I’m trying to remain as patient as possible as my dental implant saga continues. However, it’s becoming increasingly difficult to do that. I have not had a good experience so far.
It all started about six months ago when I had a dental implant done to replace tooth #2. I ended up with a sinus perforation and was told that I may have some bone loss occurring, and that my gums weren’t properly filling in. My sinus was perforated by a few millimeters.
I’m wondering if you could tell me more about the sinus perforation. I was told that it actually punctured the sinus by a few millimeters. Last week, I had the dental implant removed. After the procedure where they removed the implant, they informed me that they didn’t see any signs of infection at the site. Also, apparently it was very easy to remove because it didn’t fuse with the bone at all.
He explained that they didn’t administer intravenous antibiotics since everything looked good during the surgery. But, he did send me home with Flonase as a precaution. I was instructed not to blow my nose and to try to avoid sneezing with my mouth closed to avoid extra pressure in the area.
Unfortunately, it doesn’t sound like he was able to successfully repair my sinus area. However, he did clean it out and put stitches in the gums. He explained that it should heal OK on its own and advised me to have it checked on in a year to see if the puncture heals with sinus tissue or bone. Then, they could determine next steps.
Well, after I left the congestion continued to worsen. It got really bad at night, even when I used Flonase regularly. I also started noticing that I was having a crackle or pressure change in my ear whenever I chewed or opened and closed my mouth. There was no pain in my ear and it just felt like something strange was going on with the pressure. So, I went back in to have him check things out.
He said I was fine. I requested antibiotics at that point because I felt like it could be the start of an infection. He wasn’t onboard at first but eventually agreed to give me some. Since I’ve been on the antibiotics, my congestion has improved and I’m noticing that there aren’t any issues, and I don’t feel like air is passing through that site.
So, why didn’t he give me antibiotics to begin with? Also, does it sound normal that I’m supposed to simply wait it out to see if things heal. If there is an infection of some sort, I’m concerned that will inhibit the bone and healing overall.
I would greatly appreciate any insight you have.
-Becky in Indiana
Thank you for your questions. For starters, many dentists do not see any harm in putting patients on an antibiotic as a precautionary practice right away. As you’ve likely heard, not everyone agrees on this approach. There has been push back in recent years in this practice because it may help cultivate bacteria that become resistant to bacteria. So, every case is different. There are doctors who will not prescribe the use of antibiotics “just in case” so maybe that is the category that your doctor falls into. Flonase also seems like a good option to help control the possibility of increased mucus congestion after surgery.
There are some other concerns based on what you have shared. The failed dental implant due to a perforated sinus is a big deal. It shouldn’t be glossed over. Even though it may not sound like it to you, in dentistry a few millimeters is a lot. Also, you mention that the bone failed to integrate with the implant post. This is also concerning. These two mistakes definitely bring several more questions. Hopefully, there is a more logical, clinical explanation as to why this has occurred.
The oral surgeon’s errors may indeed be the reason that your dental implant was unsuccessful. Some surgeons would say that the surgery was sloppy. However, there are surgeons that will explain that a perforated sinus will heal on its own and not to be concerned. But, this does increase the chances for infection. Also, regarding the lack of bone integration, there are varying opinions on that too. Think of it like this. The more the implant punctures into the sinus, there is less of it being supported by bone. Most dentists would likely agree that a “few” millimeters is too far. One or two millimeters isn’t as extreme. All that to be said, implant dentistry is not a regulated specialty area within dentistry. In order to be successful, a dentist must undergo extensive training beyond dental school. Since it is not regulated, it is open to different interpretations. And for the sake of those learning more about the dental implant procedure, it is imperative to seek multiple opinions and to do your research on the success rate of a particular dentist before moving forward.
The good news is that it sounds like the implant was removed relatively easily. So hopefully you won’t be dealing with nasal and/or ear issues for long. And it’s also encouraging that the antibiotics seem to be offering you some relief. There are other patients that have had lingering sinus and nasal complications for years after the surgery.
For future reference, dental implant surgery should require that a dentist use as many x-rays as required to get a full picture of your nasal and sinus cavities. Three-dimensional x-rays are preferred to ensure there is enough bone present at the implant site as well.
The questions you need to take back to your surgeon should be along the lines of this:
- What are you doing to ensure this doesn’t happen again?
- If there wasn’t enough space for the initial placement of the implant, what will you do differently the next time around?
- Is there adequate bone density to support a new dental implant?
Bone grafting or a sinus lift procedure may be required before moving forward.
There needs to be a disclaimer here in giving you specific recommendations because it is difficult to do so without having seen you in person. We are only hearing a portion of the story. So, be sure to ask questions, find out more about the puncture and why it occurred. Also, it would be good to learn more about why the bone didn’t fuse with it.
Lastly, selecting an implant dentist is all about trust. If for some reason you have any doubts, listen to your gut. It would be a good thing to seek another opinion or two before making any further decisions.
Thank you for reaching out. Hopefully, this helps you better understand what is going on and give you an idea of next steps.
This post is sponsored by Petaluma dentist Dr. Rick Lane.