Problems and complications in maxillary implant surgery
- Complications below can occur in the maxilla regarding implant placement or bone grafting:
- Lack of primary implant stability
- Placement of the implant tip in the maxillary sinus or nasal cavity
- Perforation of the Schneiderian membrane during sinus floor elevation
- Dislocation of implants or augmentation material
In the edentulous upper jaw the proximity of adjacent anatomical structures and bone density of residual bone can compromise implant insertion and may lead to complications such as lacking primary implant stability, perforation, dislocation of implants or augmentation material and bleedings.
Due to the bone quality of the maxilla (predominantly spongious bone) implants may lack primary stability and can loosen after insertion.
Penetration and perforation
Penetration of the maxillary sinus or the nasal cavity during implant bed preparation is a minor problem if there is adequate residual bone height for implant placement and implant primary stability. The tip of the implant should not be inserted deeper than 2 mm into the maxillary sinus.
Displacement of the augmentation material into the sinus happens due to perforation of the Schneiderian membrane during mobilisation and augmentation procedures of the maxillary sinus [Katranji 2008].
Implants can be dislocated into the maxillary sinus. The persistence of the implant/augmentation material in the sinus can lead to acute or chronic infections of the maxillary sinus. Dislocated implants and/ or augmentation material should be removed via a transoral or a transnasal access. Prior to the surgical intervention a 3D radiography, such as computed tomography (CT) or cone beam computed tomography (CBCT) is recommended [Sgaramella 2014].
An anastomosing vessel is located at the facial antral wall between the posterior superior alveolar artery and the infraorbital artery. Bleedings may occur during sinus lifting procedures. With the increase of the width of the lateral sinus wall, the vessel diameter increases as well leading to an increased risk of bleedings during surgery. The mean distance to the inferior border of the vessel from the sinus floor and from the alveolar crest can vary from 8-17 mm, respectively. Treatment of intraoperative bleedings includes: pressure, bone wax, burnish with bur and electro-cautery [Kang 2013].