Intraoral Approach for Sinus Graft Infection Following Lateral Sinus Floor Augmentation With Simultaneous Implant Placement: A Clinical Case Series

Flowchart for the treatment of sinus graft infection. Additional treatments include defect degranulation, tetracycline HCl detoxification, and additional bone grafting procedure. I&D indicates incision and drainage.

At 10 days after lateral sinus floor augmentation, sinus graft infection resulted in concomitant sinusitis in the left maxillary sinus in patient 1. There was no perforation of the sinus membrane during lateral sinus floor augmentation. Clinical symptoms, including facial swelling, mucoid rhinorrhea, and postnasal drip, appeared 10 days after lateral sinus floor augmentation. (a) Coronal computerized tomography (CT) view showed that the left maxillary sinus was completely opacified, and concomitant sinusitis involved the middle meatus of the nasal cavity and the ethmoid sinus. A radiolucent space due to the sinus graft infection was seen on the buccal side of the maxillary sinus bone graft (white arrow). (b) Axial CT view showed the radiolucent space on the buccal side of the implant (white arrow).

An intraoral treatment was performed on sinus graft infection 10 days after lateral sinus floor augmentation in patient 1. Figure 3. (a) Under local anesthesia, an incision was made mesiodistally to expose the infected graft site. (b) A diagram of incision and drainage (I&D). The drainage procedure was performed through the lateral window. Figure 4. (a) The periphery of the wound was sutured with an absorbable suture to facilitate natural drainage. Nu gauze packing strips were inserted after gentle debridement of the infected area. Systemic antibiotic treatment was performed for 2 weeks after the procedure, and Nu gauze was removed after 1 week. (b) A diagram of Nu gauze insertion. Figure 5. (a) Although clinical symptoms resolved 2 months after I&D, the defect was identified, and additional treatment was planned. (b) A diagram of a sinus graft infection site, which underwent secondary healing.

Figure 6. (a) After reflecting the flap, the boundary between the healthy graft zone and the infected granulomatous graft zone was clearly visualized. No communication was observed between the preserved bone graft and the sinus cavity. (b) A diagram of debridement and degranulation of infected site. Figure 7. (a) Tetracycline HCl detoxification was performed in the infected site for 5 minutes and followed by copious saline irrigation. (b) A diagram of tetracycline HCl detoxification. Figure 8. (a) After saline irrigation, an additional bone grafting procedure was performed using biphasic calcium phosphate without a membrane. (b) A diagram of bone grafting and flap closure.

(a) At the 6-month follow-up after intraoral infection treatment, coronal computerized tomography (CT) view showed the resolution of concomitant sinusitis in patient 1. Thickness of the sinus membrane was reduced, and the maxillary ostium was observed to be opened. The additional bone grafted area was observed in the sinus graft infection site (white arrow). (b) Axial CT view showed the additional bone grafted area (white arrow).

Figure 10. (a) In group I, a sagittal cone-beam computerized tomography (CBCT) scan showed that the grafted bone was well preserved at the 17-year follow-up. (b) The cross-sectional CBCT view of group I patient after 17 years of follow-up showed the implant surrounded by grafted bone. Figure 11. (a) A sagittal CBCT view of group II patient showed that the grafted bone was partially preserved after 15.7 years of follow-up. (b) In group II, the cross-sectional CBCT view showed that the grafted bone was partially preserved after 15.7 years of follow-up. Figure 12. (a) In group III, the grafted bone was rarely seen in the sagittal CBCT view after 16.4 years of follow-up. (b) The cross-sectional CBCT view of a group III patient at 16.4 years of follow-up showed that the grafted bone had been almost entirely removed for the treatment of sinus graft infection.