View from the Chairside: Post-op solution for a maxillary sinus exposure after an extraction
By Dr. Elliott Gnidec
Dr. Elliott Gnidec is a practicing dentist in Woodstock (ON). He graduated in 1986 from the University of Western Ontario (UWO) and holds a Master’s degree in Biochemistry also from the University of Western Ontario. Currently, Dr. Gnidec is Adjunct Clinical Professor in Restorative Dentistry at the Schulich School of Medicine and Dentistry at UWO, is the Treasurer for the Oxford County Dental Society, Member of Continuing Education Committee for the Oxford County Dental Society, and the Liason between Schulich School of Medicine and Dentistry and JCDA/Oasis.
Here is a case that I recently encountered. A pulpotomy was performed on tooth #16 in September 2012. I discussed the options with the patient and awaited their decision.
In June 2013, the patient came back with a fractured filling on #16 and I once again discussed the treatment options with the patient. This time around, the patient decided to have the tooth extracted. Informed consent was given.
The extraction of the tooth required sectioning after the coronal portion of the tooth fractured. The mesial and distal roots were removed without complication, but the palatal root fractured. The remaining palatal root was difficult to remove because it seemed as if it was in the sinus space or at least secured to the sinus floor.
I called my colleague to see if he could dislodge the root tip. With light illumination and some convection, the root tip was removed with an abscess attached to the tip. Looking at the extraction site, the palatal root site showed that the sinus floor had been destroyed revealing an opening of about 3 mm in diameter. The extraction site was packed with gelfoam and silk sutures.
I saw the patient the next day and he was fine. I followed up with him again 5 days after the extraction and the palatal site was now open to the sinus. Upon calling the oral surgeon’s office to see if they would see the patient to perform closure, I was informed that primary closure is not considered for the first 4 weeks and that the site should be packed tightly with gelfoam and followed for the next 4 weeks packing as required.
The patient was seen again 9 days after the last visit and the extraction site was starting to heal, but the palatal site still had a slight opening to the sinus. The area was packed again with gelfoam and I asked the patient to return in 2 weeks. Patient returned in 2 weeks and the extraction site was healing nicely with the palatal site closed. Will follow up as needed.
What would you have done, if you had encountered the same case?
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