Surgical Relocation of a Malpositioned, Unserviceable Implant Protruding Into the Maxillary Sinus Cavity. A Clinical Report

Initial situation with severely malpositioned implant and an inadequate prosthesis luted to the cuspid and screwed to the fixture.

A computerized tomography scan showing the malpositioned fixture osseointegrated in a narrow bony architecture with the top of the implant protruding 2 mm into the maxillary sinus cavity.

(A) Master model with vestibular resin transfer template including a pickup coping. (B) Adaptation test of the transfer template on the stereolithographic model. (C) Transfer template on the stone cast duplication of the stereolithographic model after the implant analog insertion.

Figure 4.Titanium fixation plaque screwed to the implant relocated in the desired position. Figure 5.Piezoelectric full-thickness osteotomies parallel to the long axis of the implant through the buccal and palatal cortical plates and through the floor of the maxillary sinus. Figure 6.Titanium plaque in place, fixing the mobilized bone block in the preprogrammed position. Figure 7. Detail of the top of the implant (arrow), protruding into the maxillary sinus, after the block shifting. Figure 8.Reentry after 2 months: at clinical observation, the osteotomic cuts are completely closed and the block is firmly stabilized in the new position. Some particles of β-tricalcium phosphate are still recognizable in grafted areas (arrows). In the same surgery it was inserted a second implant in first premolar site. Figure 9.Clinical control of the screw retained zirconia-ceramic crowns 1 year after the finalization.

Radiographic control after 1 year of function.