JIACD
The Journal of Implant & Advanced Clinical Dentistry
Perforation in Left Maxillary Sinus while Extracting a Tooth: How do I handle it????
Thu, 06/10/2010 - 04:13 — mansoor ahamed
During an extraction of tooth #14 the sinus was perforated for about 3mm in diameter in the mesiobuccal root area.
How do i close it? What material should i use? Should I graft it at all?
What is the best way to handle a sinus perf during an extraction? What is the risk of infection or complications?
JIACD
© 2008 Journal of Implant and Advanced Clinical Dentistry. Privacy Policy | Terms & Conditions
Comments
Closure of sinus perf duringf extraction
These occurances require something to be placed into the socket to close the whole. depending on how large a hole it is you can with a small hole place some Collatape into the perf then fill the socket with a graft material that is non granular (granular can migrate and possibility of dispersing in sinus) materials that work well for this are; Novabone, Dynagraft, Grafton putty, Regeneform. when the perf is large placement of a peice of collagen membrane over the holeand linign the socket followed by filling with graft material helps. of course you need to get primary closure when possible in these cases of the soft tissue. If you cant by elevating a flap and scoring the periosteam then place a peice of PTFe over the socket and suture the tissue over this. after 10 days remove the PTFe (just grab in middle and tug it) then allow to finsh granulating over.
Greg whats Novabone?
Whats Novabone?
Sinus Perforation during extraction.
I agree with Gregs comments. I would add that I will always try and get primary closure. You can rotate a palatal flap to close. The key is avoiding a oral antral communication and sinus infection.
Cover the patient with augmentin and sudafed, afrin.
Ted
Novabone
Novabone is a synthetic graft material that is fully resorbable comes in a syringe and is putty like in consistency. www.novabone.com
Sinus Tear during extraction: You need closure
I been burned by this. I had one patient that had a oral antral fistula and sinusitis for a year. Be safe and get primary closure.
Angeline
Sinus tear during extraction: Why is primary closure important?
Why is primary closure so important? Can't you pack the site with collatape or collaplug and cover with a PTFE membrane?
Why primary closure is important
Collatape and collaplug break down very quickly and will be gone in a day or two. Since there is pressure in the sinus unless you get promary closure the communicaiton wont close.
bottom line
you can get lucky and find closure with only placement of collatape etc for a small exposure (maybe less than 2-3 mm).
if you want to avoid complications/headaches and that "if only i would have" feeling.....GET CLOSURE! imagine being the patient. sinusitis leading to several appointments for follow-up of a "hole" in your mouth is very stressful and discouraging for both the patient and you. not the best PR for your practice either.
it really is just that simple.
Sinus perf during extraction: Couldnt agree more with Heather
Heather you comments are spot on. I been an implantologist for 20 years and I have been burned by sinus exposures.
Get closure.
Sinus Perf
All sinus Perforations, openings or fistulas need a surgical approach to avoid furhter and more difficult to treat complications. Leaving or ignoring a perf can perf your patients confidence in you, patient will be going to other doctors ENTs, OMS to find a solution and you can put yourself at risk.
Sometimes the approach will be radical and sometimes just a minor OS procedure will be enough, in patients w/o S/Sx at times nothing will be needed.
For those doing more OS allow me to recommend a book that will be good:
DECISION MAKING IN ORAL & MAXILLOFACIAL SURGERY
Daniel M. Laskin
A. Omar Abubaker
you have a question and just look it up for guidance to see if you should do it or refer any particular case.
J. E. Arce, OS
Sinus perf referral: Case example
What would be the best way to refer this case mentioned above. If you take out a tooth an you have a sinus perf how is the best way to stabilize it to get over to the oral surgeon?
Perforation of the Sinus during tooth removal
This happens more then you think. I am currently repairing the area with PRF. Grafting with FDBA and a collagen membrane. If the perf is small that enough if it is large I rotate a flap.
Thoughts?