Maxillary Sinusitis Exacerbation Due To Iroot Bp Plus Overfilling

This case highlights the critical importance of accurate anatomical evaluation and material selection in endodontic procedures involving maxillary molars adjacent to the sinus floor. It demonstrates how bioceramic overfilling can exacerbate pre-existing sinus pathology, emphasizing the need for multidisciplinary management of sinonasal complications. A 37-year-old female presented with persistent right maxillary pain following multiple root canal treatments. CBCT revealed iRoot BP Plus bioceramic material overfilled 3.9mm from tooth 16′s mesio-buccal root into the maxillary sinus, with significant mucosal thickening. Initial misdiagnosis led to failed conventional endodontic therapy. Microscopic sinus surgery successfully removed the foreign material through a lateral wall fenestration, resulting in complete symptom resolution at 1-month follow-up. This case illustrates three key clinical lessons: 1) CBCT is essential for assessing root-sinus relationships, avoiding 55-86% diagnostic errors associated with 2D radiography ; 2) Bioceramics' non-resorbable nature necessitates precise apical control - overfilled material increased sinus mucosal inflammation through mechanical/chemical irritation; 3) Multidisciplinary collaboration (ENT/Endodontics/OMS) proved crucial for managing sinonasal complications. Compared to traditional sealers with 2-15% overfill complications, bioceramics require stricter length control due to their hydraulic expansion properties. This case demonstrates risks of bioceramic overfilling in maxillary molars near the sinus floor. CBCT proved crucial for diagnosis and complication prevention. Effective management required ENT/endodontics/oral surgery collaboration and microsurgical removal. Findings confirm CBCT's superiority to 2D radiography and highlight precise technique needs with non-resorbable materials like iRoot BP Plus near anatomical boundaries.