The Case of the Missing Root Tip

Preoperative Periapical Radiographs
radiograph of the missing root tip
Figure 1. The image of the missing root is located above andvery close to the radiopaque border of the alveolar recess ofthe maxillary sinus. The root seems to contain traces of aradiopaque material, possibly gutta-percha. Considering thesecond molar, the image of the zygomatic process of themaxilla covers the image of apices. Thus, the verticalangulation of the radiation beam had been excessivelyoblique. Although the root seemingly is located in the sinus,the radiograph is non-diagnostic when it comes todetermining the location of the root.
radiograph taken with vertical angulation of radiation beam
Figure 2. This radiograph was taken with the vertical angulation of the radiation beam less steep than that of the radiograph on the left. The image of the zygomatic process of the maxilla no longer is superimposed on the image of the roots of the second molar. Also in this radiograph the root appears within the boundaries of the alveolar recess of the maxillary sinus. By now there is some doubt as to whether conventional periapical radiographs will lead to an accurate conclusion regarding the location of the root.

Result of post-operative clinical examination

On palpation of the surgical site, a localized hard elevation was found on the buccal aspect of the alveolar process in the area of the left, maxillary first molar. There were no other signs or symptoms.


buccal view of gingival mass
Figure 3. There is a soft tissue swelling in the left nasal cavity and a slightly increased marginal density in the superior, inferior, and medial aspects of the left maxillary sinus.