Sinus Floor Elevation And Endodontic Microsurgery For Maxillary Molar Treatment

In this case, we successfully performed endodontic microsurgery on all three roots of the first maxillary molar, combining it with sinus floor elevation, and achieved good results. A 43-year-old male patient presented with the chief complaint of pain related to the maxillary right first molar. The patient had a history of nonsurgical initial root canal treatment 3 years ago, and was diagnosed with symptomatic apical periodontitis and previously treated tooth. The treatment included apicoectomy of buccal roots, sinus lift using piezosurgery, and endodontic microsurgery of the palatal root. The approach was successful without any untoward events. We monitored the radiographic changes after the surgery and at multiple follow-up appointments. The periapical lesion healed completely A buccal approach of endodontic microsurgery on the palatal root of maxillary molars was limited by accessibility, visibility, and risk of sinus membrane injury. When all roots needed surgery, it became more difficult and time-consuming. In this case, the palatal root protruded into the sinus. After buccal surgery on the mesiobuccal and distobuccal roots, a piezosurgery in water mode was used for sinus floor elevation. Under the microscope, the palatal root was located and apical surgery was performed. Special elongated instruments, including apical resection and retrograde preparation/filling tools, were needed. Additional instruments were used to remove the resected palatal root apex to prevent slippage. This clinical method is effective for treating maxillary molars with periapical lesions affecting all roots and the maxillary sinus floor positioned under the buccal or palatal roots.