OROANTRAL COMMUNICATION CAUSED BY ODONTOGENIC PATHOLOGY

This patient presented for evaluation of tooth #3. His chief complaint was a painful swelling of gum that would sometimes bleed in the area of tooth #3. The patient reported RCT #3 was completed over 20 years ago by an Endodontist. The patient stated that he is congenitally missing teeth #4, 5, 12, and 13. The patient denies wearing an RPD.
The patient’s chief complaint was consistent with a sinus tract located mesial to tooth #3 at the level of the alveolar crest. The sinus tract was traced with gutta-percha. Tooth #3 had an intact PFM crown, ++ percussion, ++ palpation (buccal aspect), 12mm isolated probing depth along the MB root, mobility WNL.
CBCT evaluation demonstrated previously RCT treated #3 with large j-shape PARL wrapping around the MB root. The j-shape PARL of the MB root is notable in that the lesion involves BOTH the maxillary sinus floor as well as the alveolar crest—oroantral communication. Furthermore, there is also a significant mucosal thickening of the maxillary sinus.
These findings are consistent with the possibility of root fracture. The patient was informed that the prognosis is unfavorable. Extraction and discussion of tooth replacement options with his restorative dentist was recommended.