – a retrospective study. BMC Infectious Diseases. 2016; 16(Suppl. 1): 94. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4896248/ December 10, 2019.
[iii] Jiam N., Goldberg A., Murr A., Pletcher S. Surgical treatment of chronic rhinosinusitis after sinus lift. American Journal of Rhinology & Allergy. 2017; 31(4): 271-275. https://journals.sagepub.com/doi/abs/10.2500/ajra.2017.31.4451 December 10, 2019.
[iv] Rapsa K. Sinus lifts failure resulting in chronic sinusitis. Journal of Otolaryngology-ENT Research. 2017; 8(6): 00270. http://dx.doi.org/10.15406/joentr.2017.08.00270 December 10, 2019.
[v] Little R., Long C., Loehri T., Poetker D. Odontogenic sinusitis: a review of the current literature. Laryngoscope Investigative Otolaryngology. 2018; 3(2): 110-114. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915825/ December 12, 2019.
[vi] Jiam N., Goldberg A., Murr A., Pletcher S. Surgical treatment of chronic rhinosinusitis after sinus lift. American Journal of Rhinology & Allergy. 2017; 31(4): 271-275. https://journals.sagepub.com/doi/abs/10.2500/ajra.2017.31.4451 December 10, 2019.
[vii] An J., Park S., Han J., Jung S., Kook M., Park H., Oh H. Treatment of dental implant displacement into the maxillary sinus. Maxillofacial Plastic and Reconstructive Surgery. 2017; 39: 35. https://link.springer.com/article/10.1186/s40902-017-0133-1 December 12, 2019.
[viii] Ragucci G., Elnayef B., Suárez-López del Amo F., Wang H., Hernández-Alfaro F., Gargallo-Albiol J. Influence of exposing dental implants into the sinus cavity on survival and complications rate: a systematic review. International Journal of Implant Dentistry. 2019; 5: 6. https://journalimplantdent.springeropen.com/articles/10.1186/s40729-019-0157-7 December 12, 2019.
[ix] An J., Park S., Han J., Jung S., Kook M., Park H., Oh H. Treatment of dental implant displacement into the maxillary sinus. Maxillofacial Plastic and Reconstructive Surgery. 2017; 39: 35. https://link.springer.com/article/10.1186/s40902-017-0133-1 December 12, 2019.