Management of odontogenic sinusitis related to dental implants and maxillary sinus grafting: a retrospective single-center study

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Background: The increasing use of dental implants is changing the epidemiology of Odontogenic Sinusitis (ODS). Aside from endodontic causes, we frequently encounter problems caused by implant placement and bone augmentation techniques, which present a distinct pathophysiological profile compared to classic ODS. This study analyzed the clinical features of pre-implant (Group I) and implant-related ODS (Group II) to establish surgical management strategies according to the Felisati classification. Methods: This retrospective single-center study analyzed 45 patients treated between December 2020 and December 2025. Patients were classified according to the Felisati classification into Group I (preimplantological treatment complications) and Group II (implantological treatment complications). We evaluated clinical variables -etiology, osteomeatal complex (OMC) obstruction, foreign body presence, and oroantral communications (OAC)-and surgical strategies adopted: Endoscopic Sinus Surgery (FESS), exclusive oral approach, or a combined simultaneous technique. Results: = 37) dominated the cohort (82.2%), with 8 preimplantological complications (Group I). Females accounted for 66.7%. In Group II, chronic sinusitis affected 70.3% of patients, with high incidence of foreign bodies and OACs (64.9% each). To manage this complex scenario, we favored a combined simultaneous approach in the majority of Group II cases (59.5%); we reserved the exclusive oral approach for 27.0% of patients and limited exclusive FESS to 13.5%, primarily for implant preservation. Similarly, in Group I, where chronic sinusitis affected 75% of patients, the combined approach was performed in half the cases, while FESS alone was utilized in 37.5% to retrieve dispersed graft material. At the 3-month follow-up, primary complete resolution was observed in 44/45 patients (97.8%). Only one patient (Group II) experienced a recurrence of the oro-antral communication, which was successfully closed after a secondary surgical intervention, ultimately leading to a 100% final success rate. Conclusions: Implant-related and pre-implant ODS are distinct clinical entities often complicated by OMC obstruction and foreign body reactions. Although surgical planning requires case-by-case customization, in our experience, the combined simultaneous approach represented an effective primary strategy for complex cases, while exclusive approaches were reserved for selected patients. Complete short-term clinical and endoscopic resolution was observed in the cohort at the 3-month follow-up.

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