Foreign material in a maxillary sinus as a complication of root canal treatment: a case report

Abstract

Endodontic infections of posterior maxillary teeth sometimes spread to the maxillary sinus, generating severe complications.[1] In some cases, the roots of the posterior maxillary teeth come into close contact with maxillary sinuses. They may contact with only the cortical wall of the floor of sinuses, or even project into the maxillary sinus so that teeth apices are only covered by Schneiderian membrane. Such anatomic variations can lead to the establishment of an oro-antral communication during root canal treatment. As a result, possible complications such as displacement of endodontic materials into the maxillary sinus may develop.[2] In this case report, we present a patient complaining about the pain and swelling in her right maxillary sinus area. Radiographic examination showed a dense foreign material in maxillary sinus and the patient history revealed previous endodontic theraphy and extraction of the tooth #15 because of the discomfort and pain. Those findings were compatible with the scenario of iatrogenic complication of the root canal treatment; displacement of the filling material into the maxillary sinuses. Case report 26 year-old-female patient visited our department complaining about the pain on the right side on the face and on the tooth #15. The patient reported that these symptoms had started after the related tooth had undergone endodontic theraphy. Panoramic and periapical radiographs were taken as a part of dental examination and it showed a radiodense foreign material in the right maxillary sinus (Fig. 1a and b). The foreign material was observed to have spread to maxillary sinus wall away from the region of the previously extracted tooth 15. The patient was told about the results of examination and the need for additional surgical treatment. The foreign material was removed through an antrostomy in the lateral sinus wall (Fig. 2a and b). The sinus was irrigated with a physiological saline solution. The flap was then sutured into its original position. The surgical site was uneventful in postoperative 10 day and any signs for oro-antral communication or sinus infection were seen. The roots of maxillary teeth proximity to maxillary sinuses can lead to overfilling of endodontic materials to maxillary sinuses accidentally. In some cases, overfilling of endodontic materials require surgical procedures. Foreign endodontic material within the maxillary sinus after endodontic treatment on extracted tooth #15 is presented in this case report. Foreign material inside the maxillary sinus was removed successfully by Caldwell-Luc operation. Postoperative healing was uneventfully.