title: Maxillary Sinus Impaction of a Core Carrier Causing Sustained Apical Periodontitis, Sinusitis, and Nasal Stenosis: A 3-year Follow-up.
abstract: BACKGROUND
  The aim was to present a case report of a full-length extrusion of an obturator's core carrier into the maxillary sinus, causing clinical symptoms from the nose region with differential diagnostics aspects, which, in turn, led to several surgical treatments of the nostrils before diagnosis and correct endodontic retreatment of a maxillary right first molar. A 36-year-old man presented in 2012 with complaints from the right nostril region. Medical treatment with antibiotics and surgical procedures because of nasal stenosis resulted only in partial improvement. Five years earlier, a root canal treatment was performed on the maxillary right first molar. Intraoral radiographs revealed 10-mm overfilling of root filling material into the maxillary sinus from the palatal root of tooth #3.
  
  
  METHODS
  Before surgical removal of the excess root filling material, orthograde revision was performed. Cone-beam computed tomographic imaging was used to localize the position of the root filling material, which protruded through the maxillary sinus and reached the inferior nasal wall.
  
  
  RESULTS
  Surgical removal from the palatal aspect revealed that the root filling material was a core carrier of an obturator. Scanning electron microscopy and transmission electron microscopy showed evidence of microbial biofilm on the core carrier as well as remnants of sinus mucosa. At the long-term follow-ups, the tooth had healed apically, and symptoms of nasal stenosis were markedly reduced.
  
  
  CONCLUSIONS
  This case report represents a challenging differential diagnostic topic urging the importance of a medical and dental interdisciplinary dialogue. The use of cone-beam computed tomographic imaging was crucial for the surgical retreatment.
authors: Department of Odontology, Cariology and Endodontics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. Electronic address: labj@sund.ku.dk.
authors: Lars
authors: L
authors: Bjørndal
authors: Department of Odontology, Cariology and Endodontics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors: Catharina
authors: C
authors: Amaloo
authors: Department of Odontology, Cariology and Endodontics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors: Merete
authors: M
authors: Markvart
authors: Private Practice, Copenhagen, Denmark.
authors: Vibe
authors: V
authors: Rud
authors: Department of Biomedical Sciences, Core Facility for Integrated Microscopy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors: Klaus
authors: K
authors: Qvortrup
authors: Department of Immunology and Microbiology, Costerton Biofilm Center, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors: Camilla
authors: C
authors: Stavnsbjerg
authors: Department of Immunology and Microbiology, Costerton Biofilm Center, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors: Thomas
authors: T
authors: Bjarnsholt
mesh_terms: D000328:Adult; D001419:Bacteria / Q000254:growth & development; D018441:Biofilms; D054893:Cone-Beam Computed Tomography / Q000379:methods; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D004708:Endodontics; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008437:Maxilla; D008443:Maxillary Sinus / Q000000981:diagnostic imaging / Q000601:surgery*; D015523:Maxillary Sinusitis; D008855:Microscopy, Electron, Scanning; D046529:Microscopy, Electron, Transmission; D008963:Molar; D009296:Nasal Cavity / Q000382:microbiology / Q000601:surgery; D010485:Periapical Periodontitis / Q000150:complications* / Q000000981:diagnostic imaging; D019233:Retreatment; D012387:Root Canal Filling Materials / Q000009:adverse effects*; D012389:Root Canal Obturation / Q000009:adverse effects*; D012390:Root Canal Therapy / Q000009:adverse effects; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D014092:Tooth Root
chemical_list: D012387:Root Canal Filling Materials
keywords: Biofilms; cone-beam computed tomography; core carrier; culturing; endodontics; nasal stenosis; scanning electron microscopy; transmission electron microscopy