Pathophysiology, Diagnosis and Treatment of Odontogenic Maxillary Sinusitis in the 21st Century
Treatment of Maxillary Sinusitis Caused by Dental Implantation
2022 Volume 160 Pages 105-128
Details
2022 Volume 160 Pages 105-128
Two hypotheses have been proposed for the pathogenesis of maxillary sinusitis caused by dental implant placement and/or maxillary sinus augmentation surgery.
According to the first, odontogenic infections, such as odontogenic maxillary sinusitis, are caused by the surgical procedure in which dental implants are placed. The cycle of inflammation involving odontogenic infection and factors that interfere with successful treatment of sinusitis influences the outcomes of maxillary sinusitis caused by dental implantation.
The other hypothesis is that odontogenic infections, such as maxillary sinusitis, are caused by chronic infection of neighboring teeth, such as apical periodontitis, which occurs during dental implantation.
Both the hypotheses suggest that a vicious cycle of inflammation in the closed maxillary sinus results in intractable maxillary sinusitis.
Impaired mucociliary function, bacterial and virus infections, occlusion of the ostiomeatal complex, or a combination of these three factors can perpetuate an inflammatory vicious cycle in the closed maxillary sinus and result in intractable maxillary sinusitis caused by dental implantation.
From the histopathological point of view, the pseudostratified ciliated columnar epithelium in cases of refractory maxillary sinusitis caused by dental implantation is neither severely damaged nor irreversibly injured. As a result, the mucociliary function of the epithelium is almost certain to recover once the ventilation and drainage of the maxillary sinus are successfully restored. Consequently, the pathophysiology of refractory maxillary sinusitis caused by dental implantation is one of the reasons why transnasal endoscopic sinus surgery (ESS) is indicated in cases of refractory sinusitis requiring surgery.
The treatment results are good once the ventilation and drainage of the maxillary sinus is successfully restored after transnasal ESS and support the concept that ESS can be considered as the first-line therapy for refractory sinusitis caused by dental implantation, followed by treatment of the dental implant (extraction of the implant body and/or removal of bone substitute), where necessary.
