Perforation of the tooth roots and the maxillary sinus: symptoms, treatment, photos

In addition to infectious diseases, in the treatment process, you may receive the perforation of the tooth roots and the maxillary sinus. What symptoms come with this, treatment and photos will provide below.

The reasons for this may be different diseases, but most often this problem occurs due to the wrong actions of a doctor, errors, and peculiarities of tooth in individual cases. Avoid the perforation is possible, but the dentist should know how to diagnose and treat the resulting cavity or a crack immediately to avoid complications and unpleasant consequences.

What is it?

Perforation of the tooth otherwise is also called perforation. In fact, it is education unnatural cavity where it should not be, the appearance of the message between the channels or between the inner part of the tooth and periodontium.

To see such a cavity may:

  • in the wall of the unit and become visible during the inspection;
  • in different parts of the root or between them;
  • at the bottom of the crown.

There is a perforation at the time of appearance:

  • fresh, newly formed in the process of dental treatment, it is important to notice and fix;
  • chronic, often arising from infection of the tissues and is characterized by sluggish flow, mild symptoms can sometimes appear from injury.


The etiology of the disease has different origins:

  1. Individual features of the structure of the tooth, its canals, roots, etc. When it is difficult to anticipate the direction of movement of dental tool, which formed cavity. This most often happens in the process of expanding root canal, as well as the introduction of the pin.
  2. Mechanical damage, trauma heavy fabrics from heavy impact, improper operation of the medical instrument from the application of a significant force that is excessive. Such a perforation may appear as a crack or develop a hole. The volume of the cavity will depend on the force of the blow or the size of the injuring tool.
  3. Caries and other infectious influence, when not treated, the disease gradually thins the wall of the tooth, and eventually forms the entire cavity inside of it and even reaches the roots. It can happen in acute or latent, when long enough no obvious signs of disease.

Not always full the fault lies with the dentist, because of the formation of the perforation, even during therapeutic treatment can be a special predisposition:

  • abnormal position of the tooth axis is not centered, but offset to the tongue, lips or cheeks;
  • abrasion of the enamel, which significantly decreases the volume of the wall of the tooth;
  • conduct manipulation through the hole in the artificial crown.

Consider in more detail the causes and treatment of those options for the appearance of the perforation, which occurred during the dental intervention.

A perforation in the region of the tooth crown

It may appear like a in the wall unit, it happens, and perforation of the tooth bottom. What features of the structure of inner channels often contribute to this.

The impact on the appearance of such cavities has incorrectly selected instruments of the doctor or his ignorant actions.


If the perforation is fresh and appeared immediately in the process of therapeutic treatment, her clinic is quite typical – the patient experiences acute pain and in the affected area actively secreted blood. The doctor may feel however, as his instrument as if failed.

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A more complex case, when the cavity old and almost does not manifest itself. People may occasionally feel a little nagging pain that bothers rare. Only with careful examination of an experienced physician it is possible to notice the granulation of education, internal bleeding and acute reaction to touch in a specific area.

As soon as the dentist discovers such, its task is filling the cavity, if it is not more than 2 mm. Otherwise the filling material just gets in the periodontium and cause infection of the tissues, which quickly develops into a complex form of periodontitis.


In cases where the perforation is formed in the wall of the tooth, it is easy to notice even a cursory examination.

To detect such problems in the area of the bottom will need to do the x-ray with contrast. For this purpose, a pin or a special file.


Than to close the cavity in the crown of the tooth? To do this, use fillings made of biocompatible material. If the earlier popular JRC (glass ionomer) or amalgam, today doctors prefer to use higher quality substances – MTA (mineral trioxide aggregate).

Due to the good indicators of hardening in a moist environment and low risk of rejection it is chosen as the most suitable for such purposes.

This elimination of the perforation is preferably carried out at once, not leaving for later, and use a special microscope to have good visibility of the cavity and closely monitor the quality of treatment.

A perforation in the region of the tooth root

To a crack can and in the following locations:

  • the middle part of the root or along its length;
  • only touching upon the tip;
  • in the so called zone of bifurcation.

Appear perforation of the root canal may also in the process of careless treatment when the doctor incorrectly treated the unit. This happens when the root filling with calcium hydroxide, the preparation for the implantation of an anchor post or directly in the process of installing it.

The tip of the root easily hook tool, especially if it is on the amount picked up correctly. The most difficult is the case of damage to the bifurcation, as it can cause serious inflammatory processes, up to the loss of healthy functioning units.


Because of the deep and almost inaccessible location of the perforation of the tooth root is almost not visualized. It can be detected on the basis of:

  • slight bleeding from the root region;
  • the emergence of severe pain;
  • the feelings of the doctor when the tool seemed to be slipping in the other direction than expected.

If this cavity were not the result of dental treatment, and lasted gradually through internal processes, then over time it manifests itself in the following way:

  • the constant pain affected tooth;
  • signs of inflammation of the gums of redness and swelling around the unit;
  • common symptoms of ailments such as headaches, fever, weakness, etc.


It is very important to stop the bleeding, to better see the affected area. To quality treatment channel to expand, introducing a paper pin and the traces of blood on it establish the exact location of the perforation. For additional diagnostics also use x-rays with contrast.

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To solve how to fix such a problem, the physician must consider many factors – the exact location of the perforation, its size, features of the structure of the tooth of the patient, General clinical picture, and much more. There are two main methods of treatment of the perforation, located in the root part:

  1. Conservative, which often requires a root canal or closing the cavity with the tab file.
  2. Surgical method is used when the perforation is formed on the tip of the root. In this case, make a resection of the damaged part.

In some difficult situations, especially when the perforation relevant to the area of bifurcation, produce a so called conservative and surgical treatment. Through a small incision reaches the desired area and hold the appropriate sealing materials. Sometimes this will also make removal of necrotic periodontal tissues, bone defects, etc.

In addition to office treatment that doctor might perform, will need to have a long time to pay attention to at home. When this prescribed broad-spectrum antibiotics, for oral administration, but not necessarily those in which high rates of penetration in the bone tissue. You should also take anti-inflammatory drugs, and if pain is felt, and pain medication.

To improve the condition and inflammation from the surrounding soft tissue, you can do gargle with antiseptic solutions. To do this, use chlorhexidine or other drugs based on iodine. But to make any kind of manipulation of traditional medicine and ignore the intervention of a doctor is not necessary, as this will entail the inflammation of the surrounding tissues.

Perforation of the maxillary sinus

Therapeutic treatment and any other intervention in the upper jaw often leads to injury to the area gaymanova sinus. Because it is too small bottom thickness, bone trabeculae thinned and the roots of the teeth are in close proximity, even the smallest error may be sufficient to perforation of the maxillary sinus during the removal of a tooth (especially molars and premolars).

In addition, some problems can contribute. So, in purulent processes of different nature, periodontitis, formed cysts, and periodontitis possible a more rapid destruction of these bones, their resorption and increased risks of trauma in the treatment or removal of teeth in the upper jaw.

Distinctive symptoms, which can determine a trauma are:

  • the bleeding from the hole together with air bubbles, the amount of which increases when breathing;
  • began bleeding from the nose.
  • changes in the voice of the patient to «nasal».

People can complain that it’s hard for him to breathe through the nose and he feels the passage of air through the hole where the extracted tooth and also have the feeling of fullness or heaviness in this place.

The most important methods of treatment are:

  • removal of foreign object if present;
  • blood clot formation-convolution in place of perforation;
  • closing the hole with a gauze swab with a drop of iodine.

The use of the latest manipulation happens every day throughout the week. If necessary, place a plastic plate between the mouth and opened his bosom and attaches them to the nearby teeth with clasps. Sometimes the hole is applied medical sutures.

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Also in this method of treatment applies antibiotic therapy, use of anti-inflammatory drugs and vasoconstrictor.

Indications for removal

At the very least, when it is impossible to conduct a successful treatment of the perforation, it is required to remove a damaged tooth. This is done in order to avoid deterioration due to the opened cavity. This happens when:

  • the destruction is so great that it becomes unavailable, neither the filling nor the other method of closing the cavity;
  • too strong movement of the tooth resulting from such injury;
  • appeared purulent inflammation, which can lead to infection of the surrounding tissues;
  • special anatomical complexity in the structure of the tooth, when it is impossible to reach the area and treat it.

The consequences

Any forecast in this case based on specific characteristics – the structure of internal channels, size of lesions, localization, etc. for Example, if affected only the outer part of the crown, then it is easy to seal up almost as soon as it is detected.

In the case of destruction of the tooth root, especially in the area of his discrepancies, you need to choose between treatment and disposal units. Even with a successful closing of the cavity be root will not be able to perform a reliable support for the prosthesis or to withstand greater chewing pressure. And over time, this area may develop inflammation of the surrounding tissues.

The sooner the perforation is detected and corrected, the greater the chance that the outcome of the treatment will be successful and the problem will not disturb the patient or to deliver some kind of trouble.

Video: perforation bottom maxillary sinus.


In order to avoid such injuries in the course of treatment or removal of units, the physician must act accordingly preventive precautions:

  • To conduct x-ray diagnostics of the tooth to clarify the curvature of the channels, features, etc.
  • The choice of instruments used, respectively, to the sizes, shapes and bends in the roots.
  • To create a good visibility of the working region by opening the cavity so as is necessary for its full coverage.
  • Careful control of the tool during operation, accurate movement, without excessive use of force.
  • At the first sensation of any barriers, to reduce the pressure.

Further questions

► Why x-ray shows perforation of the tooth?

Diagnosis using x-rays is not always completely reliable, as it has some special features. Due to the two-dimensional image, the image may be not visible to the buccal or oral surface of the root, making this method limited.