Dental Implant Displacement Into the Maxillary Sinus Ostium: A Case Report of Customized Surgical Management

Displacement of dental implants into the maxillary sinus is an uncommon yet clinically significant complication in implant dentistry. Migration toward the maxillary sinus ostium is rare and presents unique management challenges. This case report describes a 75-year-old woman who experienced intraoperative implant displacement into the left maxillary sinus during full-arch rehabilitation. Initially positioned at the sinus floor, the implant was later found at the ostium on cone-beam computed tomography one week after the incident, likely due to patient head movement. The patient reported mild discomfort but showed no signs of sinusitis or oroantral communication. Declining endoscopic surgery, she opted for a less invasive intraoral approach under local anesthesia. A custom-modified dental explorer with a notched tip was designed to securely engage the implant threads. A lateral sinus window was created, and indirect visualization was achieved using rhodium-coated mirrors. The implant was successfully retrieved through the intraoral route, and the sinus entry was sealed using a Bichat fat pad graft. Postoperative management included antibiotics, nasal decongestants, and analgesics. Healing progressed uneventfully, with no complications observed at 10-day, one-month, and three-month follow-ups. This case underscores the potential for dynamic implant migration within the sinus and demonstrates the effectiveness of customized instrumentation and early intervention in achieving successful, minimally invasive retrieval without the need for endoscopic techniques.