Closure of an extensive OAC following failure of a crestal approach sinus lift and implant

141 Rating(s).


Posted on By Howard Gluckman In Failures

Sinus augmentaions are not without complications. SOme are small and some are very large like this one. It is important to know how to deal with them. THis case goes through our protocols for the OAC closure




Add to Favorites
Add a comment to the discussion on Closure of an extensive OAC following failure of a crestal approach sinus lift and implant


Upload photos
1.  Photo Title:

2.  Photo Title:

Would you like to follow this post?
Case has been added to your favorites.
Case has been removed from your favorites.
Thank you for your input. Your comment has been posted.
You are now following this member. You will get notified on any new topics posted by this member.
You are no longer following this member. You will not get notified on any new topics posted by this member.
Edit Comment
1.  Photo Title:
Current Image:   Delete Image
2.  Photo Title:
Current Image:   Delete Image
Comment has been updated.

25 Comments

Howie. That is EXACTLY how I would have treated as well ( or at least tried). Well done! Thank you for sharing. Best regards. Chuck.


Reply

Chuck thanks you keep me laughing thats for sure


Reply

What a great instructive case Howie. Thanks.
What is your protocol for ensuring that a patent osteum exists?


Reply

he he Henry. I only saw the mistake now. I mean that the Osteum is patent. Dam autocorrect.


Reply

Howard

Very nice protocol to close the OAC. The peanut reference made me remember this case of what we call in this part of the country " foxtail foreign body "
Maxillary and palatal ONC. Simple flap elevation, debridement, double membrane fixation ( Fascia/Lamellar Bone ) and primary closure.

Thanks for posting this interesting case

Rocco

Presentation/Defect/Fascia
Lamellar Bone Plate/ Primary Closure


Reply

Thanks Rocco. Interesting case. Henry I have made the corrections thanks for that.
regards
Howie


Reply

Howie,

Nice closure- double layer is key- X-rays? Was the other implant treated in the Abx washout? appears close
When will you go back in- will you redraft from lateral approach- what will your bone mix be?

This is a part of your new series " How ie (we) do"! ( its a take off on a popular hip-hop statement) you could Host have your series on XP- Tough case Thursday- nothing but complication management-

Cheers,

Richard


Reply

Hi Rich.

I love the idea. Complication thursday will have to speak to the bosses of XP. THe implant in front was in bone no sinus lift around it. We will leave the case for at least 3 months for closure and then possibly go in. The patient is not keen on further intervention at this stage so we will see what happens. Time heals all wounds and we will see how it goes. Why this happened I am not sure. It could be some residual stuff in the sinus but she ia also diabetic and poor wound helaing is also an issue. Also found a peanut in the sinus which is as strange as strange can be but not sure it came after or before.


Reply

Just phenomenal skills on display here and great planning. Keep us posted my friend. regards Mo


Reply

Thanks Mo. I will keep you posted. What do u think about a complications Thursday discussion forum. Maybe a live debate or just cases hosted by someone. A great new idea for XP.


Reply

Great idea Howie....and Richard Martin. Why don't you 2 take it on. We could do it in many different ways. Speak together and let us know how best you wish to proceed. I like "Complication Management Thursday with Howie and Richard" a open discussion of modern implant and surgical complications. regards Mo


Reply

Awesome I will chat to Richard via email and we can make a plan.


Reply

Hi Howard, very nice solution. It is a great idea to show problematic cases or treatment complications. This quote is on a plaque in a hospital where I did a general dentistry residency before going to my orthodontic program. I read it more than 25 years ago and still remember it : "He who shows others his surgical problems. Is not only the finest of surgeons. But an honest man" Luis Razetti, MD, 1862-1932 (Venezuela's eminent physician and educator)


Reply

Great quote and too true. We see too much perfect work and not enough complications. We meed a blog of only our worst cases.


Reply

Howard, it is quite a case the one shown! I wonder what was initial therapy, was an implant inserted immediately? I quite agree with Miguel thoughts, showing such a complication is peculiar of a great professionist. My compliments. Please give some upgrade about the therapy follow up. Armando


Reply

Hi Amando I could not agree more with you and Miguel. The initial therapy was an immediate implant and a sinus augmentation at the same time as the extraction. This then failed due to infection and we allowed it to heal and we cam back and did the procedure a second time and this is the result. I think the patient has poor healing from the diabetes and maybe some other issues. She has a patent osteum so that is not the issue here.


Reply

Howard, well done! As usuall...
Can you tell us your OAC protocoll exactly?
What AB therapy and how long before you do this closure?
How long after?
Interesting to rinse with clorhexidine or povidone?
Thanks for this cases!
Jorge


Reply

HI Jorge yes with pleasure. I don't generally treat them straight away if they are large as I allow them to close a little on their own. That allows the normal tissue to close a lot and then it is easier to get closure rather than pulling the cheek into the defect. The I open the area out and clean the sinus membrane if necessary. If it is thick and very granulomatous then I generally remove it to speed up the healing process from fresh rather than having the body try and eliminate the infected tissue. I then rinse the sinus out with IV metranidazonle and also inject some of it into the surrounding tissue to try and help to kill the bacteria. The edges are first lasered to clean them up and then after a split thickness flap is raised. The rotated palatal flap is created and the prf is laid over the opening and the RPF is then sutured into place and then the buccal flap closed with buccal flap advancement. We normally give Avelon 400mg for 10 days 1 a day and also nasal decongestants and nose drops to keep the sinuses clear.


Reply

Very logicall. Thanks Howie!
Jorge


Reply

Miguel great quote


Reply

Absolutely the truth James. Said by the pioneer of surgery in Venezuela. A gifted physician who founded the main medical school in the country. Regards. Miguel


Reply

In your experience treating OACs, does a cortical always form after closure or do you sometime have a repaired Scneiderian membrane fused with soft tissue ? And in that case , how would you go about augmenting the site if need be?


Reply

Laurent most often there is a small adherence of the membrane to the overlying periosteum. If this occurs then what I generally do is the raise a full thickness flap and then do a sharp dissection of the adhesion and split it more on the purist side and push that into the sinus and then complete the sinus augmentation as normal


Reply

Howie- lets work on it- !! "It's complicated"

Have you ever herniated a portion of the buccal fat pad- to close an OAC? works nicely and fibroses in and is still tethered to main supply- works best if no posterior tooth but I have also harvested a piece and sutured to the periosteum if posterior tooth is present- works well for 2 layer closure

Also in the old days we used gold foil and even tongue flaps!


Cheers,

Richard


Reply

Rich I have never done that at all. I know a common technique for surgeons but not one that periodontists are familiar with.


Reply


Ritter
Salvin