Integrated Endodontic Microsurgery And Maxillary Sinus Ectopic Tooth Extraction

This case demonstrates an innovative protocol for managing refractory apical periodontitis involving an ectopic tooth within the maxillary sinus—a scenario requiring interdisciplinary precision to address cross-regional infection risks. A patient presented with swelling and pain in tooth #22 (two failed root canal treatments ). CBCT revealed a 8.2×10.8×8.0 mm cystic lesion involving the apices of #21, #22, and #23., extending to the root of an inverted ectopic tooth embedded in the sinus floor. Treatment involved: 1. Endodontic microsurgery under microscopy: submarginal rectangular flap, 3 mm root-end resection, ultrasonic retro-preparation, and retrofilling with IRoot BP (mineral trioxide aggregate, Innovative Bioceramix, Canada). 2. Ectopic tooth extraction : Atraumatic removal preserving sinus mucosal integrity. Histopathology confirmed a radicular cyst. At 3-month follow-up, CBCT demonstrated partial osteogenesis imagingand mucosal healing. The ectopic tooth’s root involvement within the cyst margin justified combined surgery. Prioritizing apical microsurgery eliminated primary infection sources, reducing sinus contamination risks. Microscopic precision and CBCT-guided planning enabled targeted intervention, while iRoot BP’s osteoconductivity enhanced regeneration. This aligns with evidence advocating staged approaches for multifactorial pathologies. Coordinated microsurgery and 3D imaging resolve complex apical-sinus interactions, minimizing complications. The protocol’s success underscores the value of interdisciplinary integration in modern endodontics, offering a replicable model for similar high-risk cases.