sinus perforation while doing a max 2nd molar exo

[groker2009]

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I recently did an exo of #2. I elevated #2 prior to using the forceps. Unfortunately, I think I tried expanding the buccal bone too fast. A root broke off. It was about the apical 2 mm of the palatal root.

After taking an xray to check it being there, I tried using some elevators to no avail. Then I took out my highspeed drill, inserted it all the way apical, and drilled around the interradicular bone ( or so I thought. I wouldn't have known at all if I drilled into the sinus, which is what worries me ). Again, I tried elevating and the root tip came out. I took an xray again, and the socket was presumably empty.

The problem is, I wasn't able to see clearly into the socket while drilling around for the root. The socket for #2 wasn't very visible. While I tried drilling away the interradicular bone, it still felt as if I drilled "up there."

What is the possibility that I might have drilled into the sinus? If I actually did drill into the sinus, is there anything that would happened right away?

 

[tinman831]

What is the possibility that I might have drilled into the sinus?

Pretty good if the sinus was low and you were drilling with poor visibility like you said you did.

If I actually did drill into the sinus, is there anything that would happened right away?

You would be able to see into the sinus.

One way to test for sinus perforation is to pinch the patients nostrils and have the patient blow through their nose. Any air bubbles appearing in the socket is a sign of sinus perforation. Use this method with caution because if you didn't have a perforation to begin with, you may cause a perforation by having the patient blow.

 

[groker2009]

You would be able to see into the sinus.

Is this very evident? And if I really did perforate, how likely is it to heal on its own? I only saw some dark holes where the three roots used to be.

I may have done some drilling but the gingiva was intact. There was no other wound from the exo other than the open socket.

The bleeding stopped within a few minutes. The patient didn't notice anything except the swelling from the lidocaine injections. I didn't suture the socket, and the patient left biting with gauze on the socket. I prescribed only Tylenol #3 for possible pain.

 

[djeffreyt]

It should have been pretty evident if you tried the nose test like described above. Even a small perf should have given you the signs of a bubbling. If you perfed the bone but somhow the membrane of the sinus was in tact, you wouldn't get bubbles. Was the radiographic line of the sinus close to that root tip or did the sinus scallop over the root tips in the radiograph?

 

[groker2009]

It should have been pretty evident if you tried the nose test like described above. Even a small perf should have given you the signs of a bubbling. If you perfed the bone but somhow the membrane of the sinus was in tact, you wouldn't get bubbles. Was the radiographic line of the sinus close to that root tip or did the sinus scallop over the root tips in the radiograph?

What are the bubbles like? Is it one large bubble? Or is it continuous bubbling? Do perforations heal on their own?

And how would you know if the sinus is radiographically close to the roots? In my experience of seeing xrays and learning radiology in school, it almost always seems as if max posterior teeth have roots close to the sinus.

 

[djeffreyt]

What are the bubbles like? Is it one large bubble? Or is it continuous bubbling? Do perforations heal on their own?

And how would you know if the sinus is radiographically close to the roots? In my experience of seeing xrays and learning radiology in school, it almost always seems as if max posterior teeth have roots close to the sinus.

Wow, did I fall for it. Troll.

 

[NileBDS]

Wow, did I fall for it. Troll.

sinus perforation while doing a max 2nd molar exo

I recently did an exo of #2. I elevated #2 prior to using the forceps. Unfortunately, I think I tried expanding the buccal bone too fast. A root broke off. It was about the apical 2 mm of the palatal root.

After taking an xray to check it being there, I tried using some elevators to no avail. Then I took out my highspeed drill, inserted it all the way apical, and drilled around the interradicular bone ( or so I thought. I wouldn't have known at all if I drilled into the sinus, which is what worries me ). Again, I tried elevating and the root tip came out. I took an xray again, and the socket was presumably empty.

The problem is, I wasn't able to see clearly into the socket while drilling around for the root. The socket for #2 wasn't very visible. While I tried drilling away the interradicular bone, it still felt as if I drilled "up there."

What is the possibility that I might have drilled into the sinus? If I actually did drill into the sinus, is there anything that would happened right away?

dealing with pain while performing extractions

This sometimes happens when I extract lower molars. ( also on upper posteriors but to a lesser extent )

Whenever I try inserting an elevator within the interdental papilla of the tooth to be extracted, the patient starts complaining of pain or discomfort.

Other than that, the patient does feel numb. My block injections are usually successful, as my patients generally admit feeling numb to the midline of their lips. For difficult molar exos, I use at least 4 carpules of lidocaine.

I usually only have topical gel, lidocaine, and short/long needle as my anesthetizing armamentarium. I don't have anything like articaine, PDL injection guns, etc so I have to make do with what I have.

What should I do for pain control when patients complain of pain whenever I stick in an elevator in between teeth?

I can't do molar endo - please help

I have a difficult time with molar endos.

1) I have a hard time instrumenting narrow canals, which is the case for mb/db canals on maxillary molars and mb/ml canals on mandibular molars. ( at least based on my experience; don't know if I'm doing anything wrong ) I find the canals too stiff to instrument to anything over a size 20.

2) For the canals of all molar teeth, I can't easily get gutta percha all the way down to the apex. Even with the narrow cones, they always seem to be several mm away from the apex.

I never have either problems when treating any other teeth. I'm getting these issues only when dealing with molars. Also, I don't use rotary or thermoplastic condensation. I only have hand instruments and gutta percha at my disposal.

I would gladly appreciate some tips and pointers.

composite fillings that keep falling out

Assume that rubber dams aren't used and also assume that generic materials are used.

What are some tips for doing composite fillings that don't fall out?

Right after placing them, I sometimes notice composite fillings coming out when I remove the matrix band, check contacts with floss, or do occlusal adjustments.

Given that I don't have control over any bonding/composite supplies and instructions for how to use them, I arbitrarily insert acid etch into the prep, rinse the prep and air dry after 5-10 secs, apply bonding ( sometimes this is from one bottle; other times I have to mix a drop from two or three bottles ) to the prep using a microbrush in a rub back and forth motion, light cure for 5-10 secs, insert hard ( or flowable ) composite and light cure for 10-20 secs.

Please help. Thank you. I know that there isn't one way of doing dentistry but I certainly haven't learned any of this effectively.

Pshhh ... no. This is just a preview of what SDN will look like once we see the first class of "dental therapists" in action.

 

[mike3kgt]

Pshhh ... no. This is just a preview of what SDN will look like once we see the first class of "dental therapists" in action.

Best good laugh I have had in a long time. Thank you.

 

[Theillestill]

agreed.