When the edema subsides after a sinus lift. Reminder after sinus lift

Clinical case

Methods

results

Discussion

conclusions

According to signs, symptoms and course, rhinosinusitis can be classified into four main groups: acute, subacute, recurrent and chronic. From 10 to 12% of maxillary sinusitis are odontogenic, although according to the literature, the number of chronic rhinosinusitis caused by dental problems is at least 30-40% of the total prevalence of these diseases. Rhinosinusitis develops when a Schneider's membrane is perforated or infected as a result of trauma, bone pathologies, cysts, contact with foreign bodies, the action of supernumerary teeth, after implantation, extraction, orthognathic surgery or sinus lifting procedure.

Dental procedures, such as lateral anthroscopy, which were first described by Tatum in 1976 and published by Boyne and James in 1980, achieve regeneration bone tissue in the area of its deficiency with the possibility of further installation in this place of a dental implant. This technique involves the formation of a bony window on the lateral wall of the sinus, after which the mucous membrane is lifted in the bottom area and the corresponding bone augmentation is performed. Another approach to sinus lift is to perform augmentation through the alveolar ridge. Both of the above iatrogenic interventions can provoke perforation of the sinus mucosa, which can subsequently lead to the development of sinusitis. This study will present one of the treatments for iatrogenic sinusitis that can be used in other clinical conditions.

Clinical case

Methods

A 47-year-old patient was referred to our department with the main complaint about bad smell, soreness in the right sinus area and headaches. 10 days ago, he underwent implantation in the area upper jaw before which a sinus lift procedure was performed. During the clinical examination, reddening of the gums and its swelling on the right buccal side, discharge of pus from the right side of the nose, and signs of lymphadenopathy on the right were determined. X-ray, performed according to the Waters method, was diagnosed with blurred maxillary sinus, which may indicate the development of inflammation (photo 1).

Photo 1. On the radiograph, performed according to the Waters method, a blurred maxillary sinus was diagnosed, which may indicate the diagnosis of acute sinusitis.

Explantation and irrigation of the sinus cavity were performed. Irrigation was performed through the formed lateral window in the canine fossa, since this area is the thinnest in the structure of the anterior wall, and is also easily accessible. Pus was aspirated through the window, which was later sent for bacteriological examination. Removal of the infected bone graft material was performed through light irrigation of the sinus cavity and gentle suction in the area of the formed window (photo 2a, b). The drainage tube was sewn into the gum. A flexible silicone suction was inserted into the right nostril towards the osteomeatal complex. Further abundant irrigation of the sinus through this drainage system was carried out through the oral cavity (photo 3a, b).

Photo 2. (a) Schematic representation of the removal of infected augmentate material and irrigation of the sinus cavity. (b) Irrigation through a window in the anterior wall of the sinus.

Photo 3. (a) Irrigation with saline through tubular drainage. (b) Flexible silicone suction inserted into the nostril to prevent leakage of solution from the nose and mouth.

In total, 4 irrigation procedures were performed for 4 days in a row, after which the drainage was removed. For 21 days, the patient took amoxicillin (500 mg), pseudoephedrine hydrochloride (60 mg), carbocisteine (750 mg) and NSAIDs three times a day.

results

After removal of the infected bone graft and implant, the patient developed symptoms of inflammation and headache. After performing 4 irrigation procedures, the discomfort in the right buccal region was significantly reduced, and the accumulation of pus was not observed. The results of bacteriological studies of pus revealed the presence of α-hemolytic Streptoccus viridans. Data computed tomography(CT) after 3.5 months confirmed the absence of any areas of darkening, which indicated a complete recovery (Photo 4).

Photo 4. Computed tomography (CT) data after 3.5 months confirmed the absence of any areas of darkening in the areas of both sinuses, which indicated a complete recovery.

Discussion

Odontogenic and non-odontogenic sinusitis differ in etiology, pathophysiology and microbiological component. Therefore, the success of treatment depends on the diagnosis of the specific cause of the disease. Eliminating the source of infection provides relief from symptoms and prevents recurrence of the pathology. Odontogenic sinusitis can be treated with medication or surgery. Treatment regimens are based on the use of antibiotics, the choice of which is determined by the sensitivity of bacterial agents to them. This type of treatment is central to the treatment of sinusitis. In one study, it was found that most often the development of sinusitis is provoked by α-hemolytic streptococci, microaerophilic streptococci and Stapylococcus aureus (as species of aerobic bacteria), anaerobic gram-negative bacilli, Peptostreptococcus spp and Fusobacterium spp. These results are very interesting because non-odontogenic sinusitis is most commonly caused by Streptococcus pneumonia, Haemophilus influenza, and Moraxella catarrhalis. Therefore, the choice of antibiotics should be carried out only after bacteriological examination of purulent wards, which was done in our case. Treatment, in addition to being of high quality, should also be carried out quite quickly, since oral antibiotics are effective against the oral microflora and sinusitis-provoking pathogens only for 21-28 days. Surgical treatment approaches may differ depending on the etiology of rhinosinusitis. Lechien and colleagues conducted a review in which they studied the causes of the development of a chronic form of odontogenic sinusitis: in 65.7% of cases, this form of the disease was caused precisely by iatrogenic factors. Previously, the classical Caldwell-Luc approach was widely used, which provoked the development of significant postoperative discomfort, recurrence of pathology in 9-15% of cases, as well as the transition acute illness in a chronic form. That is why the endoscopic method of treatment is more preferable, given its safety, microinvasiveness, and also the reduction in the total time required for the complete rehabilitation of the patient. However, this method is limited by the conditions of access to the anterior wall of the maxillary sinus. To solve it, some doctors propose to perform a puncture in the maxillary sinus area, others - to use the technique of balloon dilatation. But be that as it may, each of these approaches assumes the use, of course, of the endoscopic principles of cleaning the maxillary sinus.

conclusions

In many cases, the purchase of an endoscope seems too expensive and impractical, as for an apparatus used in a fairly small number of complications. The proposed method minimizes the level of postoperative discomfort of the patient in comparison with other surgical methods treatment similar to the Caldwell-Luke operation. In addition, the endoscopic protocol of intervention reduces the development of potential complications, minimizes blood loss during surgery and reduces the cost of the intervention itself. In addition, given the ease of implementation, the procedure can be performed under local anesthesia. But on the other hand, this method is "blind", since the doctor cannot control the quality of the manipulation due to limited visual access. However, its use in cases of treatment of odontogenic sinusitis remains highly recommended.

Complications after sinus lift One of the main objectives of today's implantology is to provide the patient with a safe, effective service. Implants in terms of their functional characteristics and level of comfort are many times superior to all existing ones. removable dentures... Unfortunately, often bone atrophy makes implantation impossible.

In recent years, techniques have been actively used to improve the quality and increase the volume of the bone. One of them is subantral augmentation, or sinus lift. It is carried out in preparation for implantation in the lateral regions of the upper jaw. During the procedure, the bone mass in the sinus area is increased, which allows the use of longer and therefore more stable implants.

The need for a sinus lift operation is determined according to the data of diagnostic studies: X-ray or computed tomography. As a rule, the operation is indicated when the bone height is less than 1 cm.

The most common complications of sinus lift

Most often, one has to deal with a rupture of the mucous membrane of the maxillary sinus. Such perforations cause contamination of the implantation site with mucus and other potentially contaminated media. To eliminate the gap, different methods can be used: suturing, patching using various materials.

Complications can also appear in the postoperative period. Violation of the protocol of surgical intervention entails infection of the wound, the formation of an oroantral fistula, and sinusitis. Also, bleeding and implant mobility may occur.

It is necessary to stop everything in a timely and competent manner. possible complications... At the first symptoms of infection, drainage of the pathological focus is established, laboratory research, allowing to identify the sensitivity of flora to antibiotics. Appropriate antibiotic therapy is prescribed. If necessary, the fistulous tract is closed. Sinusitis is treated with antibacterial and anti-inflammatory drugs.

Unsuccessful sinus lift: what to do?

When the first alarming symptoms you need to contact a specialist. It is worth saying that after stopping the inflammatory process and eliminating the causative agent of the infection, sinus lifting can be repeated. Patients at the EVITA Dental Clinic are received by dental surgeons who have a scientific degree and many years of practical experience.

Our clinic is conveniently located in the center of Moscow within walking distance from the Arbatskaya metro station. We guarantee high quality and safety of all services provided. In the clinic, patients will find a comfortable environment, a high level of service and a moderate price policy. You can make an appointment by phone or using the form on the website.

Dentistry "EVITA": treatment of complications after sinus lifting.

Doctors in the direction:

For a consultation with a doctor - call or fill out the feedback form

Sinus lift is a procedure aimed at restoring lost bone tissue. Where it has insufficient volume, this procedure allows the placement of implants.

Sinus lifting is a demanded procedure. The term is understandable to specialists working in the field of implantology, but it says little to ordinary people. This also applies to potential patients who are going to use the services of orthopedic surgery.

Deserve separate consideration. This is not a new procedure, it has been used in implantology for the past 30 years. The first experiments were not the most successful. This is why specialists have the incentive to develop better materials and tools.

When is sinus lift indicated?

The structure of the bone of the upper and lower jaw has a significant difference. They both form the basis of the facial skeleton. Chewing, swallowing, speaking and breathing - this is an incomplete list of the functions they perform. Sinus lift is aimed at restoring bone tissue by creating an optimal bone volume. This is ensured by the introduction into certain areas of material for bone growth. Such zones are located under the maxillary sinus. During the procedure, her trauma does not occur. Over time, the stimulant turns into ordinary bone tissue and grows with blood vessels. This is an excellent basis for installing a dental implant.

Sinus lifting (video)

Types of sinus lift

If the height of the bone tissue is less than 7 millimeters, an open sinus lift is indicated. The operation is complex. The doctor performs it separately from the implantation. After a sinus lift, it takes at least 20 weeks before the dentist places the implants in the bone.

When the height of the bone tissue is 7-8 centimeters, a closed sinus lift is prescribed. The surgeon does not make incisions, moves the lower zone of the maxillary sinuses.

What are the dangers to deal with?

Many patients are afraid of surgery, as they believe that the maxillary sinus may be damaged. If you fall into the hands of a good doctor, you shouldn't be afraid. This should not be an ordinary implantologist, but a maxillofacial surgeon. The modern sinus lift has nothing to do with the outdated techniques previously practiced in surgery. The risk of complications is minimized here. Modern operation:

Painless;
Carried out using ultrasound;
Requires only local anesthesia;
Does not require general anesthesia.
Sometimes the procedure takes no more than 15 minutes.

Complications after sinus lift: can they be avoided?

A lot depends on the patient. He must follow the advice of the dentist relentlessly. Complications are dangerous, so you should not treat them irresponsibly. If all instructions are followed, adverse effects are also possible. This indicates the lack of a detailed examination before the start of surgery. That is why it is wrong to assert that sinus lifting is necessarily associated with complications. They are possible in two cases:

When the patient is negligent about his health;
When the doctor is irresponsible about the procedure.

Various complications after sinus lift... Symptoms that should alert you:

heat;
bleeding;
difficulty in nasal breathing.

The dentist monitors each patient for several days after the intervention. The first visit takes place 3 days later. It is enough for the doctor to look at the operated area once in order to draw conclusions about the patient's compliance with all the recommendations prescribed by him. If there are problems, the doctor immediately fixes them. In the worst case, when the patient gets to the dilettante, his health is not paid attention to. Then a person can only independently determine if there are deviations from the norm and contact another dentist.

Pain and the like complications after sinus lift do not occur normally! Even if you just feel unwell without any external signs, see your doctor!

Sinusitis

Talking about complications after sinus lift, the symptoms of sinusitis are considered leading. The doctor can damage the Schneider membrane. It is located in the area of the maxillary sinuses. This is possible if the dentist uses hand instruments instead of an ultrasound device. An infection gets into the upper jaw, provoking sinusitis or sinusitis. Exacerbation of sinusitis is a contraindication to sinus lifting. First, you need to cure the disease. Usually the doctor will prescribe a 2-week course of antibiotic therapy.

Edema

It is observed on the first day after sinus lifting. This is the norm. In men, it occurs less often. If after three or more days the edema does not decrease in volume, you need to seek specialized help. There are drugs that quickly reduce swelling if the patient needs to attend an important event in the coming days.

What should not be done to prevent complications after sinus lift?

Physical activity

Physical activity should be minimal on the day of surgery. Otherwise, complications such as tachycardia and bleeding are possible.
Avoid lifting heavy objects after a recent sinus lift.
Avoid intense sports or other activities for about 2 weeks after surgery. physical activity requiring considerable effort.

Diet

Do not eat immediately after sinus lift. You can eat when the anesthetic wears off. But it is recommended to chew on the opposite side for at least the next 24-48 hours.
For the next few days, eat pureed food, avoid solid foods. Hot food, spices and spices that can cause irritation at the surgical site are prohibited. Avoid carbonated drinks for the next 3-4 days.
Drink plenty of fluids between meals.
Be patient, gradually you will return to your normal eating routine.
It is undesirable to touch the place where the procedure was performed with sharp objects (cutlery, toothpicks, fingers or other objects).

Oral hygiene

Good oral hygiene is essential. Your dentist will recommend a solution to rinse your mouth every day. Gargling is usually done after breakfast and before bed for 30 seconds. But in the first 24 hours after surgery, it is not recommended to rinse your mouth. Minimal impact on the operated area is desirable to prevent bleeding. After a day, take warm water and use it for rinsing. It will remove food debris and allow quick healing.

It is allowed to brush your teeth, but it is better not to touch the operated area. Brush in close proximity with a soft bristled toothbrush. Keeping this area clean is important to prevent infection. Hygiene promotes tissue healing.

How to deal with pain?

Minor pain or discomfort is normal. It does not count complication after sinus lift... You can take pain relievers prescribed by your dentist: Ketanov, Nurofen and others.
Your doctor may prescribe antibiotics for you. Strictly follow the instructions for taking the drug!
If you suddenly catch a cold and have a runny nose, see your doctor. He will prescribe you vasoconstrictor drops or other medications as needed. He will also warn you that in any case you shouldn't blow your nose.

Want to avoid complications after sinus lift? Follow the tips:

Do not blow your nose for 1 to 2 weeks.
Don't pinch your nose before sneezing. Sneeze with your mouth open to avoid pressure in your sinuses.
Do not drink through a straw!
During sleep, do not lie on the area that was operated on.
Build up sinus pressure from diving and airplane flights. Eliminate them for a while.
Avoid bending too far forward, lifting heavy objects, playing musical instruments that require blowing.
Do not smoke for the next 10-14 days. Nicotine interferes with tissue healing and can cause bleeding.
Do not touch the operated area to avoid causing bleeding and infection.

Any activity that increases pressure in the mouth and sinuses is contraindicated! Even walking up stairs can be dangerous!

Sinus lift is a common operation in dental surgery. This operation is performed to increase the height of the bone tissue of the upper jaw in the projection of the removed chewing teeth.

A sufficient height of the bone tissue is necessary for reliable fixation of the implant for many years. The stability of the implant in the bone is the key to "fusion" (osseointegration) of the implant with your body.

Sinus lifting is performed by filling the “lower floor” of the maxillary sinus with bone substitutes of various origins.

The dental implant surgery can be performed 9-12 months after the sinus lift.

What to expect after dental implantation:

Edema, hematoma of the soft tissues of the face in the projection of the installed implant. Edema, hematoma is a protective reaction of the body, it disappears within 7-14 days.
Pain. Discomfort in the form of pain can last from 1 to 14 days. The severity of pain depends both on the severity of the surgical intervention and on your psychological mood.
Taste of blood in the mouth. If there is slight bleeding, bite on a clean handkerchief or gauze cloth for 20 minutes.
Nasal discharge. Don't worry, this is possible. This inconvenience will stop within 5-7 days.

For 10-14 days it is prohibited:

Take solid and hot food
Take liquid through a straw
Go in for sports (including intimacy), visit the sauna, bath
To smoke
Open your mouth wide, disturb the wound surface with your tongue, toothpick, toothbrush or fingers.
Sleep on the side of the surgery
Sneeze and blow your nose
Lean forward
Inflate balloons
Fly by plane
Go snorkeling

Sleep with your head up

Strictly follow the doctor's instructions

For successful engraftment of bone material, it is necessary to take antibacterial drug, an anesthetic drug, rinse the mouth with a special solution and drip vasoconstrictor drops into the nose.

List of drugs required for administration. What kind of drug is right for you, only the doctor knows, do not self-medicate, it is dangerous to health.

Antibacterial a drug	Anesthetic a drug	Mouthwash solution	Vasoconstrictor spray
Augmentin 1000mg Take 1 tablet 2 times a day for 5 days. The drug should be taken at the beginning of a meal.	Ibuprofen 200mg Take 1 or 2 tablets no more than 3-4 times a day.	0.05% Chlorhexedine solution	Polydexa (spray in the nose) It is necessary to inject one press of the bottle into each nasal nostril 3 times a day, 5 days
Tsifran 500mg Take 1 tablet 2 times a day, 5 days. The drug should be taken orally on an empty stomach, without chewing, with a small amount of liquid.	Nise 100mg Take 1 tablet no more than 2 times a day. The drug should be taken at the end of a meal or after a meal with a sufficient amount of water.	0.12% solution Curasept Pour no more than 30 ml of solution into the oral cavity, hold for 30 seconds and spit it out. Rinse after meals, 3 times a day, up to 14 days.
Sumamed 500mg Take 1 tablet once a day for 3 days. Swallow without chewing, at least 1 hour before or 2 hours after meals.	0ki 80mg (powder) Dissolve the contents of one double sachet in half a glass of drinking water and take orally 3 times a day, with meals.	Apply to the skin from the side of the surgery, for 20 minutes at a 20-minute interval, in the next 4-6 hours, only on the day of the surgery.

Sinus lift is a procedure to restore lost bone tissue. Due to its implementation, it becomes possible to implant in places where there was previously insufficient bone volume for this.

This operation is quite popular, it has been practiced for the past 30 years. During this period, there were not the most successful completions of the procedure, however, over time, specialists improved the tools and materials used, which reduced the possibility of any complications in the patient.

In the process of smoking, it appears due to the suppression of the functions of the salivary glands. Because of this, there is a multiplication of pathogenic microbes associated with a deficiency of beneficial microorganisms, and as a result, there are strong painful sensations accompanied by an increased body temperature. This pathological process can provoke hematomas or, in the worst case, cause tissue death around.

Also, nicotine negatively affects the blood vessels in oral cavity and in the upper layers of the jaw. After the cigarette smoke gets inside, there is a long-term vasospasm, as a result of which the blood flow in the area of the operation is significantly impaired. Due to insufficient penetration of nutrients and oxygen into the blood, the accumulated bone mass is rejected.

For management, you should use a special solution for daily rinsing on the recommendation of a dentist.

The procedure must be carried out after breakfast or before bedtime, and its duration must be at least 30 seconds.

After a day, you need to use warm water, which will contribute to quick healing due to the elimination of food debris.

It is possible to clean your teeth immediately after surgery, but you cannot touch the operated area directly. Close to this place, you should brush very carefully, and it is better to use a soft bristle option. Observance of the simplest will avoid infection and speed up the healing process of tissues.

Apply cold for 2-3 hours immediately after the operation and do not eat for at least 4 hours.
On the postoperative night, sleep on a dais - raised pillows.
In the first two to three days after the intervention, do not eat spicy, peppery, hot foods, give preference to semi-liquid food.
In the first month, you cannot dive and jump into the water, fly on an airplane, overcool, visit the sauna and bathhouse.

The likelihood of complications after sinus lifting can be minimized by choosing the clinic where the intervention will be performed, and following all the specialist's recommendations for the postoperative period. Most often, the consequences are temporary and not hard to bear. But if the patient does not feel well, he should see a doctor.