Abstract

Background: Given the anatomical proximity, pathologic conditions and endodontic treatment procedures in maxillary posterior teeth may affect the maxillary sinus.

Case description: This report describes a case of large extrusion of filling material to the maxillary sinus, resulting in persistent acute pain and requiring hospitalization and surgical removal of the material via videolaparoscopy. A 34-year-old female experienced persistent pain in the left upper posterior region of the face, three months after endodontic treatment of tooth 14. Radiographs revealed a large amount of filling material in the maxillary sinus. Despite using analgesics, the pain persisted, with an additional burning sensation in the infraorbital area. The endodontist who treated tooth 14 confirmed that the filling was completed using Tagger’s Hybrid technique with gutta-percha and AH Plus sealer. A cone-beam computed tomography (CBCT) was requested, revealing a missed MB2 canal in tooth 14. Non-surgical endodontic retreatment ameliorated the pain; however, symptoms persisted, necessitating the surgical removal of the extruded material, which was performed via videolaparoscopy. Six months later, the patient was asymptomatic regarding tooth 14, but tooth 13 was extracted and replaced with an implant that later perforated the sinus floor. After implant replacement, the patient's pain was completely resolved.

Conclusions: This case highlights the need for caution when performing endodontic treatment on posterior maxillary teeth due to their proximity to the maxillary sinus. In cases where root apices contact, invade, or are close to the sinus, thermoplasticized root canal obturation techniques should be avoided because of the increased risk of extrusion complications and consequences. CBCT imaging significantly improves diagnostic accuracy in cases with persistent symptoms and is an important tool in treatment planning.

Introduction

The success of endodontic therapy depends on the proper cleaning, shaping, and filling of root canals, as well as effective coronal seal (Siqueira 2001, Siqueira et al. 2005). During treatment, filling materials, irrigants, debris, and microrganisms can be extruded into the periradicular tissues (Alves et al. 2018, Azizi Mazreah et al. 2022, Monteiro et al. 2024).

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