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(Accessed on 18/09/2015)
(Accessed on 18/09/2015)

The importance of prompt referral when tooth roots are displaced into the maxillary antrum

From Volume 43, Issue 8, October 2016 | Pages 760-765

Authors

Andrea N Beech

BDS(Hons), MJDF RCS(Eng)

Specialty Doctor, Oral and Maxillofacial Surgery, Gloucestershire Royal Hospital, Gloucester, UK (Andrea.Beech@glos.nhs.uk)

Articles by Andrea N Beech

Jeremy N Farrier

MBBCh, BDS

Consultant Oral and Maxillofacial Surgery, Gloucestershire Royal Hospital, Gloucester, UK

Articles by Jeremy N Farrier

Abstract

When an upper tooth is extracted a possible complication is the creation of an oro-antral communication with the added risk of displacement of tooth roots into the antrum. We present a case of a displaced palatal root of an upper first molar tooth which was found in a superior position in the maxillary antrum having been left in situ for 6 weeks. The root was in a high risk position for complications such as sinusitis, mucocoele formation and the more serious septic thrombosis of the cavernous sinus. This case report describes its safe endoscopic removal and highlights the importance of prompt referral and treatment for similar cases.

CPD/Clinical Relevance: Displaced roots in the maxillary antrum during routine extraction can result in complications ranging from sinusitis to more severe complications if not managed appropriately.

Article

It is well accepted that the apices of the roots of maxillary premolar and molar teeth are in close proximity, or directly related, to the base of the maxillary air sinus. When an upper tooth is extracted there is the potential for the creation of an oro-antral communication and the added possibility of displacement of tooth/roots into the antrum itself. The most commonly displaced tooth/root is the palatal root of the molar teeth.1 Whenever an upper posterior tooth is to be extracted a patient should be counselled regarding the potential of the creation of an oro-antral communication and the possibility of displacement of tooth roots into the antrum itself.

A root can remain in the antrum and cause minimal adverse consequence, occasionally, however, complications arise and include acute or chronic sinusitis, the development of benign mucosal cysts/mucocoeles and antrolith formation.2 Displaced roots have less commonly been reported as occluding the ostium or passing into the nose via the ostium. These have subsequently been expelled by sneezing or nose blowing or, in fact, swallowed or inhaled.3

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