Endosseous dental implants are commonly used to rehabilitate fully or partially edentulous patients. The insertion of such implants can in some cases cause complications, especially in the edentulous atrophic maxilla. In this paper, an unusual complication of altered nasal airflow after the placement of an endosseous dental implant in the maxilla is presented. Subsequent treatment of the obstructive nasal airflow is described.

A 50-year-old female patient was referred to the Department of Oral and Maxillofacial Surgery of the VU University Medical Center in Amsterdam with complaints of a long ongoing unpleasant altered nasal airflow after the placement of eight dental implants in the maxilla. Four months prior to implant surgery, a bony augmentation of the atrophic edentulous alveolar crest and a bilateral maxillary sinus floor elevation using autogenous bone harvested from the anterior iliac crest had been performed. Shortly after implant placement, one of the implants placed in the area of the left first incisor had to be removed due to an oronasal fistula and subsequent lack of osseointegration. No further complications such as rhino-sinusitis, nasal discharge, pain, recurrent epistaxis, or headaches were reported.

However, anterior rhinoscopic examination revealed that the apical part of the dental implant placed in the upper right first incisor region had perforated the nasal floor close to the nasal septum and partially extended into the right nasal cavity (Fig. 1). The mucosa of the left nasal cavity was intact and demonstrated no signs of inflammation. Radiological examination (dental and panoramic radiographs and computer tomography) confirmed that the implant placed in the right first incisor region had perforated the cortical bone of the nasal floor (Fig. 2).

After a discussion with the patient regarding the risks and benefits of surgery, transnasal resection of the apical part of the titanium dental implant in general anesthesia was opted for. During surgery, the floor of the nasal cavity was locally anesthetized and the nasal mucosa surrounding the dental implant was incised and meticulously elevated exposing the nasal floor and the apical part of the perforating dental implant. Under direct vision and adequate sterile saline cooling, the perforating implant was resected to the level of the nasal bone initially using a hard steel fissure burr. The titanium surface was further smoothened with a round diamond burr. All metal debris were carefully removed from the operating site, and the nasal mucosal flap was realigned and sutured using 4-0 Vicryl to provide a watertight mucosal seal. The patient was postoperatively instructed to avoid sneezing and nose blowing and received a broad-spectrum antibiotic (amoxicillin-clavulan acid 500/125 mg three times daily for 5 days).

No complications were apparent during the surgical procedure. Postoperative clinical and radiological examinations demonstrated an intact nasal mucosa and an adequate resection of the dental implant to the level of the nasal floor (Fig. 3). The patient had an uneventful recovery and at 2-, 6-, and 12-month follow-up, she reported having no altered nasal airflow.