Avoiding & Managing Perforation of the Maxillary Sinus

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One complication dental implant surgeons need to avoid and manage is perforation of the maxillary sinus when performing sinus lift procedures or placing implants in the maxillary sinus area.

In the Case of Lateral Window Sinus Lift Procedures

A cone beam CT scan enables the surgeon to see where the sinus septae are located. Typically, the surgeon can avoid perforation of this membrane by using a diamond bur, specialized diamond instrumentation for window preparation or Piezo electric instrumentation (Piezotome, Salvin Dental Specialties).

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Dental Implant Complications: Paresthesia

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Avoiding & Managing Dental Implant Complications: Paresthesia

Etiology and Avoidance

Nerve injuries occurring during implant surgery can be from multiple causes. Mandibular block anesthesia and infiltration, especially in the area surrounding the mental foramen, can cause an altered sensation involving the lip, chin, and the tongue. Retraction injuries can also present with similar symptoms. In the majority of these cases the resultant paresthesia will eventually resolve.

Nerve injury may also inadvertently occur during osteotomy preparation, especially when the surgeon does not realize that the system drills are longer than the planned implant. As a general rule, a safe zone of 3mm should be respected, in terms of distance from the inferior alveolar nerve and the apical extent of the osteotomy preparation. Increased distances may be indicated when the cancellous marrow is sparse and poor bone density is encountered.

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One of My Chief Concerns: Dental Implant Complications

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The initial focus of my implant practice was esthetics. I applied the principles of plastic and reconstructive maxillofacial surgery toward developing a site preservation protocol and towards achieving predictability with hard and soft tissue site development. We assembled a team that allowed us to provide a comprehensive multidisciplinary approach to esthetic implant therapy, and I shared our cumulative experience in my textbook Soft Tissue and Esthetic Considerations in Implant Therapy (Quintessence 2003).

I also focused on learning how to avoid and manage implant complications. I made a point of analyzing our own experiences with complications, and I had opportunity to treat a large number of implant related complications referred to my practice. Over time, I gained considerable knowledge and experience concerning the factors that need to be recognized to avoid a wide variety of complications, as well as the treatment planning concepts and techniques required to manage patients who had experienced these complications.

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Treating Peri-Implant Mucositis and Peri-Implantitis

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With greater awareness of the tremendous benefits that dental implant therapy provides, an increasing number of general practitioners and specialists are now providing surgical and restorative implant care. With the increasing number of patients receiving dental implant care, we are seeing an increased number of avoidable complications.

In order minimize the number of avoidable complications, it is imperative that dental professionals who want to provide implant care qualify themselves by obtaining additional education and experience specific to this treatment modality.

This being said, I would like to review the treatment protocol for peri-implant infection.

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