Editorial Type:
Article Category: Research Article
 | 
Online Publication Date: 01 Jun 2010

Oroantral Communication as an Osteotome Sinus Elevation Complication

DDS and
DDS, MS
Page Range: 231 – 237
DOI: 10.1563/AAID-JOI-D-09-00026
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Abstract

The sinus elevation procedure is a predictable technique to allow for placement of dental implants in the posterior maxilla when the height of the alveolar ridge is limited. The sinus elevation can be performed by various techniques. In the crestal approach, bone graft is utilized to hydraulically elevate the sinus membrane through an osteotomy prepared in the alveolar crest. The implant can be placed either immediately or at a later surgery. This is a case report of an oroantral communication that developed as a complication to a sinus elevation surgery performed with the crestal approach. A 54-year-old female patient presented for dental implant treatment. The patient reported sleep apnea and smoking. Full-thickness flap was reflected in the posterior maxilla and using trephines, an osteotomy was prepared, 1 mm short of the sinus. The trephined core of bone was pushed into the sinus using osteotomes. Particulate bone graft was introduced through the osteotomy to elevate the sinus membrane, and a collagen membrane was used over the bone graft. Six days after surgery, the patient returned to the clinic with an oroantral communication. The patient reported that she was using a positive-pressure breathing mask at night because of sleep apnea. A flap was extended to the tuberosity area and was rotated palatally to achieve closure. The use of the pressure breathing mask was discontinued. The oroantral communication was successfully closed. Relatively few complications have been reported using the osteotome sinus elevation technique. The use of a positive pressure mask may have complicated a sinus elevation surgery. Other factors that may have contributed to this complication include smoking and delayed healing of the area.

Copyright: 2010 by the American College of Veterinary Internal Medicine
Figure 1
Figure 1

(a) Radiograph showing bone loss in the area of #2 and sinus proximity in the area of #3. (b) Radiograph 3 months after socket preservation surgery.


Figure 2
Figure 2

(a) Incision design; the nonhealing socket of #2 is evident. (b) The nonhealing socket is debrided. Osteotomy in the area of #3 has been performed. (c) Osteotome sinus elevation is being performed. (d) Bone graft in the defect and the osteotomy. (e) Collagen membrane is adapted. (f) Closure.


Figure 3
Figure 3

(a) The flap shows no closure and there is oroantral communication. (b) Tension-free release of the buccal flap. (c) Closure showing interrupted and mattress sutures. (d) Healing 1 week later, showing closure of the oroantral communication.


Figure 4
Figure 4

(a) Clinical healing 4 years postoperatively. (b) The ridge has healed and #4 had socket preservation 6 months earlier.


Contributor Notes

Private practice, Monroe, La.
Private practice, Volos, Greece.
*Corresponding author, e-mail: janzal@yahoo.com
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