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Nonsurgical endodontic management of maxillary sinusitis of endodontic origin: a CBCT-guided case report
Mai Alzarooni1, Abdul Rahman Saleh1,2, Firas Elmsmari1
1Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, United Arab Emirates.
Background:
Maxillary sinusitis of endodontic origin (MSEO) is a recognized complication of odontogenic infection, arising from the close anatomical relationship between the posterior maxillary dentition and the maxillary sinus floor. Failure to identify the odontogenic etiology of sinus pathology risks misdiagnosis, delayed treatment, and unnecessary surgical intervention. This case report presents the diagnostic approach and clinical management of a maxillary second molar associated with sinus mucosal thickening, emphasizing the role of advanced imaging and conservative endodontic therapy in achieving successful resolution.
Case Description:
A 38 year old female patient was referred for completion of previously initiated root canal treatment on tooth #27. Clinical examination and review of presenting symptoms including a year-long increase in headache frequency and intermittent rhinorrhea in the absence of typical upper respiratory signs were supplemented with cone beam computed tomography (CBCT). Imaging revealed thickening of the Schneiderian membrane and close proximity of the palatal root apex to the maxillary sinus floor, establishing an endodontic etiology for the sinus pathology. Nonsurgical root canal treatment was completed following adequate chemomechanical preparation and obturation techniques, with mineral trioxide aggregate (MTA) placed in the palatal canal. One-year clinical and radiographic follow-up demonstrated a significant reduction in sinus mucosal thickening and complete resolution of symptoms.
Conclusion:
This case report highlights the importance of recognizing MSEO as a distinct clinical entity requiring accurate etiological diagnosis. It further demonstrates that CBCT imaging is essential in identifying sinus involvement of odontogenic origin, and that conservative nonsurgical endodontic therapy can effectively resolve associated sinus pathology, thereby preventing unnecessary surgical intervention and improving patient outcomes.
