Radiographic and Endoscopic Observation of Accidentally Perforated Anterior Nasal Cavity with Dental Implants: Case Reports with 5-23 Years of Follow-Up

Severe atrophy of the maxillary anterior region may make implant placement difficult and as a result, iatrogenic complications such as nasal floor perforation may occur.  The purpose of this case report is to present radiographic and nasal endoscopic features in the anterior nasal floor when dental implants were inadvertently perforated into nasal cavities. Between 2003 and 2018, four patients recorded with anterior nasal floor perforation with dental implants were followed and reviewed with panoramic radiographs and cone-beam computed tomography. Also, nasal endoscopic examinations were performed by one otolaryngologist. Four implants in four patients were included in this case report. All implants achieved osseointegration and survived for 5-23 years without clinical complications. Three implants did not show any mucosal thickening and only one had minor mucosal thickening as visible on the radiographs.  Nasal endoscopy examinations revealed that three implants were covered with mucosa and one had threads exposed. Intraorally, only one had clinical signs of peri-implant mucositis. Dental implants that perforated into the anterior nasal floor did not show clinical, radiographic, and nasal endoscopic complications during the long-term follow-up period. Nasal endoscopy was a better diagnostic tool to evaluate the implants perforated into the nasal cavity than conventional panoramic or cone-beam computed tomography.