Sinus Lift and Transantral Approach to Root Fragment Removal

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. 1. Introduction Various treatment modalities are available for replacing a single missing tooth: removable partial denture, fixed partial denture, or dental implant. The choice is influenced by clinical-, dentist- and patient-immanent factors [1], but both dentist and patient increasingly choose to avoid to damage neighbouring teeth and to rehabilitate with endosseous implant [2]. Traditionally, before placing dental implants, the compromised teeth are removed and the extraction sockets are left to heal for 3-4 months [3]. Sometimes complications may happen and it is important to be able to plan again a surgical procedure limiting damage and discomfort for the patient. The most frequent extraction complication is certainly the root/apex fracture in the alveolus [4]. When it occurs in upper jaw, it is important to manage it to preserve the socket and avoid an oroantral fistula. Removal of a root through the alveolar opening without the removal of bone from the extraction socket is not always possible and excessive bone removal may result in chronic complications and lack of bone volume for the following implant restoration [5]. In the literature there are some studies about removal of a foreign body from the maxillary sinus [6–9]. These studies suggest to have a clear view of the surgical field and so to use Caldwell-Luc technique that permits the elimination of blind procedures, however, removing a large portion of the anterior maxillary wall. Otherwise, this technique remains invasive and traumatic, with consequent complication rates associated [10], like swelling, infection, orbital hematoma, visual disturbances, infraorbital nerve damage, and oroantral fistula. In this clinical report, we are presenting a case in which the fragment was not dislocated in