J Clin Exp Dent. 2021;13(7):e733-6.

Implant migration into maxillary sinus

Journal section: Oral Surgery doi:10.4317/jced.58350

Publication Types: Case Report https://doi.org/10.4317/jced.58350

Removal of a migrated dental implant from a maxillary

sinus through an intraoral approach: A case report

Enrique Núñez-Márquez 1, Angel-Orión Salgado-Peralvo 2, Juan-Francisco Peña-Cardelles 3, Naresh

Kewalramani 4, Alvaro Jiménez-Guerra 1, Eugenio Velasco-Ortega 5

1
Professor of Master in Implant Dentistry, University of Seville, US, Seville, Spain
2
Master in Implant Dentistry, US. Master’s Degree in Family and Community Dentistry, US
3
Professor of the Postgraduate Program in Oral Surgery and Implantology. Rey Juan Carlos University, URJC, Madrid, Spain
4
Professor of the Postgraduate Program in Oral Surgery, Periodontology and Implantology, URJC
5
Professor of Comprehensive Dentistry for Adutls and Gerodontology, US. Director of the Postgraduate Program in Implant Den-
tistry, US

Correspondence:
Calle San Salvador 5, bajo Robles Dental
36204. Vigo, Pontevedra, Spain
[email protected]
Núñez-Márquez E, Salgado-Peralvo AO, Peña-Cardelles JF, Kewalramani
N, Jiménez-Guerra A, Velasco-Ortega E. Removal of a migrated dental
implant from a maxillary sinus through an intraoral approach: A case re-
Received: 24/02/2021
Accepted: 15/03/2021 port. J Clin Exp Dent. 2021;13(7):e733-6.

Article Number: 58350 http://www.medicinaoral.com/odo/indice.htm

© Medicina Oral S. L. C.I.F. B 96689336 - eISSN: 1989-5488
eMail: [email protected]
Indexed in:
Pubmed
Pubmed Central® (PMC)
Scopus
DOI® System

Abstract
Background: The replacement of maxillary posterior teeth often challenges the clinician due to bone resorption
after dental exodontia and low bone quality. Currently, attempts are being made to shorten treatment times by pla-
cing implants simultaneously to sinus lift procedures in borderline cases, which can lead to complications such as
displacement of implants into the maxillary sinus.
Clinical Case: a 54-year-old patient who was planned for complete rehabilitation of the maxilla through a fixed
implant-supported prosthesis on 6 implants. At the level of the 3rd sextant, a sinus lift was performed with a lateral
window approach (Caldwell-Luc type) and the simultaneous placement of two implants, one of which migrated
into the sinus. The implant was displaced after 4 months when the second stage (uncovering) implant surgery was
performed for the connection of the healing abutments. The implant was removed a week after the migration, since
it had moved to the tuberosity area in the sinus and the lateral window had been performed in a more mesial posi-
tion, so the patient was recommended to sleep on the right side to achieve the displacement of the implant to a more
favourable area, removing it after a week through the same approach.
Discussion: Surgical strategies for the removal of a migrated implant are essentially divided into two main approa-
ches: endoscopic transoral and endoscopic transnasal (and combined).
Conclusions: In case of intra-operative migration of the implant into the sinus, it is recommended to remove it as
soon as possible to avoid a possible sinus pathology of iatrogenic origin.

Key words: Dental implant complications, dental implant, dental implant displacement, maxillary sinus, case
report.

e733
J Clin Exp Dent. 2021;13(7):e733-6. Implant migration into maxillary sinus

Introduction tion® Standard, OsteoBiol) of porcine origin. The pa-

Rehabilitation through dental implants of the posterior tient’s complete prosthesis was relined after surgery with a
maxilla is often a challenge for the oral and maxillofa- soft relining material. After the healing period (4 months)
cial surgeon for the following reasons: a) resorption of a second stage implant surgery was carried out to place the
the alveolar ridge; b) progressive pneumatization of the healing abutments, before the prosthetic phase, at which
maxillary sinus and (c) low density of the alveolar bone time, the implant in position #13 migrated to the sinus.
(8). These constraints make it difficult to place implants Because the implant migrated to the tuberosity area in the
and can cause complications, such as implant displace- sinus cavity and because the antrostomy had been perfor-
ment into the maxillary sinus (DID) (3). Dental implant med in a more mesial position, the patient was seen once a
displacement (DID) is a relatively unusual complication, week, recommending him to sleep on his right side and was
but one survey by the Japanese Academy of Maxillo- prescribed ciprofloxacin 500 mg/ 12 h for 10 days. During
facial Implants on perioperative complications revealed this time, he reported nasal congestion and headache. After
that, among a total of 421 cases, 63 (15%) involved the one week, with the implant in a more favourable position, a
migration of the implant to the maxillary sinus (4). mucoperiosteal flap was raised and the sinus was accessed
This article aims to show and describe the procedure of through the original antrostomy. The Schneider membrane
the removal of an implant displaced to the maxillary si- was removed at this level and the purulent accumulation
nus through an intra-oral approach. formed after the implant migration was drained. The hea-
ling process went on without any incidents and it was de-
Case Report cided not to insert a new replacement implant, redesigning
Male patient, 54 years old, with no medical history of the implant-supported rehabilitation on 5 implants. During
interest or known harmful habits. He visits the clinic to the following year of follow-up, the patient did not mani-
restore the maxillary arch, in which there were some tee- fest any type of sinus symptomatology, (Figs. 1-3).
th remaining that were going to be removed and replaced
by an implant-supported fixed prosthesis on 6 implants Discussion
in positions #3, #5, #7, #10, #13 and #14. A prophylactic Depending on when it occurs, implant migration into
perioperative antibiotic treatment was administered with the maxillary sinus is classified as early or late displa-
Amoxycillin/clavulanic acid 875/125 mg/ 8h for 7 days, cement. Early displacement can happen at the time of
starting two days before the surgery. Mouth rinse with surgery due to an incorrect surgical technique (3), ex-
chlorhexidine digluconate at 0.20% every 8h for 15 days cessive force during implant placement (5), surgical
was indicated. In the 3rd sextant, a sinus lift was per- inexperience (9), a poor or a lack of primary stability
formed with a lateral window approach (Caldwell-Luc at the time of implant placement (3,9), inadequate bone
type) due to a remaining bone height of less than 4 mm. quality or quantity (3), autoimmune reaction, or chan-
The sinus cavity was filled with Gen-Os® (OsteoBiol), ges in intranasal sinus pressure (2). Late displacement
a porcine origin xenograft, with particles of cancellous may occur after implant loading due to early loading (9),
bone and collagenous cortical bone with a particle size inflammatory reactions that cause peri-implantitis and
of 250-1,000 µm and a Biomet 3i implant (Zimmer®) of bone loss or implant overload, among others (3). In this
5x10 mm was placed simultaneously in the position co- case, the reason for the displacement was related to mi-
rresponding to the #13. The antrostomy was sealed with cro-movements in the implant caused by the complete
a 0.5 mm thickness collagen barrier membrane (Evolu- removable prosthesis used as a provisional solution.

Fig. 1: A. Orthopantomography performed intraoperatively, after migration of the implant into the sinus cavity. B. Cone-beam com-
puterized tomography performed before the rescue of the migrated implant.

e734
J Clin Exp Dent. 2021;13(7):e733-6. Implant migration into maxillary sinus

Fig. 2: A. Access to lateral antrostomy performed one week before when the implant migrated into the sinus. B. Perforation of the
Schneider membrane and location of the implant in the sinus cavity. C. Removal of the implant.

dental implant placement (7). Another preventive mea-

sure is placing implants in areas with sufficient available
vital bone through title implants, all-on-4 techniques (in
case of full-mouth rehabilitation) avoiding the maxillary
sinus, or placing implants in anatomical buttresses, as
well as ultra-short implants, subperiosteal dental im-
plants or bone augmentation procedures.
Surgical strategies for the removal of a migrated im-
plant are essentially divided into two main approaches:
transoral and transnasal endoscopic approach (or com-
Fig. 3: Orthopantomography carried out after one year of follow-up bined). Oral and maxillofacial surgeons are more fami-
in which the patient showed no symptoms of sinus infection.
liar with the transoral approach, whereas the transnasal
endoscopic approach is more prone to be done by oto-
laryngologists. In the present case, the sinus was re-ac-
cessed through the antrostomy created during the sinus
DID into the maxillary sinus can act as foreign body lift procedure carried out a week before as it was consi-
causing serious complications, so that, it should be re- dered to be the least invasive procedure. In these cases,
moved as soon as possible, even in asymptomatic pa- the patient can be asked to move his head in different
tients, to prevent the spread of infection to paranasal directions to facilitate the implant migration near the la-
sinuses or other vital sites (1,7). The timing of surgical teral window. A fibre-optic light can be used to locate the
intervention should be as close as possible to the foreign implant. After dental implant removal, the sinus window
body insertion to minimise mucosal inflammation and will be covered with a resorbable barrier membrane.
to prevent discrepancies in the location of the implant This technique (transoral approach) enables improved
(6). The explanations of how implants migrate inside the access and visibility for the removal of the displaced
maxillary sinus have not been clearly defined. It could implant (3) and enables removal of all the granulation
be explained if it is assumed that the implant breaks tissue due to a direct visual approach, as well as a rapid
through the natural maxillary sinus ostium with the aid recovery of the patient´s symptoms (5).
of the mucociliary action so that the displaced implant
can be accidentally swallowed or aspirated, which may Conclusions
be life-threatening (8). These complications are rare; In the case of intraoperative migration of the implant
however, it can be a cause of odontogenic sinusitis (10) into the sinus, its removal is recommended as soon as
because it can cause impairment of the mucociliary clea- possible to avoid a possible sinus pathology of iatro-
rance mechanism (2) or tissue reaction (5). The most genic origin or even a complication that implies a li-
significant sequela due to foreign bodies in the maxillary fe-threatening condition.
sinus is chronic sinusitis with or without nasal polyps,
which may cause serious conditions such as pansinusi- References
tis, panophthalmitis, and orbital cellulitis (1). 1. Brescia G, Fusetti S, Apolloni F, Marioni G, Saia G. Displaced Den-
Lack of bone and lack of osseointegration due to insu- tal Materials in the Maxillary Sinus: An Original Series. Analysis and
fficient quantity of vital bone may lead to implant dis- Definition of a Surgical Decision-Making Process. Ann Otol Rhinol
Laryngol. 2019:128:177-183.
location, sinus infection and oroantral fistula formation. 2. Dundar S, Karlidag T, Keles E. Endoscopic Removal of a Dental
A sinus floor augmentation in a first stage and a delayed Implant From Maxillary Sinus. J Craniofac Surg. 2017:28:1003-1004.
dental implant placement may prevent this complication 3. Froum SJ, Elghannam M, Lee D, Cho S-C. Removal of a Dental
by increasing the quantity and quality of bone before Implant Displaced Into the Maxillary Sinus After Final Restoration.
Compend Contin Educ Dent. 2019:40:530-535.

e735
J Clin Exp Dent. 2021;13(7):e733-6. Implant migration into maxillary sinus

4. Japanese Academy of Maxillofacial Implants Academic Commit-

tee Trouble Survey Working Group. Survey report on serious medical
trouble of implant surgery (commentary). Nihon Gaku Gammen Im-
puranto Gakkai Shi. 2012:11:31-39.
5. Jin T, Wang Y, Li S, Cai Q, Huang Z. Removal of the dental implant
displaced into the maxillary sinus through the inferior nasal meatus via
transnasal endoscopy. J Craniofac Surg. 2019:30:1178-1179.
6. de Jong MA, Rushinek H, Eliashar R. Removal of dental implants
displaced into the maxillary sinus: A case series. Eur J Oral Implantol.
2016:9:427-433.
7. Manor Y, Anavi Y, Gershonovitch R, Lorean A, Mijiritsky E. Com-
plications and Management of Implants Migrated into the Maxillary
Sinus. Int J Periodontics Restorative Dent. 2018:38:e112-e118.
8. Park JH, Kim HY, Kim SJ. From the maxillary sinus to the stomach:
a rare case report of a displaced fragment of dental implant. Eur J Oral
Implantol. 2018:11:469-473.
9. Safadi A, Ungar OJ, Oz I, Koren I, Abergel A, Kleinman S. En-
doscopic sinus surgery for dental implant displacement into the maxi-
llary sinus-a retrospective clinical study. Int J Oral Maxillofac Surg.
2020:49:966-972.
10. Yoon SH, Jung S, Kang T, Yang HC. Accidental Swallowing of
Dental Implant: Complication of Transnasal Endoscopic Removal
From Maxillary Sinus. J Oral Implantol. 2019:45:219-222.

Ethical approval
None required.

Conflict of Interest
None declared.

e736