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Implants · patient case with 2 questions

Implant assessment with an incidental sinus finding

Patient: Adult being assessed for maxillary posterior implants

Chief complaint: Wishes to replace missing maxillary posterior teeth with implants.

Background: No relevant medical history reported.

Current findings: Imaging shows 15 mm of mucosal thickening within the maxillary sinus.

Question 1

What is the appropriate course of action?

  1. Abandon implant treatment permanently
  2. Refer to an otolaryngologist before proceeding
  3. Proceed directly with the sinus lift
  4. Prescribe a nasal decongestant and proceed
Show answer and explanation

Correct answer: B. Refer to an otolaryngologist before proceeding

  • A. This is unnecessarily defeatist. Once the sinus condition is treated, augmentation and implants may well proceed.
  • B. CORRECT. Mucosal thickening of 15 mm is substantial — normal mucosa is under 2 mm, and thickening beyond roughly 10 mm is generally accepted as pathological. Sinus augmentation into an inflamed or obstructed sinus risks graft infection, membrane perforation and sinusitis. The sinus must be evaluated and its patency confirmed by an ENT specialist before any augmentation.
  • C. Grafting into a pathological sinus is the direct route to graft failure and postoperative sinusitis.
  • D. Self-prescribing a decongestant does not address undiagnosed sinus pathology, nor confirm ostial patency.

Note: Rule of thumb: mucosal thickening under 2 mm is normal, beyond about 10 mm is pathological. Ostiomeatal complex patency is the decisive factor for graft success.

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Question 2

Which factor is the first consideration for long-term implant success?

  1. The implant surface texture
  2. The patient's systemic health
  3. The brand of implant selected
  4. The shade of the definitive crown
Show answer and explanation

Correct answer: B. The patient's systemic health

  • A. Surface texture influences the rate of osseointegration but is secondary to host factors.
  • B. CORRECT. Systemic health governs everything downstream. Uncontrolled diabetes, smoking, antiresorptive therapy, head and neck radiotherapy and immunosuppression all impair osseointegration and raise failure rates. Patient selection precedes surgical and prosthetic considerations.
  • C. Brand differences are marginal compared with host and site factors.
  • D. Shade is an aesthetic consideration, irrelevant to survival.

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