The contemporary dental implant treatment based on osseointegration has saved many edentulous patients who are suffered from the decline of quality of life, such as inefficient function, unsatisfied esthetics and psychological depression. However it has experienced mere a half century. There is a tendency that many dentists are interested in the short-term result nowadays, despite the original concept by Professor Brånemark had focused the long-term excellent outcome, that is well known among the experienced researchers and clinicians. Some manufacturers emphasize the easier and simple components and faster osseointegration. That is also implant but we clinicians should not forget the patient’s final objectives.
The hardware regarding implant treatment supplied by manufacturer is a very important factor in order to get the osseointegration, however the software provided by the dentists and co-dental staff should also be focused on for the optimum longevity of implant. Most of the artificial construction has the problem caused by the unfavorable force and the implant component is no exception to this rule. The selection of system and treatment planning should be performed under the biomechanical consideration, for example the availability of ”the safety valve” in order to protect the most important product. The osseointegrated fixture is the most valuable element in implant treatment, but there are many systems that ignore this concept. And the impeccable fit between the superstructure and the abutment is one of the most influential factor for the stability of marginal bone. The surgical procedure should be done under the antiseptic circumstances and gentle surgical skill, because the implant component might be realized as an antibody by living tissue even if the components are produced under strict controlled condition.
We dentist should always keep this proverb in our mind.
Maxillary sinus（MS）locates in the center of maxilla and is surrounded by 5 bony walls that form four-side pyramid structure toward the apex to the zygomatic process. It is the largest of all paranasal sinuses and drains into the middle nasal meatus through the hiatus semilunaris. Lining membrane of MS（Schneider membrane）is composed of the pseudostratified cilliary epithelium containing goblet cells that secret mucus on the surface of epithelial layer. At 5 weeks of gestation, the development of MS initiates as invagination of epithelium into the mesenchymal stem cells, which become uncinate process and inferior nasal concha. Subsequently, invaginated epithelium makes small lacuna that will be pneumatic cavity of MS. Although the development of MS is never fast during the gestational stage, its volume rapidly increases after birth and reaches a peak in the adult. The distribution of arteries and nerves in MS are complicated. Two major branches of maxillary artery, infra-orbital artery（IA）and posterior superior alveolar artery（PSAA）, are main nutrient arteries for MS. Anterior superior alveolar artery, another branch of IA, also provides blood in front of MS and makes a circle with the branches of IA and PSAA. Notably, intra-osseous branch and extra-osseous branch of PSAA are observed around MS. Especially, the access to extra-osseous branch demands great caution in surgical treatment, because their branches pass by an origin of buccinators on maxilla. On the other hand, the branches of maxillary nerve, infra-orbital nerve（IN）and posterior superior alveolar nerve（PSAN）, innervate MS. PSAN is a component of superior dental plexus anastomosing with the branches of IN, anterior superior alveolar nerve and middle superior alveolar nerve. This review will be good information for dental implant treatment.
The purpose of this article is to report an extremely rare case of Aspergillosis of the maxillary sinus involved with implant treatment.
A 67-year-old woman visited our hospital with a chief complaint of rhinorrhea, nasal obstruction and discomfort in her buccal area. On oral examination, 2 implants in the maxillary molar had neither percussion pain nor mobility, showing antraoral communication through periodontal pocket. CT revealed that the sinus was occupied by heterogeneous soft tissue density area including a few calcification area called fungus ball, foamy low density area in the right maxillary and ethmoid sinus without bone destruction, and thicken bone of antral wall, soft tissue density bulged out toward the nasal cavity. We made clinically diagnosed as fungal maxillary sinusitis, and performed removal of implants and curettage of the maxillary sinus with the surgical drainage duct. The histopathological diagnosis showed aspergillosis of the maxillary sinus. Therefore we made final diagnosis as non-invasive type, aspergillosis of the maxillary sinus. Since then the postoperative course has been uneventful. Her symptoms have been completely improved. The 8 months postoperative CT revealed normal thin mucosa in the maxillary and ethmoid sinus.
The findings of CT were useful and effective for diagnosis in this case. To our knowledge, they have been ever documented in only 2 English reports regarding to aspergillosis of the maxillary sinus involved with implant treatment, and no report in Japan. This article is the first report in Japanese one.