Dental Root Canal Treatment Filling, Upper Jaw Implant and Sinus Lift: How Do They Lead to Sinusitis?
Prof. Dr. Gediz Murat Serin – Ear, Nose and Throat Specialist
Brief Summary
Sinusitis does not always develop after a cold. The teeth in the upper jaw are very close to the sinuses. Root canal filling overflow, implant tip entering the sinus, or bone powder placed during sinus lift escaping into the sinus; initiates a foreign body reaction and chronic inflammation inside the sinus. This condition is called odontogenic (tooth-related) sinusitis. A permanent solution is usually achieved through both dental intervention and endoscopic sinus surgery through the nose.
What is Odontogenic (Tooth-Related) Sinusitis?
The roots of the upper jaw molar-premolar teeth are adjacent to the floor of the maxillary sinus (cheek sinus). Due to this proximity:
- If the filling material (gutta-percha/root canal paste) overflows from the root tip during root canal treatment,
- If an upper jaw implant advances too far toward the sinus cavity,
- If graft material escapes into the sinus during sinus lift (bone elevation),
the sinus mucosa considers this foreign; swells, thickens and inflammation begins. Over time, unilateral foul-smelling discharge, nasal congestion, heaviness/pain in the face emerge.
Antibiotics often provide only temporary relief. Without cleaning the source problem, we do not expect permanent improvement.
How Does Sinusitis Develop After Root Canal Treatment?
The overflow of root canal filling from the root tip into the sinus cavity leads to granulation and mucosal thickening inside the sinus.
Symptoms: unilateral nasal congestion, yellow-green/foul-smelling discharge, facial fullness, sensitivity when pressing on the treated tooth.
If left untreated: chronic sinusitis may develop; headaches and smell disorders may be added.
Upper Jaw Implant and Sinus Lift Complications
- Implant: If the sinus floor is thin, the tip of the implant may extend into the sinus. This triggers continuous irritation and infection in the sinus mucosa.
- Sinus lift: If the amount of bone is low, the sinus mucosa is lifted and bone powder/graft is placed. During the procedure, particles escaping into the sinus are the cause of chronic inflammation.
Possible outcomes:
- Prolonged, foul-smelling discharge and unilateral congestion
- Graft particles/implant tip at the sinus floor on CT
- In advanced cases, oroantral opening (permanent passage between mouth and sinus)
Diagnosis: What Are We Looking For, Where?
Dental X-ray alone is often not sufficient. A two-way approach is required:
- ENT Endoscopy: Inflammation inside the nose, pus, and the patency of the sinus drainage pathway (ostium) are evaluated.
- Paranasal Sinus CT: Overflowed canal material, implant tip extending into the sinus, graft escaped into the sinus, and mucosal thickening are clearly visible.
When necessary, the source tooth/implant is confirmed with periapical dental imaging and dentist examination. In some cases, simultaneous planning is made with the dentist.
Treatment: Two Steps for a Permanent Solution
1) Correcting/Eliminating the Source
- Overflowed root canal filling is corrected or removed.
- Implant extending into the sinus is retrieved, revised.
- Graft particles inside the sinus are cleaned; if necessary, the oroantral opening is closed with intraoral flaps.
2) Endoscopic Sinus Surgery (ESS)
- From inside the nose, with a camera, the sinus’s natural drainage pathway is opened/widened.
- Inflammation and foreign material are cleaned; the sinus is aerated and drained.
When these two steps are applied together, the risk of recurrence decreases significantly, smell and breathing functions recover.
What to Do at Home? (Quick Guide)
- Unilateral, foul-smelling discharge and facial pain may be tooth-related; do not delay.
- Do not use random antibiotics; they only mask the condition.
- If it started recently after a dental procedure (canal/implant/sinus lift), definitely mention it.
- Examination + CT scan shows the fastest way.
Frequently Asked Questions
1-) Will it go away with antibiotics?
It may improve temporarily; permanent results are difficult without cleaning the source.
2-) Is surgery necessary?
If there is foreign material inside the sinus, ESS is often required. It cannot be resolved with medication alone.
3-) Is it always unilateral?
To a large extent it is unilateral; findings are concentrated on the side where the tooth/implant problem is.
4-) Does it recur?
If the source is properly eliminated and the sinus is endoscopically opened/cleaned, the probability of recurrence decreases.
Final Word
Some of the sinusitis cases that are expected to “pass” actually originate from teeth. With correct diagnosis and a multidisciplinary approach (ENT + Dentistry), a permanent solution is possible.
As Prof. Dr. Gediz Murat Serin, in these difficult cases where there is a tooth-sinus relationship, we clean the sinus by planning endoscopic surgery simultaneously with dental treatments, close the mouth-sinus connection, and restore the natural anatomy.
