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Title Treatment Of A Root Fragment In The Maxillary Sinus
Clinical Question In surgical extraction patients with a root tip inadvertently pushed into their maxillary sinus, will immediate surgical therapy be a more effective way in leading to a smooth recovery as compared to a delayed operation date with antibiotic therapy?
Clinical Bottom Line As long as the clinician is confident in his/her ability to infiltrate the maxillary sinus, immediate removal of the root tip from the sinus is the most beneficial method of treatment for a root tip displaced into the maxillary sinus. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 3476894Barclay/1987A single 48 year old male with a palatal root fractured into his maxillary sinus.Case study
Key resultsThe patient had a delayed surgery date and he coughed out the palatal root fragment that was fractured in his maxillary sinus during the three week waiting period before his surgery appointment. No surgery was needed and healing was successful.
#2) 100455Lee/1978UnknownNon Systematic Review
Key resultsThere is a high degree of sinusitis in patients with a root tip left in their maxillary sinus and therefore, the root should be removed promptly at time of displacement or at the earliest opportunity.
Evidence Search Search ("Tooth Root"[Mesh]) AND "Maxillary Sinus"[Mesh]
Comments on
The Evidence
The Lee article was a review discussing the research of other authors which then gave Lee’s opinion of what should be done if a root tip was inadvertently pushed into the maxillary sinus during exodontia. No meta-analysis was done. The evidence given is unbiased but seems to primarily be an opinion based off cases other individuals had performed.
Applicability This information is very applicable in the event of an inadvertent displacement of a root tip in the maxillary sinus during exodontia. It is important to realize that there is a real probability of developing sinusitis or other problems if a root tip is left in the maxillary sinus. There are only a few cases reporting patients who have expelled a root tip that was in their sinus through their mouth, and even then, there is a possibility this root tip could be accidentally inhaled causing further problems.
Specialty/Discipline (General Dentistry) (Oral Surgery)
Keywords Tooth root, maxillary sinus, exodontia
ID# 832
Date of submission: 03/30/2011spacer
E-mail mckeed@livemail.uthscsa.edu
Author Daniel McKee
Co-author(s) e-mail
Faculty mentor/Co-author Gregory Spackman, DDS, MBA
Faculty mentor/Co-author e-mail SPACKMAN@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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Comments and Evidence-Based Updates on the CAT
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by Francisco Gallardo & Sara Fayazi (San Antonio, TX) on 08/30/2013
We conducted a Pubmed MeSH and found an article relevant to this CAT, (PMID: 21872509) published a case series study wherein they recommended retrieval of the retained root tip. However, they discouraged the readers from retrieving through the socket due to the risk of permanent Oroantral Communication and infection.

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