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 »  Home  »  Dental Implant 2  »  Inadequate Implant Angulation Resulting From Oroantral Fistula
Inadequate Implant Angulation Resulting From Oroantral Fistula
Case Report

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Su-Gwan Kim, DDS, PhD
Assistant Professor, Department of Oral and Maxillofacial Surgery, College of Dentistry, Chosun University, Kwang-Ju, Korea.

A 46-year-old male was referred to the dental clinic in August 1997 with persistent pain of the right maxillary first molar continuing for two weeks and progressive facial swelling caused by advanced periodontitis. He was treated by the extraction of the right maxillary first molar after the resolution of acute symptoms, but an oroantral fistula occurred after the extraction. Closure of the oroantral fistula was performed by using submucosal palatal connective tissue in August 1997, and the wound healed satisfactorily. There were no medical contraindications to dental implant surgery. Panoramic radiographic analysis was done.
Two months later (October 1997), a 3i (Implant Innovations, Palm Beach Gardens, FL) implant (diameter, 5 mm; length, 11.5 mm) was placed in an angulated position in the right maxillary first molar because of anatomical factors (labial alveolar bone resorption and prior oroantral fistula were present). The use of one implant was rejected because of an anatomical factor (poor bone quality) in the right maxillary second molar. In June 1998, phase-two implant surgery took place. In January 1999, the maxillary right second premolar was extracted because of severe mobility.
In February 1999, a 3i (Implant Innovations) implant (diameter, 4 mm; length, 13) was placed in the right maxillary second premolar. In February 1999, a right posterior segmental maxillary osteotomy was performed using the microplate. The patient received a local anesthetic. Using a sterile technique, a vertical incision was made through the mucoperiosteum in the canine region from the crest of the gingiva. Vertical bone cuts were made between the right maxillary second premolar and first molar through the buccal cortical plate to the palatal submucosa. The cuts were approximately parallel to the long axis of the adjacent right maxillary first premolar. A horizontal osteotomy of the buccal cortex was carried superiorly to a point estimated to be 5 mm above the apex of the canine using a thin fissure bur. This was carried posteriorly to join the osteotomy sites. The posterior segment was then freed by using an osteotome  and held in place by a microplate (0.6 mm in profile) and microscrews (length, 7 mm; diameter, 1 mm). When the segment was adequately fixed, the flap was sutured with 4-0 Vicryl resorbable material (Ethicon Inc., Somerville, NJ).
Antibiotics and analgesics were administered. Radiographs were taken immediately after surgery to check the osteotomy and verify the position of the microplate and screws.
The patient had no pulpal change in the segmental maxillary teeth after surgery. The patient accepted the procedures well and with minimal morbidity and discomfort. Nine months after osteotomy (November 1999), crowns were placed on the implants. By this time, the centric occlusion was quite satisfactory as compared with presurgical occlusion. After seven months of load, the patient is extremely satisfied with the function of the restoration.