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Case Reports a Case of Impacted Tooth in the Maxillary Sinus

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Case Reports a Case of Impacted Tooth in the Maxillary Sinus 128 Int J Oral-Med Sci 13(3):128-130, 2015 Case Reports A Case of Impacted Tooth in the Maxillary Sinus: CT Findings Keiko Sekiya,1 Marie Ishida,1 Kotaro Sekiya,1 Masaaki Suemitsu,2 Yoshinobu Hara,1and Takashi Kaneda1 Departments of 1Radiology,and 2Oral Pathology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba 271-8587, Japan Article History Abstract Received 30 January 2015 We report a case of impacted tooth in the maxillary sinus. The frequency of ectopic Accepted ઇ February 2015 impacted tooth is higher with permanent teeth than with deciduous teeth, and the mandibular third molars are the most commonly impacted teeth. The most common site of ectopic impacted teeth is the maxillary canine area, followed by the mandibular molar area and ramus. However, impaction in the nose or maxillary sinus has rarely been reported. We encountered a patient with an impacted tooth located in the maxillary sinus. This case was coincidentally found on panoramic radiography and computed tomography (CT) for assessment of the alveolar bone with dental implantation. CT showed a marginal high- Keywords : absorption area with clear and smooth boundaries of the longaxis 18 mm in size, located in impacted tooth; ectopic eruption; the floor of the left maxillary sinus. We confirmed the tooth as the second premolar imaging finding; CT; 3D images impacted in the maxillary sinus from imaging findings of panoramic radiography and CT. Introduction herein a single case of an impacted tooth in the maxillary In clinical situations, large numbers of ectopic impacted sinus identified usingpanoramic radiographyand MDCT. teeth are incidentally found on radiological examination.The frequency of encounters with impacted teeth is increasing Case Report with the spread of panoramic radiography in dental A 52-year-old woman underwent panoramic radiography clinics(1). The frequency of ectopic impacted teeth is and CT examination in our hospital. The purpose of the first greater for permanent teeth than for deciduous teeth. The examination was assessment of alveolar bone in the region third molar is the most frequently involved. Ectopic of the right first mandibular molar for dental implants. The impacted teeth are usually found in alveolar bone in the patient had no symptoms involvingthe maxilla, and no other region of the maxillary anterior teeth or in the mandibular medical history of note. ramus from the mandibular molar area, and impaction into the nose or maxillary sinus has rarely been reported(2). Radiological Modalities and Imaging Parameters However, we encountered a case with implantation of the Panoramic radiography was performed using a panoramic second premolar outside the maxillary bone. This case was unit (Veraviewepocs Digital Pantomography; J. MORITA discovered followinga request for computed tomography MFG Corporation, Kyoto, Japan) usingan imagingplate (CT) examination from a dental practitioner. Multi- (FUJIFILM, Tokyo, Japan) with a tube voltage of 75 kV and detector row CT (MDCT) with multi-planar reformation a tube current of 7 mA. (MPR) and 3-dimensional (3D) imaging have become CT was performed with a 64-row MDCT (Aquilion 64; standard parts of the preoperative assessment for dental Toshiba Medical Systems, Tokyo, Japan) usingthe following implants. CT is thus useful for the diagnosis and treatment maxillofacial protocol at our hospital: tube voltage, 120 kV; planningfor teeth in the maxillary sinus (3). We present tube current, 100 mA; field of view, 240 mm × 240 mm; rotation time, 1.0 s. The protocol consisted of axial Correspondence to : Keiko Sekiya acquisition (0.50 mm) with axial (3.0 mm) , coronal (3.0 E-mail : [email protected] mm) and sagittal (3.0 mm) MPR and 3D images. Int J Oral-Med Sci 13(3):128-130, 2015 129 Fig.1 Panoramic radiograph shows a well-defined radiopaque mass with an aggregated structure in the left maxillary sinus (arrows). Imaging Findings Panoramic radiograph findings Panoramic radiograph showed a well-defined radiopaque mass with an aggregated structure in the left maxillary Fig.2 Axial CT shows a marginal high-absorption area with sinus (Fig. 1). The mass was located in the floor of the clear, smooth boundaries of the longaxis 18 mm in size in the left maxillary sinus. The mass is located in the front of maxillary sinus, but the form of the maxillary sinus floor was the floor of the left maxillary sinus (arrow). maintained. There is no radiopaque with suspicion of mucosal thickeningor fluid retention in the maxillary sinus. Deficiency was also detected in the second premolar area on both sides of the maxilla. From the localization and morphology on panoramic radiograph, diagnoses of ectopic impacted tooth or calcium deposition were considered. CT findings CT showed a marginal high-absorption area 18 mm in size with clear, smooth boundaries of the longaxis in the left maxillary sinus (Figs. 2-4) , is located in the front of the left maxillary sinus floor. Three levels of CT opacity were evident, suggesting tooth components of enamel, dentin, and pulp chamber. Axial and reconstructed panoramic CT showed a premolar structure, includinga centrifugaltooth crown-like form and mesial tooth root-like form (Figs. 2, 5). Neither mucosal thickeningnor fluid retention were seen in the maxillary sinus. The maxillary ostium was not closed. Fig.3 Coronal CT shows a marginal high-absorption area, with clear, smooth boundaries in the left maxillary sinus The cortical bone of the left maxillary sinus was maintained. (arrow). Ectopic impacted tooth in the maxillary sinus was suggested based on the localization and CT images. No maxillary examination. Impacted teeth are those that have failed to sinusitis was evident on CT. erupt and remain completely or partially covered by bone, soft tissue, or another erupted or un-erupted tooth(1). Discussion Numerous factors can contribute to the non-eruption of An ectopic impacted tooth is called a dislocated tooth. teeth. Mainly, these involve a lack of space such as Dislocated teeth that have erupted are best seen and obstruction by cysts and tumors, supernumerary or primary evaluated by clinical examination, but those that remain un- teeth, infection, trauma affectingthe jaws and teeth, and erupted can be detected and evaluated only by radiographic systemic conditions. Impacted teeth in the maxillary sinus 130 Int J Oral-Med Sci 13(3):128-130, 2015 Fig.4 Images from 3D-CT show the marginal high-absorption area, with clear and smooth boundaries in the left maxillary sinus (arrow). normal position for eruption. Most embedded maxillary premolars are situated lingual to the roots of erupted teeth (1).However, the present case showed a very rare second premolar eruptinginto the maxillary sinus. In conclusion, panoramic radiograph and 3D findings usingMDCT offer useful imagingmodalitiesfor evaluation of ectopic impacted teeth. References Fig.5 Reconstructed panoramic CT shows a structure of the th premolar showinga tooth crown-like form and mesial 1 Gibilisco JA: Stafneʼs Oral Radiographic Diagnosis 5 Edition: tooth root-like form (arrow). Malposition of Teeth, 1985, W. B Saunders Company, Philadelphia, USA. mainly involve third molars, and ectopic eruption may result 2 Oberman M, Horowatz I,RamonY:Accidental displacement of impacted maxillary third molars. Int J OralMaxllofac Surg.15: from one of the three processes: developmental disturban- 756-758,1986. ces; pathological processes; and iatrogenic activity(3). 3 Bodner L, Tovi Fe, Ziv BJ: Teeth in the maxillary sinus ‒ Impacted teeth in the maxillary sinus are often found with imaging and management. J Laryngol Otol. 111: 820-824, 1997 cyst or tumor(4-6). Dentigerous cysts in the maxilla often 4 Vámos D, Ujpál M, Huszár T, Vaszilkó M, Németh Z: extend into the maxillary sinus, displacingand remodeling Dentigerous cyst associated with a wisdom tooth in the the bony sinus wall(7). Dentigerous cysts can involve any maxillary sinus. Case reports, review of the literature. Fogorv unerupted tooth, but usually involve third molars and rarely Sz. 105: 141-146, 2012. involve unerupted deciduous teeth, supernumerary teeth, or 5 Buyukkurt MC, Omezli MM, Miloglu O: Dentigerous cyst odontomas(5). If eruption of ectopic teeth into the maxillary associated with an ectopic tooth in the maxillary sinus: a report of 3 cases and review of the literature. Oral SurgOral sinus is gradual and relatively or completely asymptomatic, Med Oral Pathol Oral Radiol Endod. 109: 67-71, 2010. most cases are discovered incidentally on radiography(1). 6 Demirtas N, Kazancioglu HO, Ezirganli S: Ectopic tooth in the In this case, the tooth was suggested as the impacted maxillary sinus diagnosed with an ophthalmic complication. J maxillary second premolar refer to its form and missing Craniofac Surg. 25: 351-352, 2014. position. Impacted premolars are almost always second 7 Kaneda T, Weber AL, Scrivani SJ, Bianchi J, Curtin HD. Cysts premolars. The direction of the second premolar may be tumors and nontumorous. In: Som PM, Curtin HD, editors. diverted, or if removal of the obstruction is delayed too long, Head and Neck Imaging. Fifth Edition. St. Louis: Mosby; 2011. the premolar may fail to erupt even though it remains in the p.1469-1546..
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