Implants · patient case question
What is the appropriate course of action?
Patient case: 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.
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.