Consequences of getting into and the operation to remove the filling material from the maxillary sinus

To understand how the filling composition turns out to be in the maxillary sinus, one should recall the structure of the maxillary bone. And the fact that it is not a monolithic formation, but contains in its thickness the maxillary cavity (sinus), also called the maxillary cavity by the author. But this cavity is not the only one available in the upper jaw.

The bone forms a process called alveolar, literally translated: cellular. And its cells - "honeycomb" are intended to accommodate the roots of the teeth. The roots, being placed in cavities exactly corresponding to their shape and length - dental, or alveolar cells, keep the teeth from being pulled out and falling out of the jaw.

The system of cavities in the upper jaw is similar to a duplex - an apartment on two levels. Upstairs there is a spacious, empty hall of the maxillary cavity. Below it, there are many narrow vertical alveolar cavities. These are not through channels, but holes with limited depth (height). Teeth live here, densely filling the spaces of the holes with their roots growing upward.

But sometimes the roots of the tooth are too long, and, having gone through the entire thickness of the jaw, they can end up in the maxillary cavity. For its bottom (floor) is at the same time a ceiling for the dental cells of the upper jaw. This is tantamount to the case when the tenant of the lower level is too tall, breaking through the ceiling with his head, and found himself in the room upstairs.

Penetration routes

Teeth with roots that have either penetrated into the "upper room" or stopped under the "carpet" on its floor (under the mucous membrane of the maxillary sinus) are capable of becoming inflamed. And then their treatment by a dentist is required.

To cure pulpitis, the doctor needs to not only remove the pulp of the tooth (pulp) from the cavity-chamber in its interior. He must cleanse the canals of the dental roots from it, passing them through, to the apices-apexes. Then the passed canals are sealed - filled with a filling compound, and - very tightly, tightly, so that there are no cavities-voids left in the canals.

Since the filling material is injected under pressure, part of it through the apical canal (ending in a hole at the apex of the dental root) is able to penetrate into the maxillary sinus.

The ingress of foreign particles into the maxillary cavity (or sinus) is also possible during sinus lift - operations to inject material into the jaw for augmentation of the bone with the subsequent installation of the implant.

Symptoms of the presence of a foreign body

With a small volume and complete sterility of the filling composition that has fallen into the sinus of the upper jaw, it is not able to cause irritation and inflammation from the side of its mucous membrane. In this case, his stay there, detected exclusively by the X-ray method, does not require measures for its extraction.

In the variant, when the inflammation nevertheless begins, symptoms of sinusitis appear - irritation of the mucous membrane caused by an attempt to expel a foreign body from the cavity.

It is expressed:

• various pains: in the form of heaviness in the upper jaw or a feeling of transfusion inside it with a sharp change head position (tilting, turning), the appearance of painful sensations during chewing, when closing jaws;
• the appearance of discharge from the nasal cavity (first serous, then purulent with a corresponding smell and taste, felt when drawn from the nasopharynx into the mouth when blowing your nose, swallowing);
• the appearance of signs of an inflammatory process in the body: a rise in temperature, fatigue, body aches, headaches, nausea, dizziness, drowsiness.

But if the usual sinusitis is able to pass from taking medications, then the presence of a foreign body that caused and maintains inflammation in the nasal sinus requires its removal without fail.

Consequences of a foreign body in the sinus

If the filling material is left in the maxillary sinus, complications may develop in the form of:

• chronic sinusitis - the emergence of a focus of microbial infection and a source of constant intoxication of the body;
• osteomyelitis of the jaw;
• fistula formation - communication with the oral cavity (as a result of the pressure of the filling mass on the bottom of the sinus).

Given the proximity of the maxillary sinus to the orbit and the Eustachian (auditory) tube, inflammation in it can cause:

• otitis media - microbial damage to the structures of the middle and inner ear with loss of hearing and sense of balance;
• damage to the structures of the organ of vision.

The most formidable complication of sinusitis (when the infection is carried from the maxillary sinus to other paranasal sinuses during sneezing, coughing) is the infection of the cranial cavity with the development of:

• meningitis;
• encephalitis.

How is it diagnosed?

Often, the patient, without associating the development of sinusitis with dental manipulation, seeks advice from The ENT doctor confirms the existence of the disease by applying rhinoscopy or endoscopy of the nasal cavity and accessory sinuses.

But these methods are not able to identify the true cause of sinusitis - the presence of a foreign body in the maxillary sinus. Due to their significant density, the compositions used in dental fillings are radiopaque, which allows you to see them in the picture in the form of shadows that are more intense than the tissues of the teeth and jaw bones.

Therefore, the use of radiography is a prerequisite for quality control of filling, sinus lifting and other interventions in the area adjacent to the maxillary sinus.

An even more informative way to diagnose this problem is the computed tomography method.

Extraction operations

Talking about the possibility of purely conservative treatment in the development of this complication from dental intervention is not it is necessary - without removing the filling substance that maintains the sinus mucosa in an irritated state, there is no effect from it will.

The operation to remove a foreign body from the maxillary sinus is possible using one of the techniques:

• opening the anterior wall of the cavity from the side vestibule;
• creating access through the alveolar canal of the problem tooth.

Small foreign bodies are removed using an endoscope; larger foreign bodies require a larger scale of operation. In the presence of purulent detritus, it is removed from the cavity by suction followed by repeated rinsing with an antiseptic solution.

The intervention is performed under X-ray control, using an adequate method of anesthesia in an outpatient clinic (with a low complexity of the operation) or in the department of maxillofacial surgery.

Conservative treatment

It is applicable both during the preparation of the surgical intervention and immediately after its implementation, and is designed to minimize the activity of the local inflammatory process as much as possible.

If it is impossible to remove the filling material from the maxillary sinus immediately therapeutic treatment is a method of containing microbial aggression until a favorable time is reached for the operation.

The reasons for postponing the operation are:

• the onset and course of pregnancy;
• the development of an acute inflammatory (including infectious) process;
• lack of immunity;
• disorders of blood coagulation mechanisms;
• intolerance to certain drugs.

A set of measures includes the use of medicines with the effect of:

• antibacterial - suppressing the development of pathogenic microbial flora;
• anti-inflammatory - reducing the activity of tissue destruction, adapting the body to a given level of metabolism;
• antihistamine - reducing edema and preventing hyperproduction of secretions of the mucous glands, as well as the appearance of allergic reactions to the antibiotics used;
• local antiseptic - helping to remove excess mucus from the sinus when it is washed.

Prophylaxis

In order to prevent the penetration of filling compounds into the maxillary sinus, it is necessary to improve the skills of using dental techniques at this stage of tooth processing.

In addition to tactile control over the process, X-ray control is required for all manipulations on the upper jaw (in addition to getting into the maxillary cavity of the filling composition, there is a possibility of pushing a fragment of the tooth root into it due to its fragility or decay fabrics).

Dental equipment must be in good working order and fully fit for its purpose. Speaking about the responsibility of a dentist, one cannot but touch upon the interest in the successful outcome of the treatment of the patient himself.

Bringing teeth and jaws to an emergency state is not necessarily a consequence of chronic debilitating diseases and congenital features of the tissues of the oral cavity. Neglecting the norms of personal hygiene, ignoring the needs of the teeth for treatment, refusing to use prosthetics is one the soil on which subsequent oral problems are nurtured, both emotional and financial.

Operation cost

The price of this service in St. Petersburg, taking into account the low invasiveness of the endovideosurgical equipment used in the dental clinics of the city, is about 10 thousand rubles. The specific cost of the operation to remove the filling material from the maxillary sinus depends on the degree of complexity of the case and the scale of the intervention.

The cost of an initial consultation with an endovideosurgeon is an amount of 1 thousand rubles, the price of a CT scan (computer tomography) of one (upper) jaw in 3-D version is 1200 rubles (with free recording of the received data to disk).

With a second examination within 30 days, the cost of consulting a specialist doctor is 2 thousand rubles. For video endoscopic examination of any natural cranial cavity, an amount of 1,800 rubles is charged.

For unilateral maxillary sinus surgery (opening of the sinus), about 21 thousand are debited from the patient's account, with removal a foreign body through a natural anastomosis with the nasal cavity under endoscopic control - about 19 thousand rubles.

Only a dentist can competently answer the whole range of questions related to the health (and ill health) of teeth. Therefore, visiting the dental office at least once a year should become more than just one of the standards. personal hygiene, but a preventive measure to avoid subsequent costly and morally costly treatment.