Extraction of an Impacted Residual Root Adjacent to a Maxillary Sinus With Sinus Floor Elevation for Implant Placement: A Simultaneous Approach

Introduction: When an impacted root is observed in an implant placement site in proximity to the sinus, extraction of the root is required before implant placement. However, root extraction presents risks of sinus perforation and root migration into the sinus antrum. If the root remnant is close to the sinus floor, a crestal extraction approach may not be indicated because extensive bone resection may be required. The technique presented in this case report, a lateral approach to extraction of an impacted residual root adjacent to a maxillary sinus immediately after sinus floor elevation, avoids these risks. Case Presentation: A 44-year-old female presented for implant treatment. Because vertical bone height in site # 15 was not sufficient for implant placement, sinus floor elevation was required. The Schneiderian membrane was elevated after creation of a lateral window, and the root process (site #14) was palpated. The impacted root was exposed using a piezoelectric round insert from the buccal side. Immediately after sinus augmentation and extraction of the root, two implants were placed in the optimal position. Conclusions: This case report demonstrates a novel approach with extraction of an impacted residual root adjacent to a maxillary antrum. Root projection is observed on the sinus cavity, and palpation of the projection after elevation of the membrane can easily identify the positioning of the impacted root. Therefore, the lateral approach after sinus elevation minimized the risks of perforation and vertical bone loss around the root. This approach may be useful in the extraction of an impacted residual root adjacent to a maxillary sinus when the root interferes with implant placement.