A Case of Simultaneous Ectopic Tooth Extraction and Removal of Migrated Dental Implant from Maxillary Sinus

Abstract

When a dental implant migrates to the maxillary sinus it should be extracted immediately as it may cause sinusitis or further migrate to one of the other paranasal sinuses. Although usually detected due to symptoms such as nasal obstruction, nasal discharge, and nasal bleeding, an ectopic tooth in the maxillary sinus can sometimes be revealed incidentally on radiographic examination. Here, we report a case of simultaneous extraction of a dental implant that had migrated to the maxillary sinus and removal of an ectopic tooth that had arisen in the same location. The patient was a 73-year-old man who had received the implant to replace the first left maxillary molar at a local dental office. The implant had subsequently migrated to the left maxillary sinus and the patient was referred to us for its removal. On locating the implant on a CT scan at our hospital, an ectopic tooth was also observed at the base of the maxillary sinus. With patient consent, the decision was made to remove the ectopic tooth and extract the implant simultaneously. Excision of the lateral wall of the maxillary sinus allowed easy extraction of the implant. The ectopic tooth was removed by slightly expanding a fenestration in the sinus wall. Ectopic teeth in the maxillary sinus are sometimes put on follow-up if asymptomatic. Removal should be considered, however, if there is a risk of it becoming infected due to implantation-induced inflammation.

A large-scale study of treatment methods for foreign bodies in the maxillary sinus

“…As the nasal approach is facilitated via the natural ostium, it is minimally invasive. However, limitations because of the size of a foreign body are considerable (30), and it is difficult to reach areas near the floor of the maxillary sinus (11,31). When approaching via the oral cavity, an endoscope is used after making a small incision in the canine fossa, like in the Caldwell-Luc approach.…”

Modified Caldwell-Luc Technique to retrieval of tooth fragment displaced into the maxillary sinus: A case report

“…Endoscopic surgery combined with antibiotic therapy is currently the most conservative technique for managing the maxillary sinus, however, the cost of equipment, need of surgical training and impossibility of performing the technique under local anesthesia are still barriers to its broad use, furthermore, the endoscope is not suitable for retrieval of all types of foreign bodies. The CL technique remains an effective and safe option for a variety of cystic, odontogenic, and neoplastic lesions within the maxillary sinus, as well as for sinusitis that have not responded to antibiotic therapy and minimally invasive approach, offering the advantage of ample and direct access to the interior of the cavity (Huang et al, 2012;Furuya et al, 2015;Chagas Junior et al, 2016;Aukštakalnis et al, 2018).…”

“…The CL technique was the main surgical procedure to treat pathologies and remove foreign bodies from the maxillary sinus until the development of endoscopic surgery, which offers the possibility of a minimally invasive procedure, however, when it comes to foreign bodies of large dimensions, such as roots, teeth and implants, minimally invasive access becomes inadequate, in addition, it needs to be performed under general anesthesia or sedation, increasing its costs and morbidity (Furuya et al, 2015;Hara et al, 2018). Huang et al (2011) described a CLM approach, performed under a more conservative access and narrower bone window, without removal of the healthy mucosa or inferior meatal antrostomy, decreasing the surgical time and risk of complications, providing greater predictability and postoperative comfort.…”

Endoscopic treatment of ectopic teeth in the maxillary sinus

“…However, in cases such as Pathological bone quality, dentofacial deformities, and Severe bone atrophy, oral surgeons may be less enthusiastic to use the trans-oral sublabial approach. In recent years, however, ectopic teeth in the maxillary sinus have been removed endoscopically via the nasal route (8). In this study, we share our experience in the endoscopic surgical management of ectopic teeth in the maxillary sinus.…”

“…However, review of the literature reveals that ectopic tooth eruption may be associated with a variety of clinical manifestations, including facial pain, unilateral purulent nasal discharge, headache, nasal obstruction, facial edema, chronic sinusitis, epiphora, and numbness (2)(3)(4). The literature on ectopic maxillary teeth is mostly limited to case reports (5), describing a variety of presentations, including nasolacrimal duct obstruction (6)(7), ectopic teeth close to a migrated dental implant in the maxillary sinus (8), and even a maxillary ectopic tooth leading to elevation of the orbital floor (7). Several locations of ectopic teeth within the maxillary sinus, with varying pathologies, have been described (5).…”