Managing an Iatrogenic Sinus Lining Perforation During Root Canal Treatment

A46-year-old female patient was referred to our practice for the management of grossly carious26 (Left Maxillary First Molar).

On IOPA close proximity of the Palatal canal in relation to axillary sinus was noted.

In the first sitting; patency was achieved with hand files and thereafter canals were prepared till 20.04. Suddenly profuse bleeding started from the palatal canal.  It took 1 hour of pressure pack to control the bleeding. The closed dressing was given and patient advised for a segment CBCT.

Studying the CBCT revealed that the palatal canal bifurcated at the apical third and that the sinus lining had a small perforation. ENT Surgeon was also consulted for opinion and a mutual ecision was made to postpone the treatment for a month and wait for natural healing. In the second visit slowly and carefully, the palatal canal was scouted to negotiate the bifurcation without damaging the sinus lining any further.It was aided with stepwise working length easurement with EAL and verifying with radiographs. The palatal canal was shaped till 30.04.

It was cleaned and obturated using Bio Ceramic Sealer with Low Heat Modified WVC technique. NonStandardised GP cones were used to achieve a true tug back.True tug back forms a strong terminal lock that is important to prevent sealer extrusion periapical.Next sitting MB1 and MB2 canals were shaped till 25 .04 while Distal canal shaped till 30.04. All the canals obturated in the same sitting.Post Endodontic restoration was performed with composite after gingivectomy using the Saddle system