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Medical Forum / General / Dentistry / November 2005sinus lift complications
About 4 months ago I had a lateral sinus lift. One month after the procedure I had an infection. Going back to the periodontist, he said that it was an infection in the flap which hadn't completely healed. Also I had told him that while blowing a baloon that air was escaping to my nose, and that mucous had bone fragments in them. He told me not to worry about this and he restitched the area. I was given antibiotics (250mg Amoxillin 250mg Metromidezole 3 times per day) for 10 days . After antibiotics completion by 10 days, I got another infection (swelling between the lower cheak bone and the nose). After talking to the periodontist, he said most probably the infection was not due to the sinus lift. This scared me and I decided to have 2 other opinions. I went to another periodontist and to a Oral/Maxillofacial surgeon. I explained to them the case and both said that most probably I had a tear in the sinus membrane which was causing the infection. The OMS said there was a possiblity I had an infection in the graft and the graft should be removed and the tear should be repaired, while the Periodontist referred me to an ENT who requested me to do a CT-SCAN. The result of the CT-SCAN showed mucosal thickening and part of the bone had already grown (3 months 1 week post op), although an area showed loose bone fragments. The ENT told me that Sinuses were in good shape and that I did not have sinusitis. Went back to the new Periodontist and he told me that after 4 months post op I should do a dental CT-SCAN to see bone growth, and if there was enough bone, during implant he would explore where the infection was coming from. The infection is causing me to be nauseous with fatigue and headaches. I also started getting pain from a wisdom tooth which was adjacent to the sinus lift. So far I have been on 5 courses of antibiotics (500mg Amoxillin for days after surgery, 250mg amoxillin+250mg metromidezole 10days, CEFZIL 500mg 10 days, TAVANIC 500mg 15 days (ENT recommendation), and now 500mg Augmentin for 7 days. I have since done a skull scan for the sinuses, and blood test. Skull scan showed mucosal thickening, while blood test did not show excessive white blood cells. Should I go with the OMS, or should I go with the Periodontist? If there is a severe tear in the sinus membrane, will it heal with time or will I keep getting those infections (I was told that if it was a small tear it would heal by itself)? If it is a large tear in the membrane who can fix it OMS, ENT or Periodontist - and what is the procedure, another osteotomy? How can I find out if there is a tear? Any help will be greatly appreciated. i think OMFS is the right choice. > About 4 months ago I had a lateral sinus lift. One month after the > procedure I had an infection. Going back to the periodontist, he said [quoted text clipped - 42 lines] > > Any help will be greatly appreciated. >i think OMFS is the right choice. > [quoted text clipped - 13 lines] >> explained to them the case and both said that most probably I had a >> tear in the sinus membrane which was causing the infection. Most likely. >>The OMS >> said there was a possiblity I had an infection in the graft and the [quoted text clipped - 3 lines] >> bone had already grown (3 months 1 week post op), although an area >> showed loose bone fragments. No we are getting some where. Loose bone = infection = failed graft (atleast part of it). The mucosal thiskening will reverse with removal of the fragments. >>The ENT told me that Sinuses were in good >> shape and that I did not have sinusitis. Went back to the new >> Periodontist and he told me that after 4 months post op I should do a >> dental CT-SCAN to see bone growth, and if there was enough bone, during >> implant he would explore where the infection was coming from. So, what is more of the concern for this periodontist, sinking the implant or eliminating your problem? >>The >> infection is causing me to be nauseous with fatigue and headaches. I [quoted text clipped - 18 lines] >> >> Any help will be greatly appreciated. Without an exam it can be tough but you have done a great job of describing your problem. You are developing a chronic sinusitis from the irritant. You have a failed portion of the graft that is leading to the mucosal thickening and infection. All of this probably started from a tear in the membrane. If you were my patient I would remove the graft fragments and not attempt any repair of the membrane. It will heal all by itself. The only hole I would repair is if one connects the oral cavity to the sinus, which you have not described. Give it time after removal and start over if you really want this type of tooth replacement. If you have the implant placed now you may be dealing with a failed implant to go along with your failed graft. Good luck. ~~~~~~~~~~~~~~~~~~~~~ David A. King, D.M.D. Diplomate, American Board of OMS Fellow, American Association of OMS HTTP://WWW.DEOMFS.COM Great answer, you truly are the King ! :-) >>i think OMFS is the right choice. >> [quoted text clipped - 79 lines] >Fellow, American Association of OMS >HTTP://WWW.DEOMFS.COM -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Great answer, you truly are the King ! :-) It is good to be the King. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Thank you Dr. King. I now have a good idea of what my problem is. I was really worried for a while. You are a great help. The oral cavity was re-sutured after the first infection (it had been open which allowed the air to pass through to my nose), and it has completely healed and is sealed. Will the sinus membrane heal even if it is a large tear? I would still like to have the implant. I will do a dental CT-SCAN. If the bone is dense enough should I have the fragments removed and the implant done together at the same time? What is the procedure for removing the loose bone fragments? Is it an osteotomy? Thanks again for your help. >Thank you Dr. King. I now have a good idea of what my problem is. I was >really worried for a while. You are a great help. [quoted text clipped - 4 lines] > >Will the sinus membrane heal even if it is a large tear? Yes >I would still like to have the implant. I will do a dental CT-SCAN. If >the bone is dense enough should I have the fragments removed and the >implant done together at the same time? What is the procedure for >removing the loose bone fragments? Is it an osteotomy? Wait on the implant until the symptoms are eliminated. Removing any loose fragments would require going into the sinus again to clean it out. >Thanks again for your help. Your welcome. I have met with an OMFS, and he said that removal of the loose fragments would require removal of the schneidarian membrane. I asked him if he would put another membrane instead, he said not to worry the membrane would regrow by itself. He said that the graft infection compromised the membrane, and that is why it should be removed. Is this the procedure? It seems a bit drastic. Is this part of cleaning out the sinus? >I have met with an OMFS, and he said that removal of the loose >fragments would require removal of the schneidarian membrane. I asked [quoted text clipped - 4 lines] >Is this the procedure? It seems a bit drastic. Is this part of cleaning >out the sinus? The entire sinus membrane isnt removed, unless all of it is in bad shape. This should be alot faster than the initial sinus lift so hopefully you will not be in alot of discomfort. This particular OMFS said he would remove the whole membrane (he had'nt even seen the extent of the infection) with local anesthetic which was appealing to me. He said the procedure will take about 2 hours and cost about $5000. The initial sinus lift was about $1700. I have since gotten another opinion from another OMFS (Board Certified). He said that it would be under full sedation (not so appealing) and would require 1 to 2 days in hospital. He also told me that he has treated cases similar to mine (infection wise), but with molars going deep into sinuses with severe infection. I think my infection is not that bad since I have taken many courses of antibiotics since problems appeared. I think I will go with this OMFS. I just hope he's not too aggressive. I think the reason for the tear in the sinus membrane (which was probably the cause of the infection as mentioned by Dr. King) was that during the opening of the "window" to reach the membrane the periodontist punched the bone with a hammer about 4 powerful hits (it was like getting punched in the face 4 times - I was seeing stars - it really worried me). Is that a correct procedure Dr. King? I read somewhere from other periodontists on the internet that this could be the cause of major tears of the membrane (the bones sharp edges cutting into the membrane from the force of the blows). I should have looked for a more experienced surgeon I guess. Anyway it's done. This time I've done my research. Dr. King, I want to thank you again, without your insite I would be completely lost. >This particular OMFS said he would remove the whole membrane (he had'nt >even seen the extent of the infection) with local anesthetic which was [quoted text clipped - 24 lines] >Dr. King, I want to thank you again, without your insite I would be >completely lost. your welcome. FYI, the type of sinus lift (Summers procedure) performed shouldnt feel like you were punched in the face. A succesion of gentle taps is all that is necessary to upfracture the sinus floor. The procedure I had was not the Summers procedure - or crestal approach. It was the more invasive method with the "window" in the buccal bone. Is it called lateral sinus lift? Maybe I made a mistake in describing the procedure I had. The perio who did the operation told me that I had about 2mm of bone, and that was why he chose this approach. When I went to the other perio, I asked him how much bone I had, he actually went to the panoramic x-ray and measured it and said I had 4.5 to 5.5mm. Would the Summers procedure have been the correct one to do with this amount of bone - how much is enough bone to do the Summers procedure? Is the Summers procedure less expensive? I have read it is much less invasive with higher success rate. This information could be helpful for any person reading this link and thinking of doing the sinus lift surgery. > When I went to the other perio, I asked him how much bone I had, he > actually went to the panoramic x-ray and measured it and said I had 4.5 > to 5.5mm. I would not trust any x-ray image to measure the thickness of bone. unless I had multiple images at different angles. Signature/ Amatus / > The procedure I had was not the Summers procedure - or crestal > approach. It was the more invasive method with the "window" in the [quoted text clipped - 11 lines] > for any person reading this link and thinking of doing the sinus lift > surgery. >The procedure I had was not the Summers procedure - or crestal >approach. It was the more invasive method with the "window" in the [quoted text clipped - 4 lines] >actually went to the panoramic x-ray and measured it and said I had 4.5 >to 5.5mm. Regardless, gentle taps, gentle. >Would the Summers procedure have been the correct one to do with this >amount of bone - how much is enough bone to do the Summers procedure? >Is the Summers procedure less expensive? I have read it is much less >invasive with higher success rate. This information could be helpful >for any person reading this link and thinking of doing the sinus lift >surgery. No. Your bone height sounds alittle short. I like around 8mm or so. It is cheaper than the regular sinus lift and I have had better success but not by much. > About 4 months ago I had a lateral sinus lift. One month after the > procedure I had an infection. Going back to the periodontist, he said [quoted text clipped - 42 lines] > > Any help will be greatly appreciated. The decision will of course hinge on the particular doctor involved. However, in general OMFS will have far greater experience working in and around the sinus. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > The decision will of course hinge on the particular doctor involved. > However, in general OMFS will have far greater experience working in and > around the sinus. Don't tell my periodontist buddy (Don Corleone) that I said this, but I agree with Steve B. on this. I think the Periodontist is great for routine sinus plasty procedures, but for complications, well, I want the guys who have trained to work, near it, in front of it, inside it, behind it and sometimes have removed it. Signature/ Amatus / > >> About 4 months ago I had a lateral sinus lift. One month after the [quoted text clipped - 49 lines] > > Steve >>The decision will of course hinge on the particular doctor involved. >>However, in general OMFS will have far greater experience working in and [quoted text clipped - 5 lines] > have trained to work, near it, in front of it, inside it, behind it and > sometimes have removed it. I work with both periodontists and OMFS to place my implants. In my experience, the perios do mostly the slam dunks. The ones they don't want to do get sent to the OMFS, and often they are willing to do the procedure. I will generally send patients to their periodontist for implant evaluation if they already are being treated by a perio. Otherwise, I usually send patients to the OMFS. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 |
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