Perforating dental implants and maxillary sinus pathology

Objectives: To study the association between perforation dental implants into the maxillary sinus cavity and the development of sinus pathology. Methods: We retrospectively examined 3732 computerized tomography (CT) scans to detect maxillary implants. The detected scans were grouped based on apparent or lack of perforated dental implants in the maxillary sinus (study and control group, respectively). Clinical data was gathered including the CT indication, patients’ demographics, comorbidities and medications, implant features, and the radiographic appearance of the maxillary sinuses. We conducted a logistic regression to identify risk factors to develop radiopaque thickening in the sinuses. Results: Included in the study were 198 patients with 719 maxillary implants; of these, 236 and 483 implants were in the study and control groups, respectively. Sinus opacification was associated with implants’ perforations (p < 0.001), diameter, and side and place (p < 0.05). Implants’ perforation (OR = 3.679; 95% CI = 1.891–7.157) and diameter (OR = 1.608; 95% CI = 1.067–2.424), sinus floor augmentation (OR = 2.341; 95% CI = 1.087–5.042), male gender (OR = 2.703; 95% CI = 1.407–5.192), and smoking (OR = 6.073; 95% CI = 2.911–12.667) were associated with ipsilateral sinus fullness. Conclusions: A first large study on the association between maxillary dental implant and sinus pathology. Dental implant perforation is associated with sinus opacification. Considering dental implant diameter, rather than vertical depth of penetration into the sinus, as an important criterion when examining perforated dental implants necessitates a new approach to clinical decision-making.