Many clients are getting dental implants in the upper jaw. The sinuses are located right above your upper teeth, which poses a potential problem when pulling teeth and installing dental implants such as sinus perforation when having one of your upper teeth extracted?
The anatomy of the sinus floor and its relationship to the upper teeth varies from person to person. In some people, the sinus floor is well above the roots of their teeth with bone separating the roots from the sinuses. While in other people the floor follows the roots more closely. In essence, wrapping around the roots with minimal bone between the sinus and tip of the roots. Still others actually have the roots of the teeth up into the sinus, which seems to work fine, so long as they are not disturbed (i.e., extracted forcefully). For those whose sinuses are very close to or even touching their tooth roots, there is a risk that the sinuses will be perforated when their tooth is extracted. This risk is greater if the tooth being extracted is infected or has an abscess at the tip of the root. This situation calls for extreme caution and if the dentist does not comply with the standard of care, a communication between the mouth and sinus can occur and this is often a very serious complication which could have been avoided which can take months and even years to resolve.
When considering an extraction of an upper tooth, if x-rays show that the tooth’s roots are near the sinus floor or actually in the sinus cavity; or if there is an infection or abscess, the dentist should take a cone beam CT scan (“CBCT”) of that area prior to extracting the teeth and certainly before placing the implant in that area. A CBCT can assess the proximity of the roots to the sinus or assess the degree of existing defects that may lead to a sinus perforation following an extraction. Since CT scans are imperative in planning and placing implants, it is considered below the standard of care for dentists to not perform a CBCT before extraction and implant in this area. In fact, due to the complicated anatomy, it may be necessary to perform a pre-extraction CBCT and a pre-implant CBCT. This is so because the extraction may cause significant changes to the bone structure that would affect the available bone in which to place the implant. If there is enough bone height, the implant will fail, or worse, the implant will be screwed into the sinus where it will invariably lead to communication between the mouth and sinus and repeated infections. Sinus perforations, if not diagnosed and left untreated, can persist, leading to an oral-antral fistula—an opening between the sinus and the mouth. Oral-antral fistulas can result in sinus infections as well as fluid drainage from the mouth to the nose. They can also lead to drinks being leaked into the sinus, whistling noises when breathing, and a whole host of unpleasant problems caused by the opening between the mouth and sinus. It is important to manage sinus perforation at the time it occurs to prevent it from progressing to a chronic oral-antral fistula. Proper care and treatment after a communication is caused often requires that an oral surgeon consult with an ENT and/or the two of them working together to resolve the issue.
Most times, a sinus perforation secondary to a tooth extraction is managed using a three-step approach. The first step involves placement of collagen plugs or membranes at the junction of the root and the sinus opening. The next step is to place bonegraft material around the plugs and to pack it into the sides, and not directly down, to avoid displacement into the sinus. The third step is to place another collagen plug or resorbable membrane over the bone graft to keep it intact and protected in the socket. Even this 3 step approach may not be enough to avoid serious complications, so the best way to deal with this is to not commit malpractice and cause the communication in the first place.
For over 25 years, Attorney Robert J. Fleming has been handling dental malpractice, medical malpractice and other personal injury lawsuits for individuals and families who have been injured or died as a result of the negligence or malpractice of others in the Atlanta, Georgia area. He is a partner in the law firm of Katz Wright Fleming & Dodson, LLC and regularly handles cases in Atlanta as well as Alpharetta, Brookhaven, Chamblee, College Park, Duluth, Decatur, Doraville, Johns Creek, Jonesboro, Lawrenceville, Norcross, Peachtree City, Riverdale, Roswell, Sandy Springs, Stone Mountain, Smyrna, Peachtree City, and other cities in Georgia. He is committed to making a difference in his clients’ lives. If you or family member have been seriously injured or died as a result of dental negligence and would like quality legal representation or if you would just like to consult about a potential case, contact Robert J. Fleming directly on (404) 525-5150 or contact us online.