Maxillary sinusitis and periapical abscess following periodontal therapy: a case report using three-dimensional evaluation.
BACKGROUND
Maxillary sinusitis may develop from the extension of periodontal disease. In this case, reconstructed three-dimensional images from multidetector spiral computed tomographs were helpful in evaluating periodontal bony defects and their relationship with the maxillary sinus.


METHODS
A 42-year-old woman in good general health presented with a chronic deep periodontal pocket on the palatal and interproximal aspects of tooth #14. Probing depths of the tooth ranged from 2 to 9 mm, and it exhibited a Class 1 mobility. Radiographs revealed a close relationship between the root apex and the maxillary sinus. The patient's periodontal diagnosis was localized severe chronic periodontitis. Treatment of the tooth consisted of cause-related therapy, surgical exploration, and bone grafting. A very deep circumferential bony defect at the palatal root of tooth #14 was noted during surgery. After the operation, the wound healed without incidence, but 10 days later, a maxillary sinusitis and periapical abscess developed. To control the infection, an evaluation of sinus and alveolus using computed tomographs was performed, systemic antibiotics were prescribed, and endodontic treatment was initiated.


RESULTS
Two weeks after surgical treatment, the infection was relieved with the help of antibiotics and endodontic treatment. Bilateral bony communications between the maxillary sinus and periodontal bony defect of maxillary first molars were shown on three-dimensional computed tomographs. The digitally reconstructed images added valuable information for evaluating the periodontal defects.


CONCLUSIONS
Three-dimensional images from spiral computed tomographs (CT) aided in evaluating and treating the close relationship between maxillary sinus disease and adjacent periodontal defects.
Department of Dentistry, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan. tzdental@yahoo.com
Chih-Hao
CH
Huang
Michael A
MA
Brunsvold
D000328:Adult; D016301:Alveolar Bone Loss / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016025:Bone Transplantation; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D015523:Maxillary Sinusitis / Q000209:etiology*; D009957:Oroantral Fistula / Q000150:complications / Q000000981:diagnostic imaging*; D010482:Periapical Abscess / Q000209:etiology*; D010514:Periodontal Pocket / Q000601:surgery; D010518:Periodontitis / Q000601:surgery; D011183:Postoperative Complications; D012390:Root Canal Therapy; D036542:Tomography, Spiral Computed / Q000379:methods*
D000900:Anti-Bacterial Agents