Upper Molar Extraction and Sinus Communication
 

On March 18th I had an emergency visit to an OS after a periodontist tried to remove tooth #3 that had internal resorption and the crown broke off. He tried to remove the tooth while I was there for Crown Lengthening on tooth #2, but there was not enough room to work. When I arrived at the OS still bleeding and numbed up, he said that it was in bad shape because he had little to nothing to grab a hold of after crown broke off. Bunch of drilling and pulling....ouch. Long recovery and very painful for about 7 days.

During extraction a sinus communication occurred and the dang socket will not heal. No bleeding, OS says it is spotless and very clean. The communication seems small because Rinsing with water seldom if ever goes into sinus, and occasionally when I talk too load and use a word that start with "P" I feel it pop. Every once and awhile I see White tissue begin to develop deep in the socket but then it disappears every few days and I can see a small black dot area....maybe the Schneiderian membrane?

There is also a very large knot above extraction site on gum line, that is tender but not painful 5 weeks later, seems to have gotten smaller.

On last visit this week, he did a panex and Max Sinus is cloudy white on communication side, as opposed to nice and black on opposite side. I was on Antibiotics for the first 3 weeks.

The OS also says that an implant is unlikely because of bone loss and a bone graft may not work due to excessive work in the area and sinus communication......Going to see another OS for a 2nd opinion that is more current with implants.

Questions:
1. Does a Sinus communication prevent socket healing?

2. How long is too long to wait for a sinus communication to heal on its own, before entertaining a surgical procedure. I fear the whole will generate scar tissue and not heal on its own.

3. If I need surgery would an OS or ENT be the preferred surgeon?

4. Any feedback on similar scenarios and obtaining a bone graft or having an implant in area with a sinus communicaion?

v/r,
Lacrosse