Acute odontogenic maxillary sinusitis treated endodontically – two case reports and 15-day CBCT outcome

  • Lauter Eston Pelepenko
  • Marina Canali Lângaro
  • Mateus Silveira Martins Hartmann

Abstract

Patients presented acute recurrences from Otorhinolaryngology treatments with unilateral symptoms compatible with maxillary sinusitis with a dental origin (MSDO). Cone beam computed tomography (CBCT) showed sinus extensive membrane thickening that was not visible at periapical exam associated to the maxillary molar infection in both cases. Respiratory structures assessment was possible using a 6-inches field of view CBCT. Non-surgical endodontic treatment (case 1) performed and retreatment (case 2) showed a fast symptoms relief. Recall examination after 15 days revealed healthy soft tissues with normal periodontal probing and no dental mobility. In addition, 15-day CBCTs revealed initial maxillary sinus membrane recovery after the endodontic approaches in the reported cases. No additional medical intervention nor antibiotics administration were necessary in these MSDO cases management. Long-term follow-up in such cases is advisable to exclude other potential dental or respiratory issues. Diagnose and follow-up using CBCT presented significant sinus membrane thick reduction with no symptom’s recurrence after the endodontic treatment.

References

1. Patel NA, Ferguson BJ. Odontogenic sinusitis: an ancient but under-appreciated cause of
maxillary sinusitis. Curr Opin Otolaryngol Head Neck Surg. 2012 Feb;20(1):24-8. doi: 10.1097/
MOO.0b013e32834e62ed.
2. Pokorny A, Tataryn R. Clinical and radiologic findings in a case series of maxillary sinusitis of dental
origin. Int Forum Allergy Rhinol. 2013 Dec;3(12):973-9. doi: 10.1002/alr.21212.
3. Mehra P, Jeong D. Maxillary sinusitis of odontogenic origin. Curr Infect Dis Rep. 2008 May;10(3):205-10.
4. Workman AD, Granquist EJ, Adappa ND. Odontogenic sinusitis: developments in diagnosis,
microbiology, and treatment. Curr Opin Otolaryngol Head Neck Surg. 2018 Feb;26(1):27-33.
doi: 10.1097/MOO.0000000000000430.
5. Kwak HH, Park HD, Yoon HR, Kang MK, Koh KS, Kim HJ. Topographic anatomy of the inferior wall of
the maxillary sinus in Koreans. Int J Oral Maxillofac Surg. 2004 Jun;33(4):382-8.
6. Bauer W. Maxillary sinusitis of dental origin. Am J Orthod Oral Surg. 1943 Mar;29(3):B133-51.
7. Hauman CH, Chandler NP, Tong DC. Endodontic implications of the maxillary sinus: a review. Int
Endod J. 2002 Feb;35(2):127-41.
8. Lu Y, Liu Z, Zhang L, Zhou X, Zheng Q, Duan X, et al. Associations between maxillary sinus
mucosal thickening and apical periodontitis using cone-beam computed tomography scanning: a
retrospective study. J Endod. 2012 Aug;38(8):1069-74. doi: 10.1016/j.joen.2012.04.027.
9. Pagin O, Centurion BS, Rubira-Bullen IR, Alvares Capelozza AL. Maxillary sinus and posterior
teeth: accessing close relationship by cone-beam computed tomographic scanning in a Brazilian
population. J Endod. 2013 Jun;39(6):748-51. doi: 10.1016/j.joen.2013.01.014.
10. Kamburoğlu K, Yılmaz F, Gulsahi K, Gulen O, Gulsahi A. Change in periapical lesion and
adjacent mucosal thickening dimensions one year after endodontic treatment: volumetric
cone-beam computed tomography assessment. J Endod. 2017 Feb;43(2):218-224.
doi: 10.1016/j.joen.2016.10.023.
11. Torabinejad M, Rice D, Maktabi O, Oyoyo U, Abramovitch K. Prevalence and size of periapical
radiolucencies using cone-beam computed tomography in teeth without apparent intraoral
radiographic lesions: a new periapical index with a clinical recommendation. J Endod. 2018
Mar;44(3):389-394. doi: 10.1016/j.joen.2017.11.015.
12. Goodell K, Mines P, Kersten D. Impact of cone-beam computed tomography on treatment planning
for external cervical resorption and a novel axial slice-based classification system. J Endod. 2018
Feb;44(2):239-244. doi: 10.1016/j.joen.2017.
13. Cymerman JJ, Cymerman DH, O’Dwyer RS. Evaluation of odontogenic maxillary sinusitis using
cone-beam computed tomography: three case reports. J Endod. 2011 Oct;37(10):1465-9.
doi: 10.1016/j.joen.2011.06.015.
14. Nurbakhsh B, Friedman S, Kulkarni GV, Basrani B, Lam E. Resolution of maxillary sinus mucositis
after endodontic treatment of maxillary teeth with apical periodontitis: a cone-beam computed
tomography pilot study. J Endod. 2011 Nov;37(11):1504-11. doi: 10.1016/j.joen.2011.07.007.
15. Fredriksson MV, Öhman A, Flygare L, Tano K. When maxillary sinusitis does not heal: findings on CBCT
scans of the sinuses with a particular focus on the occurrence of odontogenic causes of maxillary
sinusitis. Laryngoscope Investig Otolaryngol. 2017 Dec 11;2(6):442-446. doi: 10.1002/lio2.130.
16. De-Deus G, Belladonna FG, Souza EM, Alves VO, Silva EJ, Rodrigues E, et al. Scouting ability of 4
pathfinding instruments in moderately curved molar canals. J Endod. 2016 Oct;42(10):1540-4.
doi: 10.1016/j.joen.2016.07.001.
17. Nielsen BA, Baumgartner C. Comparison of the endovac system to needle irrigation of root canals. J
Endod. 2007 May;33(5):611-5.
18. Amaral ROJF, Leonardi DP, Gabardo MCL, Coelho BS, Oliveira KV, Baratto-Filho F.
Influence of cervical and apical enlargement associated with the Waveone system on the
transportation and centralization of endodontic preparations. J Endod. 2016 Apr;42(4):626-31.
doi: 10.1016/j.joen.2015.12.005.
19. Borges ÁH, Pereira TM, Porto AN, de Araújo Estrela CR, Miranda Pedro FL, Aranha AM, et
al. The influence of cervical preflaring on the amount of apically extruded debris after root
canal preparation using different instrumentation systems. J Endod. 2016 Mar;42(3):465-9.
doi: 10.1016/j.joen.2015.10.010.
20. Üstün Y, Aslan T, Şekerci AE, Sağsen B. Evaluation of the reliability of cone-beam computed
tomography scanning and electronic apex locator measurements in working length determination of
teeth with large periapical lesions. J Endod. 2016 Sep;42(9):1334-7. doi: 10.1016/j.joen.2016.06.010.
21. Leonardo MR, Tanomaru Filho M, Silva LA, Nelson Filho P, Bonifácio KC, Ito IY. In Vivo antimicrobial
activity of 2% chlorhexidine used as a root canal irrigating solution. J Endod. 1999 Mar;25(3):167-71.
22. Ferraz CC, Gomes BP, Zaia AA, Teixeira FB, Souza-Filho FJ. In Vitro Assessment of the antimicrobial action
and the mechanical ability of chlorhexidine gel as na endodontic irrigant. J Endod. 2001 Jul;27(7):452-5.
23. Moreira DM, Almeida JF, Ferraz CC, Gomes BP, Line SR, Zaia AA. Structural analysis of bovine
root dentin after use of different endodontics auxiliary chemical substances. J Endod. 2009
Jul;35(7):1023-7. doi: 10.1016/j.joen.2009.04.002.
24. Souza M, Cecchin D, Farina AP, Leite CE, Cruz FF, Pereira CC, et al. Evaluation of chlorhexidine
substantivity on human dentin: a chemical analysis. J Endod. 2012 Sep;38(9):1249-52.
doi: 10.1016/j.joen.2012.06.003.
25. Barbosa-Ribeiro M, De-Jesus-Soares A, Zaia AA, Ferraz CC, Almeida JF, Gomes BP. Quantification
of lipoteichoic acid contents and cultivable bacteria at the different phases of the endodontic
retreatment. J Endod. 2016 Apr;42(4):552-6. doi: 10.1016/j.joen.2016.01.002.
26. Zandi H, Rodrigues RC, Kristoffersen AK, Enersen M, Mdala I, Ørstavik D, et al. Antibacterial
effectiveness of 2 root canal irrigants in root-filled teeth with infection: a randomized clinical trial. J
Endod. 2016 Sep;42(9):1307-13. doi: 10.1016/j.joen.2016.06.006.
27. Zuolo ML, Carvalho MC, De-Deus G. Negotiability of second mesiobuccal canals in maxillary molars
using a reciprocating system. J Endod. 2015 Nov;41(11):1913-7. doi: 10.1016/j.joen.2015.08.004.
28. Bitencourt MA, Rocha DGP, Bueno CES. Incidence of dentinal defects on the external apical root
surface after instrumentation with waveone reciprocating files at different working lengths. J Endod.
2017 Mar;43(3):491-495. doi: 10.1016/j.joen.2016.11.010.
29. Aksel H, Küçükkaya Eren S, Çakar A, Serper A, Özkuyumcu C, Azim AA. Effect of instrumentation
techniques and preparation taper on apical extrusion of bacteria. J Endod. 2017 Jun;43(6):1008-
1010. doi: 10.1016/j.joen.2017.01.014.
30. Sant’Anna Júnior A, Cavenago BC, Ordinola-Zapata R, De-Deus G, Bramante CM, Duarte MA. The
effect of larger apical preparations in the danger zone of lower molars prepared using the Mtwo and
Reciproc systems. J Endod. 2014 Nov;40(11):1855-9. doi: 10.1016/j.joen.2014.06.020.
31. Simezo AP, da Silveira Bueno CE, Cunha RS, Pelegrine RA, Rocha DG, de Martin AS, et al. Comparative
analysis of dentinal erosion after passive ultrasonic irrigation versus irrigation with reciprocating
activation: an environmental scanning electron study. J Endod. 2017 Jan;43(1):141-146.
doi: 10.1016/j.joen.2016.09.016..
32. Moreira MS, Anuar ASN, Tedesco TK, Dos Santos M, Morimoto S. Endodontic treatment in
single and multiple visits: an overview of systematic reviews. J Endod. 2017 Jun;43(6):864-870.
doi: 10.1016/j.joen.2017.01.021.
33. Silva EJ, Sá L, Belladonna FG, Neves AA, Accorsi-Mendonça T, Vieira VT, et al. Reciprocating versus
rotary systems for root filling removal: assessment of the apically extruded material. J Endod. 2014
Dec;40(12):2077-80. doi: 10.1016/j.joen.2014.09.009.
34. Libman H, Brockmeyer DM, Gold HS. Should we prescribe antibiotics to this patient with persistent
upper respiratory symptoms?: Grand rounds discussion from Beth Israel Deaconess Medical Center.
Ann Intern Med. 2017 Feb 7;166(3):201-208. doi: 10.7326/M16-2766.
35. MacDonald A, Newton CW. Pseudocyst of the maxillary sinus. J Endod. 1993 Dec;19(12):618-21.
Published
2019-01-24
How to Cite
PELEPENKO, Lauter Eston; LÂNGARO, Marina Canali; HARTMANN, Mateus Silveira Martins. Acute odontogenic maxillary sinusitis treated endodontically – two case reports and 15-day CBCT outcome. Brazilian Journal of Oral Sciences, [S.l.], p. e181197, jan. 2019. ISSN 1677-3225. Available at: <https://www.fop.unicamp.br/bjos/index.php/bjos/article/view/1512>. Date accessed: 17 july 2019. doi: https://doi.org/10.20396/bjos.v17i0.8654179.
Section
Original Research