The document discusses the anatomy and development of the maxillary sinus, along with its applied aspects, including endodontic treatments and their complications. It highlights the relationship between maxillary sinus issues and dental conditions, emphasizing the importance of accurate diagnosis to differentiate between sinus pain and odontalgia. The conclusion stresses that conventional endodontic treatment is usually the best option for dental origin sinusitis, while surgical intervention may be needed for refractory cases.

2. APPLIED
ANATOMY OF
MAXILLARY
SINUS AND
ITS
DEVELOPMENT

3. CONTENTS
 Introduction
 Development
 Features
 Applied aspects
 Conventional endodontic treatments
 Endodontic surgery
 Conclusion
 References

4. INTRODUCTION
 Non odontogenic cause
 Deserves important consideration
 Result of misdiagnosis
 Rhino sinusitis from odontalgia
 Understanding the effects of periapical
infections

5. Para nasal sinuses

6. Lining mucosa

7. Functions:
 Air filtration
 Humidify
 Voice resonance
 Defining tonal quality
 Voice amplification
 Reducing the weight of skull

8. Maxillary sinus
 Largest
 Most prone to infection
 Antrum
 Body of maxilla

9. DEVELOPMENT
 From the mucous membrane of lateral
wall of nose
 Growth continues
 Identified at 4-5 months

10. FEATURES
 Opening

11. Boundaries

12. Measurement
s :

13. Arterial supply:

14. Venous drainage:

15. Nerve supply:

16. APPLIED ASPECTS:
 Endo-antral-syndrome
 Rhino sinusitis
 Referral of maxillary sinus pain to the teeth
 Distinguishing differences between
symptoms of odontalgia and sinus pain
 Periapical mucositis
 Maxillary sinusitis of dental origin

17. ENDO ANTRAL
SYNDROME
 Spread of pulpal diseases beyond confines
of dental supporting tissues into the sinus
 Findings:
 Pulpal disease in a tooth
 Periapical radiolucency
 Loss of laminadura
 A faintly radiopaque mass bulging into
sinus space
 Varying degree of radiopacity of the
surrounding sinus space

18.  Treatment:
• Non surgical root canal treatment
• Surgical approach

19. ETIOLOGY
RHINO SINUSITIS

20. EPIDIMIOLOGY:
 16% - total population
 5% - all visits to primary care physicians
 Study : 247- men
93% - maxillary tooth ache

21. Rhino sinusitis
 Classification:
a) Acute
b) Sub acute
c) Recurrent acute or chronic

22. Acute :
 Sudden onset
 40-50% patients recover spontaneously
 Respond well to antibiotic and / or
adjunctive treatments
 Predominant bacterial flora
-Streptococcus pneumoniae
-Haemophilus influenza
-Moraxella catarrhalis
 Treatment: Amoxicillin
Trimethoprim- sulfamethaxazole

23. CHRONIC RHINO
SINUSITIS:
 Less severe symptoms
 More difficult to resolve
 Extremely difficult to recognize
 Mixed infection
 Treatment :
 narrow spectrum regimens
 Broad spectrum regimens
 Amoxicillin-clavulanate
 Clindamycin
 Combination of metronidazole & pencillin
 Other ajunctives: steroid nasal sprays
decongestants
saline irrigation

24.  Endoscopic sinus surgery

25. Referral of maxillary
sinus pain to the teeth:
 Close anatomic relationship
 Thickness of bony partition
-0.83 mm
 Percussion of proximate teeth
 Stimulation of maxillary sinus ostium
 Sensory innervation of the maxillary sinus

26. Distinguishing differences
between symptoms of
odontalgia and sinus pain:
 Proper diagnosis
 Important questions to ask a patient

27. MAXILLARY RHINO
SINUSITIS
 Dull aching pain, difficult to localize or
pinpoint
 Feel presuure in the cheeks and below
the eyes
 Positional changes

28. Pain usually
increases when

29. Pulpal pain
 More easily localized
 Unchanged with positions
 Rarely intermittent in intensity

30. Percussion test:
Maxillary rhino sinusitis Pulpal pain
All teeth that are
proximate to the floor of
the sinus are positive
Only offending teeth are
percussion sensitive

31. PULP VITALITY TEST
 Eelectric pulp test (EPT) or ice
 Tooth in question
 Regardless of percussion sensitivity or
patients complaint of spontaneous
dental pain, endodontic therapy is not
indicated

32. Diagnosis
 Periapical radiographs
 A variation in bone density
 Presence of maxillary sinus and its bony septa
as well as zygomatic and palatal processes
 Multiple radiographic angles
 Thorough clinical examination

33. Periapical mucositis:

34.  - Periapical mucositis is the
inflammation or swelling of the sinus
membrane secondary to periapical
inflammation

35. Radiographic representation

36. - mucositis
 Usually asymptomatic
 Not to confuse with mucocele or mucous
retention cyst
 Occasionally apical periodontitis will not
penetrate the antral floor

37. Thin layer of new bone
on the periphery of disease
process
Periapical
osteoperiosteitis
Or “halo”
Resolve following
endodontic treatment

38. Maxillary sinusitis of dental
origin:
 First referred by BAUER in 1943.
 According to ABRAHAMS ET AL.
60% cases
 According to MATILLA
80% cases

39. MSDO
 Usually affects floor of the maxillary
sinus
 If ostial obstruction occurs
-bacterial colonization
- sinus infection

40.  Reported frequency of MSDO
4.6 and 47 %
 Due to difference in criteria and
definitions as well as the inherent
difficulty in establishing an exact casual
relationship

41.  Dental infections accounts approximately:
10-15%:acute sinusitis
40.6 % : chronic sinusitis
 Chronic sinusitis- predominant anaerobic
bacteria are:
prevotella sp.,
porphyromonas sp.,
fusobacterium nucleatum
peptostreptococcus sp.,

42.  If sinus infection is secondary to dental
infection, sinus healing cannot occur unless
the offending tooth is treated or removed.
 Importance is heightened with reports in the
literature of dental infections spreading rapidly
through the maxillary sinus causing
 orbital cellulitis
 blindness
 Meningitis
 Subdural empyema
 Brain abscess
 Cavernous sinus thrombosis

43. RADIOGRAPHS
 IOPA

44.  PANOROMIC RADIOGRAPH

45.  CT

46. DENTAL ORIGIN
SINUS INFECTION
ENDODONTIC TREATMENT
EXTRACTION
CONCOMITENT MANAGEMENT

47. RESOLUTION
 Follow-up radiograph
 CT scan
 Positive patient report

48. CONVENTIONAL ENDODONTIC
TREATMENT
 Maxillary sinus poses a special
challenge
 All endodontic materials an instruments
should be restricted to the confines of
root canal system
 Procedural errors

49. Inflammatory response

50. Periapical extrusion of
debris
 Periapical inflammation
 Post operative pain
 Delayed healing

51. Overzealous reaming or
filing
 Severe damage
 Severe Inflammatory response
 Non specific mediators of inflammation
 Continued release of antigens
 Resulting in immunologic reactions

52. Severe irritation
 Defense mechanism cannot overcome
 Granuloma
 cyst

53. Sodium hypochlorite
 Commonly employed root canal irrigant
 Severe inflammatory reactions
 Extremely toxic
 Soft tissue complications

54. Immediate complications
 Severe pain
 Oedema
 Profuse hemorrhage
 Several days of increasing oedema and
ecchymosis
tissue necrosis, paraesthesia
secondary infection

55. Calcium hydroxide
 Intra canal medicament
 Irritating to tissues
 Immediate degenerative effect
 Sinusitis

56. Sealer or gutta percha or silver
cones
 Mechanical irritation results from
overfilling the root canal
 Inflammatory reaction
 Persists until the foriegnbody is
removed

57. Dodd et al. (1984)
 Maxillary first molar overfilled with silver
cones
 Chronic sinusitis
 Initially undiagnosed
 Endodontic retreatment

58. ENDODONTIC SURGERY
 Broken instruments and / or filling
materials in the maxillary sinus can only
be removed by means of a caldwell-luc
procedure

59. CALDWELL-LUC
PROCEDURE

60. CONCLUSION
 The close anatomical relationship of maxillary sinus and
roots of maxillary molars and premolars can lead to
severe endodontic complications
 In case of sinusitis of dental origin, conventional
endodontic treatment of retreatment is the treatment of
choice with surgical intervention only in refractory cases
 Root ends & materials that may enter sinus during
endodontic therapy may nee caldwell luc approach
 Antibiotics, decongestants & analgesics are indicated for
the treatment of sinusitis or when sinus is penetrated
during surgical endodontic procedures

61. REFERENCES
 HUMAN ANATOMY HEAD AN NECK, B D
CHAURASIA’S, FIFTH EDITION.
 INGLE’S ENDODONTICS SIXTH EDITION
 ENDODONTIC IMPLICATIONS OF THE
MAXILLARY SINUS- A REVIEW
 INTERNATIONAL ENDODONTIC
JOURNAL, 35, 127-141,2002

62. T
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