Discussion

Insertion of endosseous dental implants is usually associated with a low incidence of complications and excellent prognosis. However, physiologic changes following tooth loss may complicate or even impede insertion of dental implants in the upper jaw. Furthermore dental implants can only be inserted if there is sufficient bone for adequate stabilization. Therefore, in severely atrophied bone conditions, augmentation procedures using autogenous bone grafts or bone substitutes are often required.

Various short- and long-term complications such as maxillary sinusitis, oroantral fistula, and extrusion of graft material have been reported after implant placement. Particularly, dental implants that partially extend into the maxillary sinus or nasal cavity are known to cause complications. Furthermore, patients with a predisposition to develop sinusitis are prone for complications after dental implant placement in the maxillary sinus area. Interestingly dental implants that partially extend into the nasal cavity are often asymptomatic and may reside in the nose for many years. However, when complications do occur, unilateral mucopurulent and fetid nasal discharge are the most prevalent symptoms, which can be accompanied by pain, discomfort, headache, or congestion of the affected side. Therefore, patients complaining of nasal discharge after dental implant placement should be thoroughly checked for foreign bodies in their nasal cavities. Differential diagnosis of a unilateral nasal obstruction may also include nasal tumors, nasal polyps, septal deviations, hematomas, and various infections.

Minimal invasive treatment strategies for dental implants residing in the nasal cavity as described in this study have to the best of our knowledge not often been described. A more invasive removal of the complete dental implant in the presented case would have had a negative effect on the load bearing during mastication because of its strategic position in the maxilla supporting the fixed bridge construction. Furthermore, an explantation through the oral cavity could have created an oronasal communication and compromised mucosal blood supply resulting in mucosal recession with a negative outcome on esthetics and peri-implant supporting tissue. Therefore, a partial removal of the apical part of the dental implant using a transnasal approach was opted for.

In conclusion, dental implants protruding into the nasal cavity can cause alterations to the airflow. Dental implants partially residing in the nasal cavity can be minimal invasively treated by sectioning the apical part of the implant using a transnasal approach.