The aim of this case report was to report the course of treatment for the advanced paranasal sinus infection triggered by peri-implantitis, managed using functional endoscopic sinus surgery (FESS), with outcomes. A non-smoking male patient received sinus augmentation with implant placement on his left posterior maxilla 15 years ago. Possibly due to non-compliance to maintenance, peri-implantitis developed and progressed into the augmented bone area in the maxilla. Eventually, maxillary sinusitis occurred concomitantly with a spread of the infection to the other paranasal sinuses. Implant removal and intraoral debridement of inflammatory tissue were performed, but there was no resolution. Subsequently, FESS was performed, with removal of nasal polyp and sequestrum. After FESS, the sinusitis resolved. Histologically, the sequestrum was composed of bone substitute particles, necrotic bone, stromal fibrosis, and very limited cellular component. Two implants were placed on the present site, and no adverse event occurred for up to one year following the insertion of the final prosthesis. Peri-implantitis in the posterior maxilla can trigger maxillary sinusitis with concomitant infection to the neighboring paranasal sinuses. FESS should be considered to treat this condition.
Sinus graft infection is a serious complication that can occur after lateral sinus floor augmentation. Delayed treatment of sinus graft infection can cause rhinitis or paranasal sinusitis. The purpose of this case series was to evaluate the clinical outcomes of immediate and early intra-oral approach for sinus graft infection following lateral sinus floor augmentation with simultaneous implant placement.Seven patients (18 implants) diagnosed with sinus graft infection were included in this case series. Incision and drainage (I&D) were performed immediately (Group I), after one week of antibiotic therapy (Group II), and after two weeks of antibiotic therapy (Group III) after clinical manifestation. Antibiotic treatment continued for 2 weeks after I&D. After two months, infection control and additional treatments including removal of infected graft, removal of implants, detoxification with tetracycline hydrochloride solution, implant replacement, and additional bone grafting procedures were selectively applied depending on contamination of the bone graft material and stability of the implant. Thereafter, uncovering and delivery of the implant prosthesis were accomplished. Implant survival and preservation of sinus graft among the three groups were evaluated clinically and radiographically.After immediate intra-oral infection treatment, sinus graft infection was well controlled, and all clinical symptoms disappeared. Group I showed the best results in implant survival and preservation of sinus graft. However, in group III patients who had two-week antibiotic therapy prior to I&D, improvement of clinical symptoms was most delayed. With the limitations of a case series, we suggest that the timing of intra-oral approach for sinus graft infection is critical for improvement of clinical symptoms and radiographic bone opacity. Also, it seems that I&D performed immediately after clinical manifestation combined with two weeks of antibiotics is the most effective treatment for sinus graft infection.