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From: mnansari on 16 Nov 2005 03:23
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. 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. 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. 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.

From: tAby on 16 Nov 2005 07:55
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. 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. 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. 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.

From: Mark & Steven Bornfeld on 16 Nov 2005 10:14
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. 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. 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. 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.
>

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.

Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
From: Dave King on 16 Nov 2005 10:25
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


From: Amatus Cremona on 16 Nov 2005 10:37
>
> 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.

--
/

Amatus

/
"Mark & Steven Bornfeld" <bornfeldmung(a)dentaltwins.com> wrote in message
news:L1Ief.1238$Sb.1057(a)trndny03...
> 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. 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. 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. 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.
>>
>
> 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.
>
> Steve
>
> --
> Mark & Steven Bornfeld DDS
> http://www.dentaltwins.com
> Brooklyn, NY
> 718-258-5001


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