Page 31 - GP Spring 2022

These teeth had a poor prognosis due to the Implant Considerations bahang S. Outcomes of nonsurgical retreatment a. b.
previous retreatments, apicoectomies, and in- In this case, the most important consider- and endodontic surgery: a systematic review. J
fection of the palatal root. Extraction of teeth ation when it comes to placing implants is About the Authors:
Endod 2009;35:930–937.
# 14 and #15, with site preservation for future making sure the perforations in the max- 6. Chércoles-Ruiz A, Sánchez-Torres A, Gay-Es-
implant placement, was recommended. illary sinus are healed before implants are coda C. Endodontics, endodontic retreatment,
and apical surgery versus tooth extraction and
placed. Should the inflammation and perfo- implant placement: a systematic review. J En-
DISCUSSION rations not resolve before then, there is an dod. 2017;43:679–686.
Madison Cox is a student at NYU College of Dentistry in the class of 2022.
In this case, both root canal treatments and increased risk of further injury to the mem- 7. Gillen BM, Looney SW, Gu LS. Impact of the
final coronal restorations were faulty re- brane. Additionally, should the patient’s si- quality of coronal restoration versus the quality
1
sulting in reinfection of both #14 and #15. nusitis symptoms not resolve before implant of root canal fillings on success of root canal
Additionally, the teeth had already been placement, there is an increased chance of treatment: a systematic review and meta-analy-
retreated at some point, indicating that the sinusitis post-operatively. 9 sis. J. Endod. 2011;37:895-902.
infection was persistent and difficult to 8. Padbury A Jr, Eber R, Wang HL. Interactions
eliminate. To ensure that future implant At the time of the extractions, the plan was between the gingiva and the margin of resto-
treatment has a good prognosis, these sites to perform site preservation to maintain rations. J Clin Periodontol. 2003;30(5):379–385. b.
a.
9. Kim JS, Choi SM, Yoon JH, Lee EJ. What af-
needed to be monitored closely until healing the bone for future implant placement. The fects postoperative sinusitis and implant failure
was complete. oro-antral communication and thin layer of after dental implant: A meta-analysis. Otolaryn-
bone separating the apices and membrane, gol. Head Neck Surg. 2019;160:974–984.
Endodontic Considerations as seen in this case, required careful place- 10. Schwarz L, Schiebel V, Hof M, Ulm C,
About the Authors:
Maxillary molars are difficult to retreat sur- ment of graft material to avoid the possibil- Watzek G, Pommer B. Risk factors of membrane
gically, should nonsurgical treatment fail. ity of graft material entering the sinus. The perforation and postoperative complications in
This is due to the position of the sinus and presence of graft material in the sinus would sinus floor elevation surgery: review of 407 aug-
Madison Cox is a student at NYU College of Dentistry in the class of 2022.
other anatomical landmarks such as the decrease its chance of success because of mentation procedures. J Oral Maxillofac Surg.
greater palatine nerve. These factors prevent bacterial contamination and increase the 2015;73(7):1275–82.
a buccal or palatal approach to surgically chance of post-operative sinusitis. How-
10
retreating the palatal root and make retreat- ever, once the area heals well and another Madison Cox is a stu-
ment more difficult for the mesiobuccal and CBCT confirms the closure of the sinus per- dent at NYU College of
distobuccal roots because they are typically forations, implant success should be unaf- Dentistry in the class of
closer to the floor of the sinus. 2,3 In addi- fected by the previous issues. 9 2022.
tion, the risk of perforation was increased
due to the persistent infection which has the CONCLUSIONS Jonathan Fayzakov is a student at NYU College of Dentistry in the class of 2023.
potential to thin out the bone between the The endodontic and prosthodontic treat-
apex of the tooth and the floor of the sinus. ments were inadequate in this case, leading Jonathan Fayzakov is a
2
Finally, the presence of a large periapical le- to a chronic infection of #14 and #15. Due
sion, sinus tract, and interappointment pain to the complexities of the case such as the student at NYU College
4
reduce the chance of retreatment success. size of periapical lesions, sinus perforations, of Dentistry in the class

Nonsurgical retreatment is an alternative to and previous retreatments, both teeth had a of 2023.
an apicoectomy and shows a similar success poor prognosis and were extracted. The ex-
Jonathan Fayzakov is a student at NYU College of Dentistry in the class of 2023.
rate. However, the prognosis of nonsur- tent of the infection and perforations of the
5
gical retreatment after a tooth has already sinus meant we had to proceed with caution
Dr. Angela De Bartolo
been nonsurgically retreated is poor com- to ensure adequate healing before implant Dr. Niloufar Amintavakoli is a Clinical Associate Professor at NYU College of Dentistry in the Department of
is a Clinical Associate
pared to a single tooth implant which has a placement. The prognosis for the implants Oral Maxillofacial Pathology, Radiology, and Medicine. She is a Diplomate of the American Board of Oral
higher chance of success in this case. 6 and implant crowns are favorable as long as Professor at NYU Col-
these steps are followed. lege of Dentistry in the

Prosthodontic Considerations Department of Cariolo-
Both an adequate root canal and adequate Acknowledgements gy and Comprehensive
Dr. Niloufar Amintavakoli is a Clinical Associate Professor at NYU College of Dentistry in the Department of
crown are necessary for a good prognosis in The authors would like to thank Dr. Ana- Care and she is a Group
Oral Maxillofacial Pathology, Radiology, and Medicine. She is a Diplomate of the American Board of Oral
healing a periapical lesion. The meta-anal- lia Veitz-Keenan for her contributions in Practice Director.
ysis from Gillen also suggests that poorer reviewing the manuscript and Dr. Niloufar Dr. Niloufar Amintava-
Dr. Angela De Bartolo is a Clinical Associate Professor at NYU College of Dentistry in the Department of
clinical outcomes may be expected from an Amintavakoli for her help with radiographic koli is a Clinical Asso-
Dr. Angela De Bartolo is a Clinical Associate Professor at NYU College of Dentistry in the Department of
Cariology and Comprehensive Care and she is a Group Practice Director.

ciate Professor at NYU
adequate root canal filling and an inadequate interpretation. Cariology and Comprehensive Care and she is a Group Practice Director.
restoration than from the opposite, but it College of Dentistry in
should be noted that there is no significant References the Department of Oral
Maxillofacial Patholo-
difference in the odds of healing for each. In 1. Khandelwal P, Hajira N. Management of Dr. Niloufar Amintavakoli is a Clinical Associate Professor at NYU College of Dentistry in the Department of
7

and Maxillofacial Radiology and is the Director of Oral Maxillofacial Radiology.
gy, Radiology, and Med-
this case, both the endodontic treatment and oro-antral communication and fistula: var- Oral Maxillofacial Pathology, Radiology, and Medicine. She is a Diplomate of the American Board of Oral
coronal restoration were inadequate, and the ious surgical options. World J. Plast. Surg. icine. She is a Diplo-
mate of the American Board of Oral and
findings of the systematic review highlight 2017;6(1):3-8. Dr. Analia Veitz- Keenan is a Clinical Professor at NYU College of Dentistry in the Department of Oral
Maxillofacial Radiology and is the Di-
the importance of prosthodontics in final 2. Von Arx T, Kach S, Suter VGA, Bornstein Maxillofacial Pathology, Radiology and Medicine and Epidemiology and Health Promotion Department. Dr.
rector of Oral Maxillofacial Radiology.
restoration and long-term prognosis. The MMM. Perforation of the maxillary sinus floor Veitz-Keenan is the 2022 President-elect of the NYSAGD.

and Maxillofacial Radiology and is the Director of Oral Maxillofacial Radiology.
inadequate coronal restoration has not just during apical surgery of maxillary molars: a ret-
contributed to the endodontic problem, but rospective analysis using cone beam computed Dr. Analia Veitz- Keenan
is a Clinical Professor
Dr. Analia Veitz- Keenan is a Clinical Professor at NYU College of Dentistry in the Department of Oral
also to the periodontal problem. The open tomography. Aust Endod J. 2020;46(2):176-183. at NYU College of Den-
Maxillofacial Pathology, Radiology and Medicine and Epidemiology and Health Promotion Department. Dr.
3. Kang SH, Kim BS, Kim Y. Proximity of pos-
margins of the crowns affected the peri- terior teeth to the maxillary sinus and buccal tistry in the Department
Veitz-Keenan is the 2022 President-elect of the NYSAGD.
odontal condition of those teeth. These open bone thickness: a biometric assessment using of Oral Maxillofacial
margins became a trap for food and caused cone-beam computed tomography. J Endod. Pathology, Radiology
periodontal issues as demonstrated by the 2015;41:1839–46. and Medicine and Ep-
isolated 5mm probing depths next to the 4. Ng Y-L, Mann V, Gulabivala K. A prospective idemiology and Health Promotion De-
coronal defect. This entrapment of plaque study of the factors affecting outcomes of non- partment. Dr. Veitz-Keenan is the 2022

and food led to the gingival inflammation in surgical root canal treatment: part 1: periapical President-elect of the NYSAGD.
this case and, if left untreated, would cause health. J Endod. 2011;44:583–609.
eventual interproximal bone loss. 8 5. Torabinejad M, Corr R, Handysides R, Sha- and Maxillofacial Radiology and is the Director of Oral Maxillofacial Radiology.
www.nysagd.org l Spring 2022 l GP 31

Dr. Analia Veitz- Keenan is a Clinical Professor at NYU College of Dentistry in the Department of Oral
Maxillofacial Pathology, Radiology and Medicine and Epidemiology and Health Promotion Department. Dr.
Veitz-Keenan is the 2022 President-elect of the NYSAGD.