Root most often dislodged into maxillary sinus

# The root of which tooth is most often dislodged into the maxillary sinus during an extraction procedure?
A. Palatal root of the maxillary first premolar
B. Palatal root of the maxillary first molar
C. Palatal root of the maxillary second molar
D. Palatal root of the maxillary third molar

The correct answer is B. Palatal root of the maxillary first molar.

If an entire tooth or a large fragment of one is displaced into the sinus, it should be removed. If the tooth fragment is irretrievable through the socket, it should be
retrieved through a Caldwell-Luc approach ASAP. However, this should be performed only if the dental surgeon is well versed with the procedure, else, the patient should be referred to an oral and maxillofacial surgeon.

If a small communication is made with the maxillary sinus during extraction of a tooth, the best treatment is leave it alone and allow the blood clot to form.

Post-operative instructions to patient:
• Avoid nose blowing for 7 days
• Open mouth when sneezing
• Avoid vigorous rinsing
• Soft diet for 3 days

If a sinus communication should occur the following medications may be prescribed for one week:
1. local (nasal) decongestant
2. Antibiotics (Amoxicillin)
3. systemic decongestant

1. If the opening is of moderate size (2-6 mm), a figure of eight suture should be placed over the tooth socket.
2. If the opening is large (7 mm or larger), the opening should be closed with a flap procedure.

The integrity of the floor of the maxillary sinus is at greatest risk with surgery involving the removal of a single remaining maxillary molar. The fear here is possible ankylosis.

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