Intraoral Approach for Dental Implant Placement in Pneumatized Maxillary Sinuses With Postoperative Maxillary Cysts: A Report of Two Cases
A postoperative maxillary cyst (POMC) is a delayed complication of the original Caldwell-Luc operation, which was once widely performed to treat chronic rhinosinusitis. Two patients who had previously undergone Caldwell-Luc operations desired dental implant treatment. In both cases, preoperative cone-beam computerized tomography (CBCT) revealed a POMC occupying the entire maxillary sinus on the side where the implants were to be placed. The residual bone height was 3–4 mm. Furthermore, the sinuses were divided into compartments by septum-like structures. An intraoral approach was applied for POMC enucleation and implant placement. The implants were placed with sinus floor penetration due to the small residual bone height. No bone substitute material was grafted in the sinus. Postoperative healing was uneventful. All implants were successfully osseointegrated and performed well (4 and 5 years for each patient). No sinonasal complications were reported. Follow-up CBCTs showed that the exposed implant parts were covered by newly formed bone. The intraoral approach is a feasible option for implant placement in a pneumatized maxillary sinus with POMC.
Preoperative radiographs of Case 1, (a) panoramic radiograph, (b) sagittal CBCT (cone-beam computed tomography) image showing the right maxillary sinus, (c) coronal CBCT image in the #3 area, (d) axial CBCT image.
Clinical photographs of Case 1. (a) Healthy mucosa is observed. (b) The prepared bony access window. The lateral wall is absent distally. (c) Cystic fluid discharged from the sinus cavity. (d) The septum has been partially removed. The cyst is enucleated after detaching the cystic soft tissue from the sinus walls. (e) 3 implants penetrating the sinus floor have been placed. (f) Clinical situation 4 years after final prosthesis insertion.
Histopathologic findings in Case 1 (a) and Case 2 (b).
Radiographic follow-up of Case 1. (a–c) panoramic radiographs, (a) immediately after surgery, (b) immediately after final prosthesis insertion, (c) at the 4-year follow-up, (d–f) sagittal cone-beam computerized tomography (CBCT) images, (d) immediately after surgery, (e) immediately after final prosthesis insertion, (f) at the 4-year follow-up, (g–i) coronal CBCT images in the #4 region, (g) immediately after surgery, (h) immediately after final prosthesis insertion, (i) at the 4-year follow-up, (j–l) coronal CBCT images in the #3 region, (g) immediately after surgery, (h) immediately after final prosthesis insertion, (i) at the 4-year follow-up, (m–o) coronal CBCT images in the #2 region, (m) immediately after surgery, (n) immediately after final prosthesis insertion, (o) at the 4-year follow-up.
Preoperative radiographs of Case 2, (a) panoramic radiograph, (b) sagittal cone-beam computerized tomography (CBCT) image showing the right maxillary sinus, (c) coronal CBCT image in the #3 region, (d) axial view of the CBCT.
Clinical photographs of Case 2. (a) Healthy mucosa is observed. (b) Prepared bony access window. (c) Yellowish cystic fluid. (d) Cyst enucleation and sufficient saline irrigation are performed. (e) An implant penetrating the sinus floor is placed. (f) Clinical situation 5 years after final prosthesis insertion.
Radiographic follow-up of Case 2. (a–c) panoramic radiographs, (a) immediately after surgery, (b) immediately after final prosthesis insertion, (c) at the 5-year follow-up, (d–f) sagittal cone-beam computerized tomography (CBCT) images in the #3 region, (d) immediately after surgery, (e) immediately after final prosthesis insertion, (f) at the 5-year follow-up, (g–i) coronal CBCT images in the #3 region, (g) immediately after surgery, (h) immediately after final prosthesis insertion, (i) at the 5-year follow-up.
Contributor Notes