10/08/08 - 6 Implants, Male, Age 70 - Sinus Comm. Repair

[ChristianWoodward]

Todays patient is a 70 year old male. He was referred to us by an out of state doctor and that doctor gave us the following synopsis of treatment:

1) Initial surgery performed 7/15/2008. Extraction #2 and ramus block of bone placed over extraction site and secured with a mini implant and two 5.1 mm implants. Lateral sinus lift also performed and sinus filled with BFDBA, CaSo4, P-15 particles. Site closed with a vertical translation of the buccal flap.

2) 7/29/2008. Block bone site naked of tissue. Block bone graft removed. Replaced implant #2 with a 6mm implant. Removed loose implant #3 and refilled sinus with chips of DFDBA, CaSo4 and P15. Closed site #3 with Grafton plug material.

3) 8/12/2008. Tissue opening, placed two sutures.

4) 8/26/2008. Sinus opening 10 x 10 mm. Pt asymptomatic.

5) 9/2/2008. Sinus opening 15 x 15 mm. Attempt at tissue closure with vertical translation, refill of sinus w/ DFDBA and vertcial translation. Removed implant #2 as it has become loose. 8 sutures placed.

6) 9/9/2008. Site re-opening 3 x 5 mm.

7) 9/13/2008. Defect is 9 x 12mm. Plugged opening with collatape and collaplug and sutured with 4 sutures.

8) 9/18/2008. Defect at 7 x 10 mm.

9) 9/23/2008. Defect 8 x12mm.



When the patient showed up from the airport, he had a nickel sized sinus oral cavity that was asymptomatic. The patient wanted treatment as he was highly uncomfortable with the opening. Dr. Chen spoke with the patient and decided to perform his invagination technique. The patient also asked us to add implants on #4-5 as well as #12-15 using HSC.

Dr. Chen performed the surgery completely under local anesthetic (lidocaine). Dr. Chen's invagination technique was performed to close the sinus opening and all the infected tissue in the patient's sinuss was removed. The implants were placed using a sinus lift (HSC) as well as immediate placement and immediate load.

The patient will be back tomorrow for a follow up exam and his flight leaves in a few days.

Dr. Chen notes that on the clinical photos, the opening appears to be about the size of a nickel. However, upon cleaning the tissue, the size was actually closer to that of a half dollar. See the below clinical photos for a better idea of size.

Panos
Before


One Hour After



CAT Scans
Before


One Hour After


Clinical Photos

[Dr Hugh]

Very nice defect closure/invagination tech + 6 implants.YOU ARE THE MAN! Hope I never have to repair this defect? You do take care of your students! Hope to see you in Taipei Saturday? Please give me a phone number to call when I arrive. English or portuguese speaker. Thanks for sharing. Thanks for this forum! This forum is taking dental implantology to the next leval! Abraco

[leonchen]

my taiwan cell is 0911791173. calling from state is 011886911791173

[ChristianWoodward]

Patient Update:
Before

5 days later after surgery

[ChristianWoodward]

The patient came back from Hawaii for final impression today Feb.25th. All implants are solid and all healing has gone perfectly. Impression was taken and final restoration is scheduled.


4 months later

[Jason Chen]

Dr Chen
Bravo!
What a beautiful surgery.

Can you tell us that what was the tissue you lifted in this picture?




Did you suture up the perforated membrane?
Did you graft the surgical site with some kind of graft?
The post operative picture looked like a CT graft over the wound??

Thanks for sharing the advanced tech!

[leonchen]

Dr. Jason

nice to see you back. That was the disease tissue I found inside the sinus cavity. I used invagination technique remember in my sinus perforation lecture ? this complication is considered class V sinus perforation. No I did not use CT graft, I sandwiched the bone particulates during the invagination technique.
I don't see this kind of huge complication in the HSC procedure, only in the window and block procedures.

[Jason Chen]

Dr Chen
Thank you again for the detail.
I think you just put maxillary sinus surgery to a higher level.
Althrough the case reminds me your lecture, I wish I can do several surgeries to catch the essense of your teaching!

[leonchen]

I will send you the invagination animation DVD next time when i visit Taiwan

[Jason Chen]

thank you very much
Dr Chen
I am waiting for that DVD.