Orbital Pain and Headache Secondary to Overfilling of a Root Canal

doi:10.1097/00004770-200311000-00020

Journal of Endodontics

Volume 29, Issue 11, November 2003, Pages 771-772

https://doi.org/10.1097/00004770-200311000-00020 Get rights and content

A 35-yr-old woman was referred to the Istanbul University, Faculty of Dentistry, Oral Surgery Department with complaints of orbital pain and headache. Panoramic radiographs showed overfilling of a maxillary premolar, which caused a perforation in the maxillary sinus floor. The etiology, clinical manifestations, and treatment of this complication are discussed with emphasis on early surgical intervention to decrease the risk of a superimposed aspergillosis infection.

Section snippets

CASE

A 35-yr-old female with an unremarkable medical history presented with the chief complaint of constant pain in the right maxilla and orbita. Although she was unable to exactly pinpoint the location, she focused mainly on the premolar area and orbita. She mentioned that her dentist had treated her maxillary second premolar approximately 2 yr ago. The discomfort was of a few years duration and definitely had started after dental treatment. The radiographic examination revealed that the root

DISCUSSION

Serious problems such as maxillary sinusitis including aspergillosis infection, paresthesia, and similar neural complications may occur after overfilling (7). Teeth with overextension of the root-canal sealer into the sinus might be the main etiological factor for aspergillosis of the maxillary sinus in otherwise healthy patients (⁷). Root canal materials including zinc oxide are considered to be a growth factor for aspergillus (7, 10).

Ozeki (⁵), Kozan (¹⁵), and Trowbridge et al. (¹⁷)

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Removal of small foreign bodies from the maxillary sinus using CT image-guided surgical navigation and rapid paired-point registration and calibration with reference markers on an occlusal splint
2019, Oral and Maxillofacial Surgery Cases
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Most foreign bodies associated with root canal treatments are small, and they are difficult to identify and remove when deeply embedded in the maxillary sinus [12]. Furthermore, failure to remove such foreign bodies can result in sequelae, such as maxillary sinusitis [14,15]. Very small (width, approximately 2 mm; maximum thickness, 1 mm) foreign bodies were identified in the maxillary sinus of the present patient on CBCT.
Computed tomography (CT)-guided surgical navigation is useful for removing foreign bodies from the maxillofacial region. Accuracy and speed of registration and intraoperative calibration are essential for functional intraoperative navigation. A case in which foreign bodies were removed from the maxillary sinus using paired-point registration and calibration with reference markers on an occlusal splint for CT-guided surgical navigation is reported. A 49-year-old woman presented with spontaneous right cheek pain. Panoramic radiography showed two foreign bodies in her right maxillary sinus. Under general anesthesia, an occlusal splint with reference markers was set on the maxillary dental arch, and the anterior wall of the maxillary sinus was exposed. Foreign bodies were identified using an infrared optical Kick^® Navigation System (Brainlab AG, Munich, Germany). The anterior wall of the maxillary sinus closest to the foreign bodies was penetrated with a trephine bur, the foreign bodies were removed, and the wound was completely closed. Several repeated calibrations were required to obtain accurate positional information about the foreign bodies during the surgery, but these were completed within 30 seconds. Histopathological findings and the postoperative clinical course indicated that the spontaneous right cheek pain was due to maxillary sinusitis with granulomatous inflammation caused by the foreign bodies. CT-guided surgical navigation using an occlusal splint with reference markers was useful for locating the foreign bodies in this patient, and rapid calibration allowed accurate positional information to be obtained during surgery to remove them from the maxillary sinus.
Retrieval of extensive gutta-percha extruded into the maxillary sinus: Use of 3-dimensional cone-beam computed tomography
2013, Journal of Endodontics
Close proximity of the maxillary sinus to the roots of maxillary teeth can predispose to the inadvertent deposition of endodontic products into the maxillary sinus. One such material is thermoplasticized injectable gutta-percha, which has gained popularity of late. As a consequence of overfilling, some patients warrant surgical retrieval.
A case report of extreme overextension of gutta-percha within the maxillary sinus after endodontic retreatment on tooth #14 was provided. The distobuccal and palatal canals had been obturated with gutta-percha master cones and backfilled with thermoplasticized injectable warm gutta-percha. The mesiobuccal canal had only been filled with thermoplasticized injectable warm gutta-percha, the origin of the extrusion. Imagery with 3-dimensional cone-beam computed tomography was performed for localization of the gutta-percha.
The patient underwent a Caldwell-Luc approach for removal of the extruded material. The gutta-percha was successfully removed intact, and the patient had an unremarkable postoperative course. However, the patient continues to have mild tenderness in the sinus region.
The featured case exemplified the consequence of overinstrumentation and ensuing inadequate apical stop. In these situations, the obturation of a maxillary tooth with thermoplasticized injectable gutta-percha, without master cones, can potentially result in overfilling and deposition into the antrum. Use of 3-dimensional cone-beam computed tomography could enhance endodontic diagnosis, serve as an aid for visualization of foreign materials within the sinus and contiguous soft tissue structures, and improve clinical outcome.
Five-year follow-up of a root canal filling material in the maxillary sinus: a case report
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Citation Excerpt :
No pathologic changes in antral and even periradicular tissues were observed (Fig. 4). Accidental overfilling of root canals may sometimes cause damage to surrounding anatomic structures with permanent annoying or disabling problems, such as maxillary sinusitis including aspergillosis infection, paresthesia, and similar neural complications.2,6-11 Foreign bodies in the sinus can cause maxillary sinusitis, stemming from irritation of the mucous membranes, especially when they are larger than the ostia lumen.
This report describes the 5-year clinical and radiographic follow-up of an accidental extrusion of a root canal filling material into the maxillary sinus and emphasizes the importance of monitoring of similar cases. The most favorable prognosis is achieved by surgically removing the extruded material from the sinus. Excess zinc oxide–eugenol–based materials in the sinus might cause aspergillosis sinusitis, and this entity often needs many years to develop. In this case, endomethasone was the filling material; however, the patient refused to undergo any surgical intervention. After a follow-up period of 5 years, the patient had no symptoms and radiographic examination disclosed no pathologic changes in the antrum.
Antroliths: Survey of the literature and report of a case
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However, the patient's dental history and clinical/radiologic examinations of the lesion strongly suggested an antrolith which occured after an endodontic therapy. It is reported in the literature that the close proximity between the roots of maxillary posterior teeth and the floor of the maxillary sinus may predispose to the establishment of an oroantral passage during conventional endodontic therapy.15,16 Generally, there is a bony wall between the roots of the teeth and the sinus, but frequently this may be replaced by a very thin layer of cortical bone or by antral mucosa alone; causing risk of perforation of sinus floor during cleaning and shaping procedures.
In the present report, a case with a radiopaque mass within the right maxillary sinus antrum is presented, and the clinical/radiographic features of the lesion are provided. The patient's dental history has revealed extrusion of calcium hydroxide into the periapical area during a previous endodontic treatment. This finding has underscored the need to discuss the potential role of endodontic materials in the development of calcified tissues within the adjacent body cavities.
Comparison of quality of obturation using radiographs-a retrospective study research article
2021, International Journal of Dentistry and Oral Science
Complications due to root canal filling procedures
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CASE REPORT/CLINICAL TECHNIQUESOrbital Pain and Headache Secondary to Overfilling of a Root Canal

Section snippets

CASE

DISCUSSION

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol

J Endodon

J Endodon

Oral Surg Oral Med Oral Pathol

J Endodon

CASE REPORT/CLINICAL TECHNIQUES
Orbital Pain and Headache Secondary to Overfilling of a Root Canal