PERIAPICAL ABSCESS WITH FISTULA COMPLICATED BY MAXILLARY SINUSITIS (CLINICAL CASE)
Abstract and keywords
Abstract (English):
Subject. Chronic odontogenic maxillary sinusitis is an inflammatory disease of the mucous membrane of the maxillary sinus caused by an odontogenic infection. According to foreign sources, this disease occurs in 14-20% of the world's population. Sinusitis of odontogenic etiology account for up to 40% of all inflammatory diseases of the maxillary sinus. Biofilm, the root cause of apical periodontitis and odontogenic sinusitis, is resistant to the isolated effects of most medications. The combination of mechanical removal and irrigation in most cases leads to a sufficient reduction in microbial load. Several studies have concluded that none of the currently used root canal treatment methods and endodontic instruments can completely clean root canals, especially root canals with "irregular anatomy". When preparing the upper molars with rotary instruments, 43% ± 29% and 33% ± 19% of the walls of the mesiobuccal and distobuccal channels, respectively, remained intact. Methodology. The article presents a case of treatment of a patient with a periapical abscess with a fistula communicating with the maxillary sinus, as well as concomitant maxillary sinusitis. Positive dynamics in the healing of the periradicular process was achieved by increasing the apical diameter of the preparation. Result. Healing of the periradicular process, as well as inflammatory phenomena in the maxillary sinus at the time of examination after 10 months from the start of treatment. Conclusions. Thus, an increase in the apical diameter to sizes "unusual" for a dentist (45.02, 50.02 according to ISO) not only contributes to the healing of the periradicular process, but also does not weaken the root of the tooth, since the true diameter of the apical zone is much larger than it seems at first glance.

Keywords:
endodontics, maxillary sinusitis, periapical abscess, apical dissection, apical diameter
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