Management of a Symptomatic Maxillary Implant Adjacent to the Schneiderian Membrane Using Cone Beam Computed Tomography (CBCT)-Guided Explantation and Reimplantation: A Case Report

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Dental implants are a predictable treatment option for the replacement of missing teeth; however, complications related to implant positioning and proximity to adjacent anatomical structures may result in discomfort and compromise long-term outcomes. Cone beam computed tomography (CBCT) plays an important role in the diagnosis and management of implant-related complications by providing detailed three-dimensional evaluation of implant position and surrounding anatomy. This case report describes the management of a symptomatic maxillary implant in a patient who presented with intermittent pain during mastication and occasional discomfort in the region of a previously restored implant-supported crown. The patient subsequently reported accidental ingestion of the implant crown and was referred to a hospital to rule out aspiration or airway involvement. Following medical evaluation, CBCT imaging was obtained and revealed a wide-diameter implant positioned in close proximity to the Schneiderian membrane. Based on the clinical and radiographic findings, treatment consisted of CBCT-guided explantation of the existing implant followed by site redevelopment using bone grafting and a collagen membrane. Three-dimensional digital planning was performed to optimize the position, angulation, and dimensions of the replacement implant while maintaining a safe relationship with the Schneiderian membrane. A narrower implant was subsequently placed according to the digital treatment plan. Postoperative healing was uneventful. After six months of osseointegration, a second-stage procedure was performed, and a healing abutment was placed for soft tissue maturation. A digital impression was obtained using a scan body, and a definitive implant-supported crown was fabricated and delivered. At follow-up, the patient reported complete resolution of symptoms, satisfactory function, and improved comfort during mastication. Clinical and radiographic evaluation demonstrated successful implant integration and stable peri-implant tissues. This case highlights the value of CBCT-guided diagnosis, explantation, and reimplantation in the management of symptomatic implants located near the Schneiderian membrane and demonstrates the importance of three-dimensional planning in achieving predictable functional and restorative outcomes.