The Journal of Laryngology and Otology April 1990, Vol. 104, pp. 333-334
Maxillary sinusitis from dental osseointegrated implants R. E. QUINEY*, E. BRiMBLEt, M. HODGE* (Brighton)
Introduction Unilateral purulent maxillary sinusitus is frequently caused by either overt or hidden dental sepsis. Upper tooth roots lying close to the antral floor, when removed, allow a route for infection from the mouth or retained roots, following incomplete extraction, become chronically infected and spread sepsis to the antrum. Gross dental caries of the upper teeth may also eventually cause maxillary sinusitis. We present another dental cause of unilateral maxillary sinusitis: the use of osseointegrated titanium implants in the upper jaw for cosmetic dental reconstruction.
laterally where the other two implants had been inserted. The three implants were removed via a sublabial antrostomy with an extended buccal mucosal flap, the infected bone of the upper alveolus was curetted and an intranasal antrostomy was fashioned. A mixed culture of Haemolytic Streptococci group F and mixed anaerobes was grown from the aspirated pus; the patient made an uneventful recovery and continued her antibiotic treatment for a month. Discussion The use of osseointegrated implants in cosmetic reconstructive dental surgery is relatively new in the United Kingdom but is becoming increasingly popular. For osseointegration to occur the bone must be healthy and vascular (Hansson et al, 1983). The screw thread of the implant (the fixture) is slowly twisted into the alveolar bone either under local or general anaesthesia and buried under the gingival mucosa and left undisturbed for two to three months. This allows osseointegration to occur prior to the fitting of an externally protruding
Case report A 44-year-old female presented with a two day history of unilateral facial pain and a puffy left malar region. Two weeks before she had three osseointegrated implants screwed into the left upper alveolus by her dentist for future use with a permanent dental plate as described by Branemark et al. (1977). Her upper alveolus had remained tender since insertion of the implants and on examination was erythematous and swollen with no sign of the implants. There was pus filling her left nasal cavity. Occipito-mental and lateral sinus X-rays (Figs. 1, 2) showed an opaque left maxillary antrum containing two dislodged implants. An orthopantomogram (Fig. 3) showed the third implant in place but complete loss of upper alveolar bone
FIG. 1 Occipitomental sinus X-ray showing opaque left maxillary antrum.
FIG. 2 Lateral sinus X-ray.
* Senior Registar in Otolaryngology, t Senior House Officer, % Consultant in Maxillofacial Surgery, Royal Sussex County Hospital, Brighton. Accepted for publication: 4 January 1990. 333
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FIG. 3 Orthopantomogram.
abutment to which either a permanent plate or individual teeth are attached. The implants used in this patient (Manufacturer: Intoss) are normally inserted into the bone to a depth just short of the adjacent tooth roots. The second premolar and first molar tooth roots are often very close to the mucosa of the floor of the maxillary sinus (Pickard, 1987) and even occasionally project into the sinus itself. In addition there may be insufficient bone depth in the upper alveolus to site an implant without penetrating the maxillary sinus due to expanded maxillary sinuses, to wide nasal cavities or inherently small bucco-palatal dimensions of the remaining alveolar process after tooth removal. Great care is therefore required when using foreign body implants in the upper jaw particularly if the bone is chronically infected from previous dental sepsis. In the elderly edentulous patient bone resorption of the upper alveolus can occur to such an extent that such implants invariably are too long and their use is therefore probably contraindicated. However Adell et al., (1981) reported a series of 371 patients having osseointegrated implants for dental reconstruction in which 101 implants into the upper jaw entered the maxillary sinus because there was insufficient alveolar bone present, yet they had no cases of maxillary sinusitis in a two to ten year follow up.
References
Adell, R.,Lekholm, U., Rockier, B., Branemark, P. I. (1981) A15 year study of osseointegrated implants in the treatment of the edentulous jaw. International Journal of Oral Surgery 10: 387^16. Branemark, P. I., Hansson, B. O., Adell, R., Breine, U., Lindstrom, J., Hallen, O., Ohman, A. (1977) Osseointegrated implants in the treatment of the edentulous jaw. Experience from a ten year period. Scandinavian Journal of Plastic and Reconstructive Surgery, 11: Supplement 16. Hansson, H. A., Albrektsson, T., Branemark, P. I. (1983) Structural aspects of the interface between tissues and titanium implants. Journal of Prosthetic Dentistry, 50: 108-113. Pickard, B. H. (1987) The complications of sinusitis. In ScottBrown's Otolaryngology, Vol 4, (Mackay, I. S. and Bull, T. R. eds) p 207. Butterworths, London. Address for correspondence: R. E. Quiney, Department of Otolaryngology, Royal Sussex County Hospital, Eastern Road, Brighton, East Sussex BN2 5BE
Maxillary sinusitis from dental osseointegrated implants R. E. QUINEY*, E. BRiMBLEt, M. HODGE* (Brighton)
Introduction Unilateral purulent maxillary sinusitus is frequently caused by either overt or hidden dental sepsis. Upper tooth roots lying close to the antral floor, when removed, allow a route for infection from the mouth or retained roots, following incomplete extraction, become chronically infected and spread sepsis to the antrum. Gross dental caries of the upper teeth may also eventually cause maxillary sinusitis. We present another dental cause of unilateral maxillary sinusitis: the use of osseointegrated titanium implants in the upper jaw for cosmetic dental reconstruction.
laterally where the other two implants had been inserted. The three implants were removed via a sublabial antrostomy with an extended buccal mucosal flap, the infected bone of the upper alveolus was curetted and an intranasal antrostomy was fashioned. A mixed culture of Haemolytic Streptococci group F and mixed anaerobes was grown from the aspirated pus; the patient made an uneventful recovery and continued her antibiotic treatment for a month. Discussion The use of osseointegrated implants in cosmetic reconstructive dental surgery is relatively new in the United Kingdom but is becoming increasingly popular. For osseointegration to occur the bone must be healthy and vascular (Hansson et al, 1983). The screw thread of the implant (the fixture) is slowly twisted into the alveolar bone either under local or general anaesthesia and buried under the gingival mucosa and left undisturbed for two to three months. This allows osseointegration to occur prior to the fitting of an externally protruding
Case report A 44-year-old female presented with a two day history of unilateral facial pain and a puffy left malar region. Two weeks before she had three osseointegrated implants screwed into the left upper alveolus by her dentist for future use with a permanent dental plate as described by Branemark et al. (1977). Her upper alveolus had remained tender since insertion of the implants and on examination was erythematous and swollen with no sign of the implants. There was pus filling her left nasal cavity. Occipito-mental and lateral sinus X-rays (Figs. 1, 2) showed an opaque left maxillary antrum containing two dislodged implants. An orthopantomogram (Fig. 3) showed the third implant in place but complete loss of upper alveolar bone
FIG. 1 Occipitomental sinus X-ray showing opaque left maxillary antrum.
FIG. 2 Lateral sinus X-ray.
* Senior Registar in Otolaryngology, t Senior House Officer, % Consultant in Maxillofacial Surgery, Royal Sussex County Hospital, Brighton. Accepted for publication: 4 January 1990. 333
334
R. E. QUINEY, E. BRIMBLE AND M. HODGE
FIG. 3 Orthopantomogram.
abutment to which either a permanent plate or individual teeth are attached. The implants used in this patient (Manufacturer: Intoss) are normally inserted into the bone to a depth just short of the adjacent tooth roots. The second premolar and first molar tooth roots are often very close to the mucosa of the floor of the maxillary sinus (Pickard, 1987) and even occasionally project into the sinus itself. In addition there may be insufficient bone depth in the upper alveolus to site an implant without penetrating the maxillary sinus due to expanded maxillary sinuses, to wide nasal cavities or inherently small bucco-palatal dimensions of the remaining alveolar process after tooth removal. Great care is therefore required when using foreign body implants in the upper jaw particularly if the bone is chronically infected from previous dental sepsis. In the elderly edentulous patient bone resorption of the upper alveolus can occur to such an extent that such implants invariably are too long and their use is therefore probably contraindicated. However Adell et al., (1981) reported a series of 371 patients having osseointegrated implants for dental reconstruction in which 101 implants into the upper jaw entered the maxillary sinus because there was insufficient alveolar bone present, yet they had no cases of maxillary sinusitis in a two to ten year follow up.
References
Adell, R.,Lekholm, U., Rockier, B., Branemark, P. I. (1981) A15 year study of osseointegrated implants in the treatment of the edentulous jaw. International Journal of Oral Surgery 10: 387^16. Branemark, P. I., Hansson, B. O., Adell, R., Breine, U., Lindstrom, J., Hallen, O., Ohman, A. (1977) Osseointegrated implants in the treatment of the edentulous jaw. Experience from a ten year period. Scandinavian Journal of Plastic and Reconstructive Surgery, 11: Supplement 16. Hansson, H. A., Albrektsson, T., Branemark, P. I. (1983) Structural aspects of the interface between tissues and titanium implants. Journal of Prosthetic Dentistry, 50: 108-113. Pickard, B. H. (1987) The complications of sinusitis. In ScottBrown's Otolaryngology, Vol 4, (Mackay, I. S. and Bull, T. R. eds) p 207. Butterworths, London. Address for correspondence: R. E. Quiney, Department of Otolaryngology, Royal Sussex County Hospital, Eastern Road, Brighton, East Sussex BN2 5BE
