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From: Mark & Steven Bornfeld on 16 Nov 2005 10:52
Amatus Cremona wrote:

>>The decision will of course hinge on the particular doctor involved.
>>However, in general OMFS will have far greater experience working in and
>>around the sinus.
>>
>
>
> Don't tell my periodontist buddy (Don Corleone) that I said this, but I
> agree with Steve B. on this. I think the Periodontist is great for routine
> sinus plasty procedures, but for complications, well, I want the guys who
> have trained to work, near it, in front of it, inside it, behind it and
> sometimes have removed it.
>


I work with both periodontists and OMFS to place my implants. In my
experience, the perios do mostly the slam dunks. The ones they don't
want to do get sent to the OMFS, and often they are willing to do the
procedure.
I will generally send patients to their periodontist for implant
evaluation if they already are being treated by a perio. Otherwise, I
usually send patients to the OMFS.

Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
From: W_B on 16 Nov 2005 11:20

Great answer, you truly are the King ! :-)


On Wed, 16 Nov 2005 15:25:30 GMT, Dave King <lefort3(a)verizn.net> wrote:

>On 16 Nov 2005 04:55:57 -0800, "tAby" <alperaktas(a)gmail.com> wrote:
>
>>i think OMFS is the right choice.
>>
>>
>>mnansari wrote:
>>> About 4 months ago I had a lateral sinus lift. One month after the
>>> procedure I had an infection. Going back to the periodontist, he said
>>> that it was an infection in the flap which hadn't completely healed.
>>> Also I had told him that while blowing a baloon that air was escaping
>>> to my nose, and that mucous had bone fragments in them. He told me not
>>> to worry about this and he restitched the area. I was given antibiotics
>>> (250mg Amoxillin 250mg Metromidezole 3 times per day) for 10 days .
>>>
>>> After antibiotics completion by 10 days, I got another infection
>>> (swelling between the lower cheak bone and the nose). After talking to
>>> the periodontist, he said most probably the infection was not due to
>>> the sinus lift. This scared me and I decided to have 2 other opinions.
>>> I went to another periodontist and to a Oral/Maxillofacial surgeon. I
>>> explained to them the case and both said that most probably I had a
>>> tear in the sinus membrane which was causing the infection.
>
>Most likely.
>
>>>The OMS
>>> said there was a possiblity I had an infection in the graft and the
>>> graft should be removed and the tear should be repaired, while the
>>> Periodontist referred me to an ENT who requested me to do a CT-SCAN.
>>> The result of the CT-SCAN showed mucosal thickening and part of the
>>> bone had already grown (3 months 1 week post op), although an area
>>> showed loose bone fragments.
>
>No we are getting some where. Loose bone = infection = failed graft
>(atleast part of it). The mucosal thiskening will reverse with removal
>of the fragments.
>
>>>The ENT told me that Sinuses were in good
>>> shape and that I did not have sinusitis. Went back to the new
>>> Periodontist and he told me that after 4 months post op I should do a
>>> dental CT-SCAN to see bone growth, and if there was enough bone, during
>>> implant he would explore where the infection was coming from.
>
>So, what is more of the concern for this periodontist, sinking the
>implant or eliminating your problem?
>
>>>The
>>> infection is causing me to be nauseous with fatigue and headaches. I
>>> also started getting pain from a wisdom tooth which was adjacent to the
>>> sinus lift.
>>>
>>> So far I have been on 5 courses of antibiotics (500mg Amoxillin for
>>> days after surgery, 250mg amoxillin+250mg metromidezole 10days, CEFZIL
>>> 500mg 10 days, TAVANIC 500mg 15 days (ENT recommendation), and now
>>> 500mg Augmentin for 7 days.
>>>
>>> I have since done a skull scan for the sinuses, and blood test. Skull
>>> scan showed mucosal thickening, while blood test did not show excessive
>>> white blood cells.
>>>
>>> Should I go with the OMS, or should I go with the Periodontist? If
>>> there is a severe tear in the sinus membrane, will it heal with time or
>>> will I keep getting those infections (I was told that if it was a small
>>> tear it would heal by itself)? If it is a large tear in the membrane
>>> who can fix it OMS, ENT or Periodontist - and what is the procedure,
>>> another osteotomy? How can I find out if there is a tear?
>>>
>>> Any help will be greatly appreciated.
>
>Without an exam it can be tough but you have done a great job of
>describing your problem. You are developing a chronic sinusitis from
>the irritant. You have a failed portion of the graft that is leading
>to the mucosal thickening and infection. All of this probably started
>from a tear in the membrane. If you were my patient I would remove the
>graft fragments and not attempt any repair of the membrane. It will
>heal all by itself. The only hole I would repair is if one connects
>the oral cavity to the sinus, which you have not described. Give it
>time after removal and start over if you really want this type of
>tooth replacement. If you have the implant placed now you may be
>dealing with a failed implant to go along with your failed graft.
>
>Good luck.
>
>~~~~~~~~~~~~~~~~~~~~~
>David A. King, D.M.D.
>Diplomate, American Board of OMS
>Fellow, American Association of OMS
>HTTP://WWW.DEOMFS.COM
>

--

W_B
Take out the G'RBAGE
wubbabubbazG(a)RBAGEyahoo.com
From: Mark & Steven Bornfeld on 16 Nov 2005 12:24
W_B wrote:

> Great answer, you truly are the King ! :-)

It is good to be the King.

Steve
>
--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
From: mnansari on 16 Nov 2005 13:00
Thank you Dr. King. I now have a good idea of what my problem is. I was
really worried for a while. You are a great help.

The oral cavity was re-sutured after the first infection (it had been
open which allowed the air to pass through to my nose), and it has
completely healed and is sealed.

Will the sinus membrane heal even if it is a large tear?

I would still like to have the implant. I will do a dental CT-SCAN. If
the bone is dense enough should I have the fragments removed and the
implant done together at the same time? What is the procedure for
removing the loose bone fragments? Is it an osteotomy?

Thanks again for your help.

From: Dave King on 17 Nov 2005 09:13
On 16 Nov 2005 10:00:00 -0800, "mnansari" <maenansari(a)hotmail.com>
wrote:

>Thank you Dr. King. I now have a good idea of what my problem is. I was
>really worried for a while. You are a great help.
>
>The oral cavity was re-sutured after the first infection (it had been
>open which allowed the air to pass through to my nose), and it has
>completely healed and is sealed.
>
>Will the sinus membrane heal even if it is a large tear?

Yes

>
>I would still like to have the implant. I will do a dental CT-SCAN. If
>the bone is dense enough should I have the fragments removed and the
>implant done together at the same time? What is the procedure for
>removing the loose bone fragments? Is it an osteotomy?

Wait on the implant until the symptoms are eliminated.

Removing any loose fragments would require going into the sinus again
to clean it out.

>
>Thanks again for your help.

Your welcome.

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