Medical Science: Updates and Prospects Vol. 8

Background: Cone beam computed tomography (CBCT) plays a pivotal role in diagnosing implant-related sinus pathology by providing a detailed assessment of peri-implant bone loss, sinus membrane thickening, and integrity of the sinus floor.

Aim: This chapter describes the clinical presentation, surgical management, and outcome of implant-related oroantral communication complicated by chronic maxillary sinusitis following sinus augmentation, using a staged approach involving implant retrieval, antral lavage, and combined buccal advancement flap and buccal fat pad closure.

Case Presentation: A 65-year-old male patient presented with pain and pressure in the right infraorbital region, halitosis, chronic rhinosinusitis, and mobility of the implant-supported prosthesis in the right posterior maxilla. Cone beam computed tomography revealed bone loss around the implant associated with chronic sinus pathology and oroantral communication. Surgical management included retrieval of the displaced implants, thorough antral lavage, placement of autologous PRF within the defect, and closure using a buccal advancement flap reinforced with harvested buccal fat pad to achieve tension-free primary closure in two steps due to active sinus infection. Postoperative evaluation was performed at regular intervals, including 7 days and 3 months.

Results: Healing was uneventful with successful closure of the oroantral communication. The patient demonstrated complete resolution of sinonasal symptoms, absence of nasal regurgitation, and stable soft tissue healing. At the 3-month follow-up, no recurrence of oroantral communication or sinus infection was observed. CBCT findings of peri-implant bone loss and mucosal thickening are consistent with chronic inflammatory changes of odontogenic origin. Removal of the etiologic factor—in this case, mobile implants—is mandatory, as retained foreign bodies perpetuate sinus inflammation and impair mucociliary clearance.

Conclusion: Combined use of implant retrieval, antral lavage, PRF, and dual soft tissue closure using buccal advancement flap and buccal fat pad provides a predictable and effective approach for the management of implant-related oroantral communication with chronic sinusitis. Retrieval of mobile implants, effective sinus decontamination, biological augmentation with PRF, and tension-free closure using a combined buccal advancement flap and buccal fat pad can result in predictable healing and long-term symptom resolution.