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Root Displaced Into Sinus — ORE Part 1 MCQ

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HardOral SurgeryRoot Displaced Into SinusORE Part 1

A 55-year-old man undergoes extraction of the upper left first molar. During the procedure, a root tip fractures and is displaced into the maxillary sinus. The remaining tooth is removed successfully. What is the most appropriate immediate management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Suture the socket, give sinus precautions, prescribe antibiotics and arrange urgent OMFS referral

**A is correct.** A root fragment displaced into the maxillary sinus is not managed by blind further elevation through the socket. The socket should be closed, the patient given sinus precautions, antimicrobials prescribed in the context of the oro-antral communication, and urgent referral made for specialist management. UK Faculty of Dental Surgery guidance states that root fragments introduced into the sinus require immediate referral and specialist management within 48 hours. NHS England categorises displaced fragments into the maxillary antrum and procedures requiring antral access as Level 3 complexity. **B** risks driving the fragment further into the sinus and enlarging the communication. **C** describes a specialist surgical approach, not an immediate procedure for routine primary dental practice. **D** does not provide definitive closure or appropriate urgent referral. **E** is unsafe because a retained sinus foreign body may cause sinus complications; observation alone is not the appropriate immediate plan in this scenario.

Reference: Faculty of Dental Surgery, Royal College of Surgeons of England. Antimicrobial Prescribing in Dentistry, section 12.1.5 “Oral antral communications”, 2020. https://www.rcseng.ac.uk/-/media/Files/RCS/FDS/Publications/FDS-AMP-2020.pdf