Tooth extraction when root is in sinus cavity

During a tooth extraction, complications can sometimes arise where the oral cavity becomes connected to the maxillary sinus due to its close proximity. If a root is accidentally forced into the sinus cavity, it can cause chronic inflammation or other issues such as sinusitis, so it’s important to try to remove the root immediately, either through the socket left by the extracted tooth or through the side wall of the sinus, similar to a procedure called sinus lifting.

Tooth extraction can become complicated when a root is in the sinus cavity, since there is a risk of it being displaced into the sinus cavity during extraction. If this happens, immediate diagnosis and treatment are necessary.

The traditional treatment for this is the Caldwell-Luc technique, which is an invasive oral surgical procedure, though in recent years, the endoscopic approach, which involves inserting a small camera into the sinus cavity via the nasal passages, has become a popular alternative. This technique is minimally invasive and generally results in less postoperative discomfort and a faster recovery time compared to the Caldwell-Luc technique.

Another option for removing a displaced tooth root is the crestal route. This approach involves making a small incision in the gum above the tooth socket and using specialized instruments to retrieve the tooth root from the sinus cavity. The crestal route is a less invasive procedure than the Caldwell-Luc technique, but it may not be suitable for all cases.

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The maxillary sinus is a space in the maxilla bone that is often affected when teeth accidentally move out of their proper place. This usually happens during tooth extractions, with a prevalence of 0.6-3.8%.

The most common cause of this is mistakes made during dental treatment or trauma. Although the incidence of this complication is relatively low, various risk factors can influence its occurrence, including:

  • Close anatomical relationships – due to close proximity of tooth root to the sinus cavity
  • Excessive force
  • Lack of surgical experience, and
  • Inadequate clinical and radiological assessment

When a tooth moves into the maxillary sinus, it can get stuck in different places, such as between the bone and the cheek, the floor and the lining of the maxillary sinus, or it can even break through the sinus lining. To fix this problem, a proper diagnosis is necessary using imaging like x-rays or computed tomography.

How to remove tooth from the maxillary sinus

Diagnosis of dental displacement is based on clinical and radiological evaluation, and the main complication is maxillary sinusitis. Treatment options for this complication include removal of the dental fragments and elimination of the pathological sinus mucosa using endoscopic surgery or Caldwell-Luc approach, or the crestal route.

Endoscopic retrieval and Caldwell-Luc approach are the most described surgical methods for removing foreign bodies from the maxillary sinus cavity. However, endoscopic surgery is a more conservative approach with a faster recovery time and fewer complications than the Caldwell-Luc approach.

1. The Caldwell-Luc technique

This is a traditional surgical procedure used to gain access to the maxillary sinus. It involves making an incision in the gum above the upper teeth and removing a section of bone from the maxilla to expose the sinus cavity.

This procedure provides excellent visualization of the sinus, allowing for the removal of foreign bodies or treatment of sinus disease. However, it is an invasive technique that can lead to complications such as numbness of the upper teeth, prolonged swelling, and bleeding. It also requires a longer recovery time compared to other techniques.

2. The endoscopic procedure

The endoscopic procedure is a minimally invasive approach that utilizes an endoscope to visualize the inside of the sinus through the nasal cavity. The surgeon makes a small incision in the nasal lining and inserts a thin, flexible tube with a camera attached to it. The endoscope allows for a clear view of the sinus and facilitates the removal of foreign bodies or the treatment of sinus disease.

This approach has several advantages over the CL technique, including a faster recovery time, reduced pain and swelling, and a lower risk of complications. However, it requires specialized training and equipment, and not all surgeons are skilled in this technique.

3. The crestal route

The crestal route is a technique used in implant dentistry to access the maxillary sinus through the alveolar ridge. It involves creating a small hole in the bone of the alveolar ridge and elevating the sinus membrane. This approach is commonly used in cases where the patient requires a dental implant but does not have enough bone height in the upper jaw due to sinus expansion.

The crestal route has the advantage of being a minimally invasive procedure that can be performed under local anesthesia. However, it has limitations regarding the amount of bone that can be elevated and the size of the sinus that can be accessed.

4. Therapeutic abstention – No treatment

Surgery is usually the first choice for treating teeth that get stuck in the sinus. But in some cases, if there are no signs of infection and the sinus is healthy, doctors might suggest waiting before doing anything. This is called “therapeutic abstention”. If the tooth piece is small and not blocking the opening of the sinus, it might be okay to leave it there. Some studies have shown that teeth roots can be left in the sinus for a long time without causing problems. But this is not common and patients need to know there is still a risk of infection in the future.

Which treatment is best for my case?

The CL technique provides excellent visualization of the sinus but is invasive and requires a longer recovery time. The endoscopic procedure is a minimally invasive technique with a faster recovery time and lower risk of complications, but requires specialized training and equipment. The crestal route is a minimally invasive procedure used in implant dentistry but has limitations regarding the amount of bone that can be elevated and the size of the sinus that can be accessed.

So, ultimately, the choice of the surgical technique depends on the individual patient’s needs and the surgeon’s preference and experience.

Final thoughts

In conclusion, it can be said that the chances of teeth getting displaced into the sinus cavity is not high, and can be minimized through precise clinical and radiographic assessment and conducting gentle dental extraction. Furthermore, it is recommended to retrieve even small dental fragments in patients who do not show any symptoms of tooth root in sinus cavity to prevent the occurrence of sinus-related complications.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7806358/

https://www.jomos.org/articles/mbcb/full_html/2020/03/mbcb200001/mbcb200001.html#:~:text=Roots%20or%20whole%20teeth%20accidentally,cavernous%20sinus%20in%20rare%20cases.

Author

  • Editorial team

    A team comprising oral health care professionals, researchers, and professional Writers, striving to impart you with the knowledge to improve your oral health, and that of your loved ones. 

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