ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 44 of 61
JMBS 2019, 4(5): 281–285

Optimization of the Interdisciplinary Approach to the Secondary Endodontic Treatment of the Upper Jaw Molars with the Mesiobuccal Root Complex Anatomy with Odontogenic Sinusitis

Nazaryan R. S., Scheblykina N. A., Kolesova T. A., Fomenko Yu. V., Golik N. V.

Odontogenic sinusitis occupies a special place in the structure of inflammatory diseases of the maxillofacial area, for the reason that their treatment requires an interdisciplinary approach. According to various authors, the proportion of odontogenic sinusitis is from 10 to 75.0% among all cases of maxillary sinusitis. The purpose of the study was to determine the effect of the quality of endodontic treatment of maxillary molars on the development and rehabilitation of maxillary sinusitis using data from computed tomography and clinical observations. Material and methods. We analyzed 19 tomograms of patients aged 26-67 years old who applied to the dentist-therapist with complaints of varying degrees of discomfort in the molars of the upper jaw. All teeth were previously endodontically treated. Results and discussion. The prevalence of stomatological sinusitis is steadily increasing. The reason for this may be the complex anatomical structure of the upper jaw molars and the unreasonable expansion of the indications for their preservation. The upper molars mesial-buccal roots have a large number of variations in the structure of the root canal system. MB2 channel which is missed during the primary endodontic treatment can be the cause of odontogenic sinusitis. The channels MB1 and MB2 communicate with each other. If MB1 is infected, then MB2 will be infected as well. Despite the fact that the access to the canal is under a layer of dentin and its detection is difficult in most cases, finding and treating MB2 is a prerequisite for successful endodontic treatment of apical pathology. Secondary dental intervention cannot be considered adequate without modern methods of X-ray diagnostics. Computed tomography in endodontics gives information about the shape of the roots, the number of root canals, their exact length and location, the anatomical features of the bends, the presence of isthmuses, calcification areas, filling material and presence of broken instruments in root canals. In addition, the anatomical features of the upper jaw, namely, the proximity of the teeth roots to the maxillary sinus walls, the presence of fistulas, which can form between the periapical focus of inflammation and the cavity of the maxillary sinus, are determined due to computed tomography. An important point is the assessment of the ENT organs mucous membrane state. A patient with odontogenic sinusitis should be under the supervision of an ENT specialist and a dentist simultaneously. Chronic inflammatory process in the maxillary sinus can take a long time. It is due to the incomplete elimination of microflora in the root canal system, often because of previous ineffective endodontic treatment. The most common failure cause in upper molars endodontic treatment is the undetected channel MB2. To detect MB2 at the planning stage of primary endodontic treatment, it is imperative to carry out a tomographic study that will give information about the anatomical features of manipulation area: the number of roots and channels, their direction and bends, as well as the ratio of the maxillary sinus bottom and teeth apexes. Planning endodontic retreatment should begin with an analysis of previously formed endodontic access, because the creation of incorrect access is the most common cause of the primary treatment failure. Using of an operating microscope in searching the MB2 location allows increasing efficiency of its successful detection. After passing MB2 there are no differences with other channels in in the treatment protocol. Conclusions. Thus, the use of computed tomography and magnification in dentistry is of great importance for the identification and localization of the anatomically complex MB2 channel, which improves the quality of primary endodontic treatment and reduces the probability of odontogenic sinusitis.

Keywords: odontogenic sinusitis, mesiobuссal canal MB2, maxillary molars, repeated endodontic treatment

Full text: PDF (Rus) 515K

  1. Innovatsii v sovremennom mire [Innovations in the modern world]. Sbornik statey Mezhdunarodnoy nauchno-prakticheskoy konferentsii. Moskva, 2 aprelya 2015. Ed by prof RN Shaybakov. M: RIO EFIR; 2015. 114 с. [Russian]
  2. Malanchuk VA, Garlyauskayte IYu, Keyan DN. Primenenie svobodnogo autogennogo kostnogo transplantata pri khirurgicheskom lechenii odontogennykh sinusitov s oroantralnym soobshcheniem [Use of free autogenous bone graft in the surgical treatment of odontogenic sinusitis with oroantral message]. Visnik stomatologiyi. 2012; 3: 65-8. [Russian]
  3. Nazaryan RS, Fomenko YuV, Shcheblykina NA, Kolesova TA, i dr. Morfologicheskoe issledovanie sostoyaniya kornevykh kanalov zubov posle endodonticheskogo pecheniya, vypolnennogo s primeneniem rezortsin-formalinovoy smesi [Morphological study of the state of the root canals of teeth after endodontic baking, performed using resorcin-formalin mixture]. Meditsina sogodni i zavtra. 2014; 1: 111-6. [Russian]
  4. Zuolu ML, Kerlakyan D, de Mellu ZhE, de Karvalu MKK, Fagundes MIRK, i dr. Povtornoe endodonticheskoe lechenie [Repeated endodontic treatment]. Per s angl A Ostrovskiy. M: OOO «Azbuka stomatologa»; 2016. 318 p. [Russian]
  5. Rogatskin DV. Konusno-luchevaya kompyuternaya tomografiya. Osnovy vizualizatsii [Cone-beam computed tomography. Basics of visualization]. Lvov: GalDent; 2010. 148 p. [Russian]
  6. Kuts PV, Nespryadko VP, Ugrin MM, Solonko MYu, y dr. Suchasni aspekty rentgenologiyi v stomatologiyi [Modern aspects of X-ray in dentistry]. Novyny stomatologiyi. 2011; 1: 64–9. [Ukrainian]
  7. Chibisova MA, Zubareva AA, Dudarev AL. Differentsialnaya kompyuterno-tomograficheskaya kharakteristika odontogennykh intrasinusalnykh kist verkhney chelyusti [Differential computer-tomographic characteristic of odontogenic intrasinusual cysts of the upper jaw]. In-t stomatologii: nauchno-prakticheskiy zhurnal. 2018; 4: 32-6. [Russian]
  8. Yarulina ZI, Sedov YuG, Kubantseva IE. Rol oslozhneniy endodonticheskogo lecheniya zubov verkhney chelyusti v razvitii vospalitelnykh zabolevaniy verkhnechelyustnykh sinusov po dannym konusno-luchevoy kompyuternoy tomografii [The role of complications of endodontic treatment of the teeth of the upper jaw in the development of inflammatory diseases of the maxillary sinuses according to cone-beam computed tomography]. X-Ray Art. 2013; 3(02): 12-7. [Russian]
  9. Bomeli SR, Branstetter BF 4th, Ferguson BJ. Frequency of a dental source for acute maxillary sinusitis. Laryngoscope. 2009; 119(3): 580-4.
  10. Lee KC, Lee SJ. Clinical features and treatements of odontogenic sinusitis. Yonsei Med J. 2009; 51(6): 932-7.
  11. Patel NA, Ferguson BJ. Odontogenic sinusitis: an ancient but under-appreciated cause of maxillary sinusitis. Curr Opin Otolaryngol Head Neck Surg. 2012; 20(1): 24-8.
  12. Fernandes NA, Herbst D, Postma ThC, Bunn BK. The prevalence of second canals in the mesiobuccal root of maxillary molars: A cone beam computed tomography study. Australian Endodontic Journal. 2019; 45: 46-50.