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Avances en periodoncia; 16; 3; 179-186; 2004. Prof. Dr. Miguel Peñarrocha Diago y Cols. Valencia University Medical and Dental School, Valencia, Spain.
Perforation of the floor of the maxillary sinus or nasal cavity during implant placement in the residual bone located below is not an infrequent situation. It’s been strongly reported that slight membrane puncture while preparing implant bed does not play a significant role in clinical outcome, as it heals spontaneously, but it is an essential requirement that the implant remains intraoperatory stable.We present the case of a 54 yr. old woman that consulted in our office referring permanent cacosmia and halitosis associated to sporadic episodes of pain and purulent rhinorrhea, that didn’t ease to the administration of several different antibiotics. Radiological findings show three dental implants in the first quadrant replacing teeth 1.2, 1.3 and 1.6: first one piercing the nostril and the third one with its apical end completely into the right maxillary sinus with a delimitated radiopaque mass associated. Once confirmed the existency of an oroantral fistula and its involvement in the two-year evolution chronic sinusitis diagnosed, the treatment established included the extraction of the three implants and the simultaneous osseous reconstruction with an autologous bone chin graft. After the removal of implant 1.6, a composite resin-like material is found stuck to its surface with supposedly retentive purposes, contributing in this way in a very strong way to increase irritation. Remanent defect is so important that makes impossible bone grafting in this area, so we proceed to curette harmed sinusal mucosa, sending a sample for histological evaluation, and close with a Bichat fat pad pedicled flap. Postoperatory follow-up and evolution was favourable, achieving total remission of sympthomatology and complete recovery.