Dental implants, Zygoma Implant, Odontogenic Sinusitis and Oroantral Fistula

Dental Implants, Zygomatic Implant, Odontogenic Sinusitis, and Oroantral Fistula – Prof. Dr. Gediz Murat Serin

The Truth Behind a Difficult Case

Introduction

Sinusitis is one of the most common ear, nose, and throat diseases in society. It occurs when the air-filled cavities around the nose (sinuses) become inflamed. Especially when it becomes chronic, it both reduces the quality of life and may signal underlying diseases.

As Prof. Dr. Gediz Murat Serin, I have been working for many years on both classical sinusitis and especially dental-origin sinusitis (odontogenic sinusitis), treating many complex cases. In this article, I will first talk about general sinusitis, then discuss different aspects of odontogenic sinusitis, and finally share a special patient story we encountered.

What is Sinusitis and How Does It Develop?

The sinuses are air-filled cavities located around the nose. Normally, they are filled with air and drain easily through the nasal passages. However, in some cases, the mucosa lining the sinuses swells, disrupting their drainage.

Factors leading to the development of sinusitis include:

• Upper respiratory tract infections
• Enlargement of the nasal turbinates
• Septum deviation (nasal curvature)
• Allergies
• Genetic or structural nasal abnormalities

As a result of these factors, the sinuses become blocked, allowing bacteria to multiply easily and cause infection. This condition is what we call sinusitis.

Symptoms include:

• Pressure and pain in the face
• Nasal congestion
• Foul-smelling nasal discharge
• Headache, reduced sense of smell

Odontogenic (Dental-Origin) Sinusitis: Why Is It Different?

Odontogenic sinusitis is a special type of sinusitis in which the source of infection is not the nose but the upper jaw teeth. This is because the roots of the upper jaw teeth are very close to the maxillary sinus (cheek sinus).

Causes of odontogenic sinusitis:

• Infections in tooth roots
• Improperly placed implants
• Openings that develop after tooth extraction
• Complications of advanced procedures such as zygomatic implants

Unlike classical sinusitis, odontogenic sinusitis usually causes unilateral complaints. In addition, antibiotic treatment is often ineffective, because the cause is usually a foreign body or a persistent opening such as an oroantral fistula.

Oroantral Fistula: An Undesired Connection Between Mouth and Sinus

Oroantral fistula is an abnormal opening between the oral cavity and the maxillary sinus. It most often occurs after tooth extraction, implant placement, or jaw surgery.

The most common complaints patients experience:

• Food and liquids leaking into the nose
• Recurrent cheek sinusitis
• Foul-smelling nasal discharge
• Changes in voice during speech

The goal of treatment is to surgically close the fistula and remove any foreign body from the sinus.

Zygomatic Implant: A Solution or a Problem?

A zygomatic implant is an advanced method used when there is severe bone loss in the upper jaw and there is not enough bone for a classical implant. Instead of being placed in the jawbone, the implant is anchored in the cheekbone. This allows for dentures or fixed dental prostheses to be applied.

However, the fact that the implant passes through the maxillary sinus can cause serious problems in some patients. This is because the sinus cavity must remain a sterile area, without any foreign objects inside.

Complications:

• The implant remains in the sinus as a foreign object
• It does not integrate with the bone
• Recurrent sinusitis attacks develop
• An oroantral fistula forms

Our Patient’s Story

About two years ago, a 50-year-old female patient consulted me. Due to advanced bone loss in her upper jaw, she had previously received a zygomatic implant. The implant had been technically placed correctly; however, it passed through the sinus cavity.

Her complaints included:

• Persistent pain in her face
• Unilateral foul-smelling nasal and postnasal discharge
• Constant need for medication
• Food and liquids entering her nose while eating

Despite multiple dental treatments and sinus interventions, her complaints did not improve. On the contrary, bone loss worsened, the sinus wall was damaged, and the upper jawbone had almost reached the point of complete resorption. The situation had become intractable.

At this stage, the best approach was to remove the implant from the sinus cavity and close the oroantral fistula. Unfortunately, in some cases, both patients and dentists insist on keeping the implant in place. However, this approach fuels infection and worsens the condition.

My Treatment Approach

In my clinical practice, the steps I follow in such cases are:

• The foreign body (implant or zygomatic implant) is removed from the sinus cavity.
• The sinus cavity is cleaned both through the mouth and the nose.
• Endoscopic sinus surgery is performed to restore the natural drainage of the sinus.
• The oroantral fistula is closed with appropriate flap techniques.

Thanks to this approach, the patient is relieved of both sinusitis and the complaints caused by the fistula.

Conclusion

Sinusitis is not just limited to the nose and sinuses; it is directly related to dental health and jaw surgery as well. Especially in cases of odontogenic sinusitis and oroantral fistula, medication treatments alone are insufficient.

A zygomatic implant can be beneficial when applied with the correct indication. However, when complications develop, the priority should always be the patient’s health rather than preserving the implant.

As Prof. Dr. Gediz Murat Serin, with my experience in ear, nose, throat, and jaw surgery, I aim to use the most up-to-date surgical methods in such challenging cases, offering my patients the best possible functional and aesthetic outcomes.

Frequently Asked Questions (FAQ)