The penetration of bones and the root of the tooth into the maxillary sinus indicates the perforation of the latter. A similar complication may be accompanied by treatment at the dentist. Perforation of the maxillary sinus is quite common. From the above article you will find out the causes of such a pathology, signs of perforation, methods of diagnosis and treatment, as well as prevention. Photos of tooth roots in the maxillary sinus can also be seen in sections of the article.
Features of the maxillary sinus
The maxillary or maxillary sinus is located in the thickness of the upper jaw. Its bottom is formed with the help of the maxillary alveolar process, which separates it from the oral cavity. The sinuses are quite large in volume. In an adult, they can reach up to ten cubic centimeters.
Reasons for the gap
The sinus, called sinus or maxillary, is not characterized by tightness. It interacts with the nasal cavity with a small gap. As a rule, sinus rupture occurs in the area of its lower part. This happens due to the characteristic features of the structure and against the background of certain diseases, namely:
- The roots of molars and premolars are located very close to the sinus. In some cases, the bone layer is quite thick and reaches 1 cm. However, sometimes the barrier can be less than 1 mm in thickness.
- The first and second molars in the root can be located directly in the sinus cavity and can only be separated by the mucous membrane.
- Rapid thinning of the bone layer against inflammatory diseases in acute or chronic form, including cysts, periodontitis and periodontitis.
- Thin trabeculae of the bone in the maxillary tissues.
All these factors can cause sinus rupture during dental treatment. In this case, there may be no violation of the technology for performing dental procedures. This may be the result of the individual anatomical features of each patient. Let's see why the tooth root penetrates the maxillary sinus.
Frequent cases
Perforations of the maxillary sinus occur, as a rule, as a result of the work of the dentist in the treatment of teeth. Tissues breaks are characteristic for the following situations:
- Tooth extraction.
- Dental implantation.
- Endodontic therapy.
- Resection of the tooth root.
If the perforation occurred during the operation to remove the tooth, then this may be due to unskilled and excessively rough work of the dentist, as well as individual structural features of the maxillary sinus of the patient. In the case of the location of dental roots directly in the sinus cavity, perforations when removing molars are almost inevitable.
One of the complications during endodontic therapy can also be perforation of the tooth root, which in most cases is associated with perforation of the sinus floor. A similar situation can occur as a result of an excessively strong expansion of the root canals, as well as when using brute force when installing the pins and sealing cement for fillings. In this case, most often not only the root of the tooth can be in the maxillary sinus, but also its fragments and particles of material for filling. And this is dangerous for the patient.
When a rupture occurs during implant placement or during root canal filling, as well as as a result of inserting pins into the root of the tooth, this in the vast majority of cases is a therapeutic mistake by a specialist. Sometimes you can find the roots of the wisdom tooth in the maxillary sinus.
Severe consequences of dental prosthetics
With dental prosthetics and root implantation, perforation of the maxillary sinus is considered a serious complication. This is due to the fact that resection provokes rapid degeneration of bone tissue. As a result of this process, the height of the alveolar jaw process decreases. If these important points were not taken into account by the dentist at the preparatory stage of implantation, as well as as a result of the incorrectly selected size of the implant itself, sinus perforation occurs.
Cyst of the tooth root in the maxillary sinus
Removing the tooth root is considered the most effective way to treat cysts localized in the apex. When the patient has not been thoroughly examined, and the dentist does not have information about the thickness of the bone tissue that separates the cystic wall from the sinus fundus, and also when it is necessary to remove a large amount of jaw bone, sinus tissue rupture occurs quite often.
Symptoms
When perforation and getting a tooth root into the maxillary sinus occur during dental resection procedures, characteristic signs of rupture appear, including:
- Bleeding from a tooth cavity with small air bubbles, the amount of which increases when you try to make a sharp exhalation with your nose.
- Discharge from the nose of bloody contents from the side of a torn sinus.
- A sharp change in the tone of voice of the affected patient, characterized by nasal.
In the presence of a tooth root in the maxillary sinus, the symptoms cannot go unnoticed. Sometimes, after resection, the patient begins to complain about the difficulty of air passing through the formed hole, as well as pressure and heaviness in the projection of the maxillary sinus.
When perforation occurs during implantation or endodontic therapy, signs of such a complication are:
- A specific failure of an instrument or material for implantation after some effort to advance it in the jaw.
- Reposition of the used tool in the resulting wound.
- The appearance of small air bubbles and blood discharge from the hole.
Perforation may not be detected and not eliminated immediately after a sinus rupture, which leads to infection of the sinus cavity and is accompanied by signs of sinusitis or sinusitis in acute form. For such pathologies, the following symptoms are characteristic:
- Acute intense pain in the sinus of the upper jaw.
- Swelling of the nasal mucosa from the side of injuries, accompanied by difficulty in nasal breathing.
- Purulent secretions from the nose.
Systemic complications and symptoms of intoxication are manifested, which are characterized by chills, headaches, weakness and fever. But how to detect a tooth root in the maxillary sinus?
Diagnostics
For an experienced dentist, specific studies may not be required to confirm maxillary sinus perforation. If we are talking about tooth resection, then a similar complication, like a soft tissue rupture, is accompanied by a typical clinical picture. If the dentist is in doubt when perforation occurs during endodontic treatment, the following additional examination methods may be required:
- Probing of the hole formed after tooth extraction, as well as the root canal. For this purpose, a thin probe is used. Thus, it is possible to establish the absence of a bone floor in the wound. The instrument during the study freely passes through the soft tissue.
- X-ray examination of the sinuses. The images will show darkening in the sinus cavity, indicating the accumulation of blood in this area, as well as filling material and fragments of teeth and an implant. In some cases, contrast radiography may be required with the introduction of a special substance into the perforation cavity.
- CT scan. Such a diagnostic method makes it possible to detect a gap and the presence of foreign bodies. The image is obtained as accurate and informative as possible.
- If the perforation is old, it is recommended to donate blood for its general examination, according to the results of which it will be possible to draw a conclusion about the presence or absence of an infectious focus in the body.
After carrying out the necessary diagnostic measures and confirming the rupture of the maxillary sinus, the dentist prescribes the appropriate treatment. So, a person has a tooth root in the maxillary sinus - what should I do?
Treatment
The choice of treatment for maxillary sinus perforation depends on the changes that have occurred as a result of the rupture. Non-surgical treatment is possible in case of violation of the integrity of the tissues during tooth extraction, when the pathology was detected immediately, and according to the results of an X-ray examination, it is clear that there is no infection of the sinus cavity and there are no foreign bodies in it. With this clinical picture, the doctor, as a rule, tries to keep the blood clot formed in the hole as much as possible. In addition, preventive measures are taken to prevent wound infection.
For this purpose, a small gauze swab dipped in iodine solution is introduced into the well. As a rule, the tampon is independently fixed in the wound cavity. However, sometimes a suture on the gum may be required. Treatment with iodine solution should be carried out for 6-7 days, until the defect disappears, and full granulation is formed. It is not recommended to remove the tampon from the hole during treatment, as this can damage the clot and lead to infection of the wound.
When a tooth root is found in the maxillary sinus, everyone should know what to do. In some cases, the doctor decides to close the defect with a special plastic plate, which is fixed to adjacent teeth with clasps. Thus, it is possible to achieve separation of the sinus and oral cavity.
Inflammation prevention
In addition to preserving the wound, prophylactic therapy is carried out aimed at preventing the development of the inflammatory process. Most often, antibiotics are prescribed, as well as anti-inflammatory drugs. In addition, drops are prescribed for instillation into the nasal passages, which have a vasoconstrictor effect. It is possible to conduct treatment both on an outpatient basis and while staying at home.
If the examination revealed the presence of a foreign body in the maxillary sinus, then treatment is carried out only in a hospital. Therapy consists of an operation to open the cavity and remove the root of the tooth from the maxillary sinus.
Complications
Rupture of the maxillary sinus is a serious consequence of dental procedures, the treatment of which most often occurs in a hospital setting. What is this fraught with if the root of the tooth has grown in the maxillary sinus?
Self-treatment of the problem with traditional medicine methods can lead to even more serious complications, including:
- Severe inflammatory process in the sinus cavity with further infection of adjacent tissues. Then there is the development of osteomyelitis in the upper jaw.
- The transition of the inflammatory process to other cranial sinuses, including wedge-shaped, frontal and ethmoid.
- The loss of healthy teeth located in the area of perforation.
- The formation of foci of pus, phlegmon and abscesses.
Due to the close proximity of the brain, against the background of the fact that the root of the tooth went into the maxillary sinus and the gap of the latter occurred, the occurrence of an infectious lesion of the meninges is possible. The next stage of serious complications may be meningitis or meningoencephalitis, which are life threatening to the patient.
Prevention
As for preventive measures regarding perforation of the maxillary sinus, they consist in the following rules:
- A thorough and multifaceted examination of the patient before major dental events, including tooth resection or implantation.
- Correct assessment of the anatomical features of the structure of the jaws of each patient.
- Strict observance of all technological requirements for complex dental events.
Conclusion
The key to a favorable outcome for the patient’s health, if the root of the tooth is in the maxillary sinus, is timely and correctly selected treatment.
Self-medication and improper implementation of a specialist’s prescription can lead to serious consequences and complications. It must be remembered that even chronic perforations can be cured. However, this can only be done surgically. Therefore, it is better to solve the problem immediately, without delay.