Apical surgery of a maxillary molar creating a maxillary sinus window using ultrasonics: a clinical case

Int Endod J. 2010 Nov;43(11):1054-61. doi: 10.1111/j.1365-2591.2010.01776.x. Epub 2010 Aug 18.


Aim: To describe a method of carrying out apical surgery of a maxillary molar using ultrasonics to create a lateral sinus window into the maxillary sinus and an endoscope to enhance visibility during surgery.

Summary: A 37-year-old female patient presented with tenderness to percussion of the maxillary second right molar. Root canal treatment had been undertaken, and the tooth restored with a metal-ceramic crown. Radiological examination revealed an apical radiolucency in close proximity to the maxillary sinus. Apical surgery of the molar was performed through the maxillary sinus, using ultrasonics for the osteotomy, creating a window in the lateral wall of the maxillary sinus. During surgery, the lining of the sinus was exposed and elevated without perforation. The root-end was resected using a round tungsten carbide drill, and the root-end cavity was prepared with ultrasonic retrotips. Root-end filling was accomplished with MTA(®) . An endoscope was used to examine the cut root face, the prepared cavity and the root-end filling. No intraoperative or postoperative complications were observed. At the 12-month follow-up, the tooth had no clinical signs or symptoms, and the radiograph demonstrated progressing resolution of the radiolucency.

Key learning points: When conventional root canal retreatment cannot be performed or has failed, apical surgery may be considered, even in maxillary molars with roots in close proximity to the maxillary sinus. Ultrasonic sinus window preparation allows more control and can minimize perforation of the sinus membrane when compared with conventional rotary drilling techniques. The endoscope enhances visibility during endodontic surgery, thus improving the quality of the case.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aluminum Compounds / therapeutic use
  • Apicoectomy / instrumentation
  • Apicoectomy / methods*
  • Calcium Compounds / therapeutic use
  • Dental Materials / chemistry
  • Drug Combinations
  • Endoscopes*
  • Female
  • Follow-Up Studies
  • Humans
  • Maxilla / surgery*
  • Maxillary Sinus / surgery*
  • Molar / surgery*
  • Mucous Membrane / pathology
  • Osteotomy / methods
  • Oxides / therapeutic use
  • Periapical Diseases / surgery
  • Retreatment
  • Retrograde Obturation / instrumentation
  • Retrograde Obturation / methods
  • Root Canal Filling Materials / therapeutic use
  • Root Canal Therapy
  • Silicates / therapeutic use
  • Tungsten Compounds / chemistry
  • Ultrasonic Therapy / methods*


  • Aluminum Compounds
  • Calcium Compounds
  • Dental Materials
  • Drug Combinations
  • Oxides
  • Root Canal Filling Materials
  • Silicates
  • Tungsten Compounds
  • mineral trioxide aggregate
  • tungsten carbide