Sinus lift and transantral approach to root fragment removal

Abstract

The aim of this case report is to present a case of root fragment removal during planned sinus lift procedure. After failed molar tooth extraction, we chose to retrieve the residual root apex with transantral approach not to damage excessively bone volume. Without changing primary implant rehabilitation purpose, the fragment removal procedure was performed prior to implant placement during necessary sinus lift surgery. Higher visibility of surgical field was achieved. The root fragment residual was removed without an additional surgery appointment avoiding postoperative discomfort. The goal is to underline the importance of being able to change planning during intrasurgical complications. It is most appropriate to operate with safe and simple procedures to reduce surgical discomfort for the patient.

Figure 1

Initial X-ray examination.

Figure 2

X-ray examination after first extraction: residual root and insufficient bony support.

Figure 3

Bone lesion occurred trying to retrieve the residual fragment before sinus lift approach.

Figure 4

((a), (b)) Radiographic exams (paraxial images) also revealed not only the residual root apex in the palatal side, but also insufficient bone volume.

Figure 5

Surgical site.

Figure 6

Alveolar bone exposed.

Figure 7

Antrostomy on the lateral maxillary wall.

Figure 8

(a), (b): Intra-operative images during retrieval of residual root apex through the antrostomy.

Figure 9

(a) Insertion of graft material; (b) collagen membrane positioned.

Figure 10

Reopening after 3 months.

Figure 11

X-ray control after 3 months.

Figure 12

Retrieved residual root fragment.