Introduction

This report reviews relevant literature on foreign bodies identified with cone-beam computed tomography (CBCT) and documents a rare case of a foreign body that was serendipitously identified during routine implant treatment planning.

Case presentation

The literature shows a frequent occurrence of incidental findings with CBCT. This case documents incidental findings in the maxillary sinus and external auditory canal that were identified during routine CBCT used for implant treatment planning. The finding in the maxillary sinus was diagnosed as a mucous retention pseudocyst that did not require treatment. The finding in the external auditory canal was diagnosed as a foreign body (remnant of a cotton swab). Removal of the foreign body was prompted because of its presumed association with chronic headaches that were unresolved. Removal of the foreign body alleviated the chronic headaches, and implant placement proceeded uneventfully.

Conclusions

This review and case underscore the importance of a thorough review of the entire tomographic image volume. Using advanced technology for treatment creates new responsibilities and places more liability on providers not to overlook findings that may be significant to the patient's health.

BACKGROUND: Although mucosal thickening is the most common radiographic finding observed regarding sinus pathology, the knowledge regarding its clinical significance on the outcomes of dental implants and grafting in the maxillary sinuses is still limited. We hypothesized that mucosal thickening would not alter the predictability for sinus floor augmentation and dental implant placement. The purpose of this retrospective study was to evaluate the outcomes of dental implant placement in sinus-augmented areas with preexisting sinus mucosal thickening. METHODS: This study involved the review of cone-beam computed tomographic (CBCT) scans taken on patients that underwent both maxillary sinus elevation with grafting and implant placement at the University of Michigan School of Dentistry from 2004 to 2014. Cases with documented radiographic and clinical follow-up were included. The data analyses revealed the following. RESULTS: A total of 29 CBCT scans met the inclusion criteria for evaluation, and 93.1% of them had maxillary sinus mucosal/tissue thickening. Specifically, 6.9% of cases exhibited no thickening, 6.9% had minimal thickening (1-2 mm), 20.7% of cases had moderate thickening (2-5 mm), and 65.5% had severe thickening (>5 mm). We propose these categorical measurements of tissue thickening as a new mucosal thickening index. The tissue thickening did not vary based on gender, age, or smoking status, nor did it relate to the underlying alveolar ridge height. However, patients with a history of periodontal diseases demonstrated a significant association with mucosal thickening (p = 0.0043). These data indicate that there is high implant and grafting success rate (100%) in the maxillary sinus despite large and varied physiologic sinus mucosal/tissue thickening. CONCLUSIONS: Based on study findings, this research will help guide dental practitioners regarding cases that exhibit mucosal thickening. These data support the concept that physiologic mucosal thickening in varied ranges is not associated with implant or grafting failure in the maxillary sinus.