The current tx plan is to place an 8mm implant in an upper molar area where the ridge height is approx. 7-8 mm. The surgical plan is to drill through the sinus floor quickly and carefully to achieve bicortical fixation without sinus lift. But my questions are: 1. if the sinus membrane is much thickened like this case, is there no need to worry about nicking the sinus membrane? 2. if the drill goes into the sinus membrane by 2-3mm in this case and drills back and forth, I am just curious if the sinus membrane gets torn?
Roger Gomez comments:Why not further investigate that lesion before embarking on an implant in that area? Why to take the risk under those conditions?...unless you are happy with either an ultra short implant or having to deal with serious legal.problem
Junaid comments:From previous experience, be wary of thickened maxillary sinus lining. There will be underlying pathology which has caused this. Further investigation and past history needs exploring. I have inadvertently perforated the lining in a patient with underlying pathology in which she required hospitalisation. This should answer both questions; 2/3 mm perforation will tear the lining.
Have you considered the internal sinus lift / Summers Osteotome technique? Prepare up to 2mm of the sinus floor and tap, tap, tap, tap, tap, tap to transport the floor upwards. With that much thickness of the lining, you will not perforate.
Lalaali comments:what pathology did you encounter in the case you above-mentioned ?
Junaid comments:Also, consider ultra short implants like the Bicon implant system. I have had excellent results in these clinical situations over the last 15 years.
Daniel Sweet comments:No problem,, just use the Versah Densa drills. They can run in reverse and not shread anything.
Matt comments:This looks like a dome shaped lesion indicative of a pseudocyst or retention cyst. Quite common and should be fine if lifting with Versah or Osteotomes, but best to get clearance from ENT first.
Matt comments:Also, best to have a CBCT to see entirety of lesion and make sure ostium is patent.
AM comments:I agree. Osteotome or versah sinus lift. And you can get an ENT to look at this. But the reality is that any complication will fall on your shoulders regardless. So if you feel comfortable with the patient and you have explained the risks then move along and place. But yes. Be careful and use the proper drills or osteotomes to do this so you don’t run into trouble. The regular drills will shred this tissue.
Greg Kammeyer, DDS, MS, D comments:I agree Versah or Osteotome. Burrs will cut the membrane and Matt is right: you should get a full view of the sinus to see how big the lesion is. This will help you decide if you need an ENT consult and as well how patent the OMC is. The later is critical with any sinus signs or symptoms.
Dale Miles comments:Whoa...slow down gents...you have a small field of view...have not seen the opposite maxillary sinus, nor the ostiomeatal complex...all paranasal sinuses communicate...there may be inflammatory change - which is what you are calling a "thickened sinus membrane" - in other sinus spaces. We dentists only think of the maxillary sinus...there are ethmoid air cells, frontal and sphenoid sinus spaces to consider...if you do not image or send the patient for imaging the additional spaces, you may place an implant in a sea of inflammation...and exacerbate the patient's problem...what you don't know or see CAN hurt you...respectfully Dale Miles[Doctorconebeam.com](Link)
PS…Dr. Kammeyer is closest to next steps, because he has read this in previous radiology reports from me… :rolling_on_the_floor_laughing: