Sinus Perforation in Extraction

Extraction of the upper left 2nd premolar turns out to be difficult.  The root is stable and easy to break.  Periotomes, forceps, elevators and surgical bur have been used.  The roof and the distal wall of the socket are as thin as egg shell and perforated (Fig.3).  It appears that there is no residual root in the socket or the sinus (Fig.1,2).  Osteogen Plug is placed in the socket and fixated with 4-0 Chromic gut suture.  Bone graft would be displaced into the sinus.  Periodontal dressing is applied.  The latter remains in place 1 week postop (Fig.4 D).  There is no nasal symptom.  When the periodontal dressing is dislodged 18 days postop, the socket is healing normally (Fig.5).

The patient returns for implant placement approximately 5 months post socket preservation.  There appears to be bone fill in the socket with repair of the sinus floor (Fig.6).  The socket heals with mild buccal plate collapse (Fig.7).  Use a 3/2 mm trephine bur to start osteotomy for 7 mm and collect bone sample for research.  Sinus lift is conducted with 2.8 mm round bur (Sinus Master Kit) from 8 to 12 mm.  The perforated sinus membrane is repaired with Osteogen plug, followed by insertion of autogenous bone/allograft/Osteogen (Fig.8 arrowheads).  A 4.5x10 mm SM implant is placed with insertion torque > 35 Ncm (Fig.9).  A cemented abutment (4.8x4(3) mm) is tightened for an immediate provisional.  There is minimal hemorrhage.  There is no sign of sinusitis 4 months postop (Fig.10).  A modified screw-retained crown is fabricated.  The distal sinus floor appears to form 9 months post cementation (Fig.11 dashed line); there seems to be no crestal bone loss thanks to subcrestal placement (Fig.12).  The bottom of the sinus (S) seems to have been ossified 1 year 3 months post cementation (Fig.13).  CBCT is taken 2 years 5 months post cementation (Fig.14,15) when the tooth #9 fractures.  Incidentally the mesiobuccal root of the tooth #14 is found to be split vertically with large radiolucency.  The tooth should be extracted with bone graft soon.

Return to Upper Premolar Immediate Implant Chinese Osteogen Plug for Sinus Lift

Xin Wei, DDS, PhD, MS 1st edition 12/28/2015, last revision 08/14/2020