Treatment of Sinusitis Following Dental Implantation: A Systematic Review and Meta-Analysis

Abstract

Background Implantological procedures aimed at rehabilitating upper jaw edentulous patients (dental implant placement and/or maxillary sinus grafting) can sporadically result in sinusitis. In these patients, endoscopic sinus surgery is the most commonly employed treatment, but clinical scenarios and comprehensive management strategies are extremely heterogeneous across studies. Objective We sought to systematically define treatment strategies and related success rates for sinusitis following dental implantation, detailing different current treatment choices and concepts. Methods Adopting a PRISMA–compliant review framework, systematic searches were performed in multiple databases using criteria designed to include all studies published until November 2020 focusing on the treatment of human sinusitis following dental implantation. We selected all original studies, excluding case reports, specifying treatment modalities with objective treatment success definitions. Following duplicate removal, abstract and full-text selection, and quality assessment, we reviewed eligible articles for treatment modalities and success rates, which were pooled in a random-effects meta-analysis. Results Among 581 unique citations, eight studies (181 patients) were selected. Seven studies were retrospective case series. All studies relied on endoscopic sinus surgery, often coupled with intraoral accesses, and assessed therapeutic success endoscopically. The pooled treatment success rate was 94.7% (95% confidence interval, 91.5%–98%). Failures were treated in seven of 15 cases with further antibiotic therapies and in another seven cases with surgical revision. A single patient was lost to follow-up. Conclusions Endoscopic sinus surgery appears to be the most frequent treatment of choice for sinusitis following dental implantation, with excellent success rates. The protean clinical picture drawn from the selected studies calls for the standardization of diagnostics and definitions in this field to enable direct comparisons between the results of different studies. The role of postoperative antibiotic therapies, which have been employed unevenly across studies, should also be prospectively investigated.

Retrospective comparison of first-line treatments for odontogenic sinusitis based on duration of symptoms

“…In contrast, several recent studies have revealed that ESS may be a more effective first-line treatment for ODS. Two meta-analyses 30,31 demonstrated a high overall success rate for ESS in treating ODS, consistent with our results. Craig et al 16 conducted a prospective study of 37 patients with ODS.…”

Odontogenic sinusitis: A literature review

“…Furthermore, the significant costs associated with dental implantation make decisions for removal poorly acceptable to patients. Although implant preservation through medical treatment and primary ESS should be considered first, the outcomes for conservative treatment is reported to be poor 60 . A recent systematic review and meta‐analysis involving eight studies with 181 patients reported a pooled success rate of 94.7% for primary ESS and dental surgery in the treatment of sinusitis following dental implantation 60 .…”

“…Although implant preservation through medical treatment and primary ESS should be considered first, the outcomes for conservative treatment is reported to be poor 60 . A recent systematic review and meta‐analysis involving eight studies with 181 patients reported a pooled success rate of 94.7% for primary ESS and dental surgery in the treatment of sinusitis following dental implantation 60 . Dental surgery involved the debridement of infected osseous grafts, removal of dental implants with peri‐implantitis and OAF closure.…”

“…60 A recent systematic review and meta-analysis involving eight studies with 181 patients reported a pooled success rate of 94.7% for primary ESS and dental surgery in the treatment of sinusitis following dental implantation. 60 Dental surgery involved the debridement of infected osseous grafts, removal of dental implants with peri-implantitis and OAF closure. Treatment success was defined by the endoscopic absence of sinus infection.…”

The Lifetime Pursuit of Solving Complex Questions

“…Seventy percent are diagnosed clinically or via direct visualization, and extra-sinus recurrence heavily relied on radiographic evaluation to suggest the utility of frequent clinical monitoring and imaging over an extended period of time beyond the traditional “5-year” mark. Allevi et al 16 attempt to define a treatment algorithm for odontogenic sinusitis status post-dental implantation. Their evaluation of 8 studies demonstrates that endoscopic sinus surgery (ESS) has a pooled success rate of 95%.…”