Clogged Blocked Sinus For Zygomatic Implants

This is a great educational image of a clogged sinus. The plan is for this patient to have zygomatic implants. The plan could also be for a sinus lift bone graft.

Regardless of the procedure the sinus on the left side of the picture is blocked. A clogged sinus is a recipe for disaster for zygomatic or sinus lift procedures!

Clogged sinus indicated by red arrows. The healthy sinus is pitch black. ​
Clogged sinus indicated by red arrows. The healthy sinus is pitch black.

When the sinus is clogged, there is no way for the natural clearing of the sinus to occur. Basically the drain hole of the sink is blocked.

If you get an infection there is no way to clear the infection. Besides resulting in graft or zygomatic implant failure this can also create a “hole” (fistula) between the sinus and mouth that doesn’t heal.

What does a clogged sinus look like?

A healthy sinus is pitch black on the x-ray. You can see numerous, curvy channels of the nose when it is clear.

The unhealthy sinus is grey. The channels are not visible.

How do you clear a blocked sinus?

The blocked sinus usually clears itself after removing the bad teeth in the upper molar area. If not, medications such as Flonase can help. Some do not clear and require a “FESS” procedure to open up the drainage system. FESS is done by an ENT physician not a dentist. There are some unique but effective ways to clear a sinus with saline rinses and baby shampoo! Bad upper molars or bad root canals on the upper back teeth need to be removed to help the sinus clear.

Smoking also paralyzes the natural sweeping “cilia” that clear the sinus. Stop smoking and vaping!

In order to see a blocked sinus for dental implants you must have a scan that shows really high up near the eyes. Many dentists do not have a scanner large enough to see appear and we’re not aware if this area is blocked.

If you already have implants and you’re having sinus pain this area should be evaluated. It is called the ostiomeatal complex.

I hope this helps somebody learn bit more about sinus relationships to implants

 

Ramsey A. Amin, D.D.S.

Diplomate of the American Board of Oral Implantology /Implant Dentistry

Fellow-American Academy of Implant Dentistry

Burbank, CA

10 thoughts on “Clogged Blocked Sinus For Zygomatic Implants”

  1. Had a crown come off, but daughter was in hospital 7 months, I was with her whole time. It wasn’t painful, but sensitive. I continued to eat on it. Last August, I went to address it, hoping to not have to pull it. I was told maybe I can buy you a couple years, I will clean it out, put another temp crown on it. By December it was bothering me, had CBCT done, was told it was infected. No antibiotics given. I kept getting respiratory infection and had to be Covid tested, which delayed 2 extraction appointments ( never had Covid). By February I call and say this has got to come out. They couldn’t get me in for 3 weeks. So, I went to random guy to have it pulled. I had to go back 10 days straight, he wasn’t sure if dry socket or not. Repeated antibiotics. I went back to original dentist, who did another CBCT, sat my husband and I down, said during extraction my sinus was punctured. He showed us on film, we could see it. He said he would fix it , by cleaning out the site, and use PRF, but wanted me on another antibiotic for a week. In the meantime I ended up having MRI showing severe sinus blockage. He said in first CBCT no sinus issue, after extraction, sinuses were becoming blocked.
    Long story short, my dentist decides not to do the procedure. Said he didn’t feel qualified. I had been on cancellation list, but when told he would do it, I would get calls, and told them I was covered. By this time we are into April, and one of my physicians got me into someone 2 and a half hours away.
    Brought in my CBCT’s. He tells my husband and I , he doesn’t see a perf. He sets me up for surgery #14 upper left.
    He cleaned it, used PRF, removed 2 pieces of bone, biopsy not back yet. My sinuses need surgery on them and getting worse. I am scheduled 21st this month.
    I am still in excruciating pain in extraction site, and still have sutures in. He said my incision had a hole, wasn’t healing, he cultured it, that’s not back yet.
    I have asked him to get with other dentist for him to show where he felt there was a sinus puncture. I have been on one antibiotic after another, with cheek swelling (no fever). He doesn’t want to take sutures out, in case all of it opens, but feels I should continue on with sinus surgery.
    I’m a little fearful in case he has missed the puncture, or if it’s closed on its own.
    Either way still have infection there, and wondering your thoughts? It definitely hurts in the extraction site. I do know my sinuses need help, I have had glandular swelling in neck too.

    Reply
    • The most likely scenario is that you had a clogged sinus before the extraction. Even if the dentist made a hole in the sinus those will heal on their own and 99% of situations on people that do not smoke and are nondiabetic. You probably have what is called an oral antral fistula. This can be corrected with a buccal fat pad advancement procedure but prior to that he should be seen by an ear nose and throat physician to make sure that your sinus is clear so that this procedure works. Typically they do a FESS procedure to clear the sinus which then makes all of these dental procedures successful. Let me know that you receive this reply

      Reply
      • Hello, I had Zygomatic implant surgery 4 months ago and the surgeon said I had a sinus hole that may have been present since 2007, when I was shot in the mouth. I never had any sinus or ear problems until the surgery was done. Following the zygomatic surgery, I developed severe pain and itching in my ear (deep in ear drum). Also developed sinus issues and allergies. I went to an ENT and he put me on antibiotics for an infection. The ENT said the infection cleared and I then followed up with the surgeon to close the sinus hole (a week ago). I still have such bad ear pain, itchiness in my ear and terrible sinus issues. Any suggestions.

        Reply
        • Hmm…pain and itching in my ear (deep in ear drum) I have never heard of. I have placed and restored many zygomatic implants for many years now and have never heard of anything with the ear.

          Usually the sinus hole is closed by taking some cheek fat and covering over it. But none of it is related to the ear. Maybe there was some damage to the ear nerve when shot in the mouth? Can you tell me more about this terrible incident?

          Respectfully,

          Dr. Amin

          Reply
          • Hello and thank you for replying. In 2007 I was robbed and shot in the face, stomach and side. It was a long process of recovery and fortunately I have come a long way. The procedure was done exactly how you mentioned in terms of the cheek fat being placed over the sinus hole. I have lost a significant amount of hearing in my left ear resulting from the shooting. I agree, I will need to see about nerve damage and thank you for your correspondence. Ever since the Oct. Zygomatic surgery my sinus’s and allergies (as well as my ear) have bothered me. I will f/u with the ENT. Thanks again.

    • I’m sorry about your ordeal. I too have had sinus infection and messy extraction issues. Long term treatment for MS has been assaulting my bones, and now I’m thinking about why medical and dental are treated as 2 totally different things. I’m sure it’s all about insurance companies controlling our medical care. And they are only in it for the money.
      We need universal health and dental care, with seamless coordination.

      Reply
  2. Been dealing with an odd situation with #4 tooth Which, due to clenching and in hindsight an inordinate amount that sides pressure going all on that tooth would lead to soreness. Then for first time in life developed a sinus infection that seemed localized to that exact tooth followed by more consistent discomfort in the tooth and sensitivity to hot foods. I’m wondering if that tooth has a crack in the root and perhaps due to all the forces at work is somehow communicating with the sinus. Any advice you can offer would be greatly appreciated.

    Reply
      • Thanks for the reply. I just don’t know how to determine if root canal or extraction is the right move because I know problem is not from decay but the force from clenching. And the concurrent sinus infection in the exact same spot makes me think there is a connection between the two. Cut the force from clenching have cracked the bone separating sinus from roots? And could this be an issue with extraction? Any help again would be appreciated.

        Reply
        • Extraction is most definitive and will not be a problem.

          Of course doing a root canal is less invasive because you keep your tooth.

          Yes the force from clenching cracked a tooth which then creates the channel to the bone 😩

          Reply

Leave a Comment