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.

Objectives

Given that the nature and presence of voids present within grafted sinuses following maxillary sinus elevation procedures were not known, nor was the contribution of these factors to implant success, the purpose of this study was to investigate these parameters and their relationship to implant success.

Materials and methods

This study evaluated data from 25 subjects who had a lateral window maxillary sinus augmentation procedure. Cone-beam computed tomography (CBCT) was performed at baseline and 4 months after surgery. CBCT images were used to evaluate grafted sites prior to implant placement. Using CBCT images, three examiners independently measured bone-grafted areas (BG), void areas (V), and percentage of void areas (V%) from six different sections within grafted sites. The six sections were defined as a cross-sectional (CS) midpoint, CS mesial point, CS distal point, horizontal section (HS) low point, HS midpoint, and HS high point. Implant success was also determined.

Results

The calculated V% (V/BG) for the CS midpoint, CS mesial point, CS distal point, HS low point, HS midpoint, and HS high point were 5.30 ± 6.67%, 5.79 ± 8.51%, 6.67 ± 7.12%, 2.07 ± 2.56%, 5.30 ± 6.62%, and 4.92 ± 5.17% respectively. Implant success after 6 months of follow-up approximated 100%.

Conclusions

Although voids within grafts varied in terms of distribution and size, the V% within the HS low point were significantly smaller compared to those within the CS midpoint and CS distal point, which had the most intra-subject V%. Thus, more attention should be given to the distal aspect of the sinus when compacting graft materials in the lateral wall sinus augmentation procedure. Implant success was not influenced by the existence of voids as implant success remained high.

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.