PMC5646311_01
Placement of implants, panoramic radiographs. (a) Initial situation, (b) immediately after implant placement in sites 23, 24, and 25, and (c) 7 months later, immediately after implant placement in sites 25 and 26.
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In April 2003, a 62-year-old Caucasian woman presented for the rehabilitation of sites 23-26 (residual bone height: 12, 5, 2, and 4 mm, resp.; Figure 1(a)). A lateral sinus floor augmentation with deproteinized bovine bone material (Bio-Oss , Geistlich AG, Wolhusen, Switzerland) was performed with the simultaneous placement of three standard endosseous implants (<=10 mm in length; Straumann AG, Basel, Switzerland) in sites 23-25 (Figure 1(b)). AG) and grafting material (Bio-Oss, Geistlich Pharma AG; Figure 1(c)). After 4 months, a percussion test showed that all implants were clinically stable.
Ten years after implant placement. (a) Periapical radiograph, (b) clinical view, flap at site 25, and (c) cone-beam computed tomography image. Note the opacity of the left sinus.
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Radiography showed crestal bone loss around implant 25 (Figure 2(a)). It revealed that the bone loss reached the implant apex (Figure 2(b)). Cone-beam computed tomography (CBCT; Model CS 9300, Carestream Health, Inc., Rochester, New-York, USA) showed an opaque left sinus (Figure 2(c)).
The implant 25 was removed and the bridge was rescrewed. The patient underwent antibiotic treatment. (a) Periapical radiograph and (b) clinical view.
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The failed implant got out spontaneously when the bridge was removed (Figures 3(a)-3(b)).
Six months after the removal of the implant 25. The cone-beam computed tomography image revealed that the opacity of the left sinus was still present.
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Six months later, persistence of the sinus opacity was observed on CBCT (Figure 4) and an OAF was then formed.
The oroantral fistula was closed with a buccal advancement flap. (a)-(d) Clinical views.
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The OAF was closed with a buccal advancement flap under antibiotic therapy initiated the day prior to surgery (Dalacin; Figures 5(a)-5(d)).
Two months after the closure of OAF. (a)-(b) Clinical views. The oroantral fistula remained successfully closed. (c) Cone-beam computed tomography image. The left sinus was totally healed.
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Clinical examination showed that the OAF remained successfully closed (Figures 6(a)-6(b)), and CBCT images confirmed total healing of the sinus (Figure 6(c)).
Two years after the closure of OAF; the radiographic control showed a stable crestal bone level.
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Radiographic control showed that the crestal bone level was stable in this area (Figure 7).