Orbital Pain and Headache Secondary to Overfilling of a Root Canal Mehmet Yaltirik, PhD, Hulya Koc ¸ ak Berberoglu, Prof.Dr, Meltem Koray, PhD, Oktay Dulger, PhD, Sema Yildirim, Assoc.Prof, and Barıs ¸ Altug Aydil, PhD A 35-yr-old woman was referred to the Istanbul University, Faculty of Dentistry, Oral Surgery De- partment with complaints of orbital pain and head- ache. Panoramic radiographs showed overfilling of a maxillary premolar, which caused a perforation in the maxillary sinus floor. The etiology, clinical man- ifestations, and treatment of this complication are discussed with emphasis on early surgical inter- vention to decrease the risk of a superimposed aspergillosis infection. One complication that occurs after endodontic treatment is over- filling root canals, which can impinge on the maxillary sinus (1– 4). The use of a nonresorbable filling material paste leads to various complications (4). Overfilling by nonresorbable filling materials may require surgical resection (4). Aspergillosis of the maxillary sinus has been reported as a complication of the overextension of root canal filling materials (5–7). The filling materials most com- monly associated with such complications are those containing paraformaldehyde such as N2 (8 –10) and Endomethasone (4, 5, 11). There also are reports of problems after the use of AH 26 (DeTrey Dentsply, Zurich, Switzerland) (12), Hydron (NDD Den- tal Systems, Inc. New Brunswick, NJ) (12), Diaket (3M/ESPE, Minnesota) (13), Riebler’s paste (Karl, Germany) (14), SPAD (Qetigny, France) (6, 15), and Endoseal (Promedica Dental Mate- rial GmbH, Neumu ¨ nster, Germany) (16). A case of orbital pain and headache resulting from overfilling with root canal material pushed into the maxillary sinus is presented in this article. CASE A 35-yr-old female with an unremarkable medical history pre- sented with the chief complaint of constant pain in the right maxilla and orbita. Although she was unable to exactly pinpoint the loca- tion, she focused mainly on the premolar area and orbita. She mentioned that her dentist had treated her maxillary second pre- molar approximately 2 yr ago. The discomfort was of a few years duration and definitely had started after dental treatment. The radiographic examination revealed that the root filling of the right maxillary second premolar tooth had extruded into the maxillary sinus (Fig. 1). A dense, well-defined radiopaque mass near the opening to the nasal cavity was observed. Surgical management was performed at the Istanbul University, Faculty of Dentistry, Department of Oral Surgery. Elevation of a buccal flap revealed a large osseous defect over the apex of right maxillary second premolar with the undersurface of the antral mucosa visible at the base of the hole. The overfilling and the inflammatory tissue around the overfilled paste were removed from the maxillary sinus (Figs. 2 and 3). The sinus was irrigated with saline solution. Because of the inadequate root filling, the second maxillary premolar tooth was retreated by lateral condens of gutta-percha. AH Plus was used as a filling material. After the wound was cleaned, the flap was sutured to its original position. Anti-inflammatory and pain medication were given to the patient for the first 3 days, and antibiotics for 7 days. Sutures were removed after 7 days. The chronic orbital pain and headache were totally eliminated. When examined 1 yr postoperatively, the patient remained pain- free, and the radiograph showed restitution of a normal periapex with regeneration of the osseous sinus floor (Fig. 4). DISCUSSION Serious problems such as maxillary sinusitis including aspergil- losis infection, paresthesia, and similar neural complications may occur after overfilling (7). Teeth with overextension of the root- canal sealer into the sinus might be the main etiological factor for FIG 1. Preoperative panoramic radiograph showing overfilling of the root canal. JOURNAL OF ENDODONTICS Printed in U.S.A. Copyright © 2003 by The American Association of Endodontists VOL. 29, NO. 11, NOVEMBER 2003 771