Successful Management of Dental Implants in Postoperative Maxillary Cyst: A Case Report With a 13-Year Follow-Up
The report is presenting a case of implant placement in the postoperative maxillary cyst (POMC) with a follow-up of 13 years. The POMC is a complication associated with various surgical interventions involving maxillary sinus diseases such as Caldwell-Luc operation, orthognathic surgery, and sinus grafting procedures. The lesion of POMC is believed to develop as a result of the changes of ciliated cells or the blockage of ostia inside the maxillary sinus. Two dental implants were placed near the lesion that was later confirmed to be POMC. Of the 2 dental implants placed, one was explanted and the other was successfully managed with surface debridement followed by guided bone regeneration. The removed specimen inclusive of the implant and surrounding tissue was evaluated with clinical photographs, radiographs, and histology and the findings are described in the paper.
(a) Preoperative panoramic radiograph. (b) Immediately after the implant surgery. (c) 6 months after the surgery. Implant # 4 was removed due to nonintegration. (d) 13 years post-loading of the implants. Severe bone loss around implant #2 (white arrows).
(a) Panoramic view of cone-beam computerized tomography (CBCT) scan. A separate compartment below the sinus floor where 2 implants are located. The cavity is wide and opacified. (b) Coronal view of CBCT. The lesion is isolated from the maxillary sinus by fibrous septum. (c) Sagittal view of CBCT. The lesion is clearly lined with the thin cortical bone. (d) Axial view of CBCT. The lesion is expansive in mediolateral dimension (yellow arrows) with missing facial bone plate (white arrow).
(a) The site of explantation showing active discharge of pus. (b) Careful dissection and reflection of the buccal flap. Underlying granulation tissue is visible. (c) Enucleation of the lesion is performed in conjunction with the mechanical debridement with a titanium brush. (d) Tetracycline HCl is mixed with saline solution and applied for 5 minutes. (e) The cavity is filled with biphasic calcium phosphate. (f) The flap is sutured without tension. (g) Panoramic radiograph immediately after the surgery. (h) Panoramic view of cone-beam computerized tomography (CBCT) immediately after bone grafting. (i) Coronal view of CBCT. The cavity is completely filled with bone graft.
Figure 4. (a) The cystic lesion is lined with ciliated, pseudostratified columnar epithelium (hematoxylin and eosin [H&E] stain, ×100 magnification). Ciliary loss is also observed. (b) The lymphocytic cells infiltrated in the connective tissue. Highly inflammatory proliferative tissue and cholesterol clefts are seen (H&E stain, ×50 magnification). Figure 5. (a) Clinical photograph of the area 1 year after the surgery. (b) Panoramic view of the cone-beam computerized tomography (CBCT) taken 1 year after the treatment showing increased radiopacity of the grafted site. (c) Coronal view of CBCT. There is increased bone density with a high degree of homogeneity.
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