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Aim: To show how an unsuccessful retrieval attempt of a broken root tip of an upper molar could lead to dislocation into the maxillary sinus and and end up at the ostium of the maxillary sinus, necessitating a FESS procedure for retrieval. Summary: An upper right first molar was removed with forcesp extraction. The extraction was complicated with a root fracture. Manipulating the residual root tip resulted in root tip dislocation into the maxillary sinus. It was decided to leave the root tip at the bottom of the sinus, but in the following months the root tip migrated and got stuck into the ostium of the maxillary sinus. There, it was retrieved using functional endoscopic sinus surgery (FESS). Key Learning Points: 1. Manipulating a residual root tip after forceps extraction of an upper molar significantly increases the risk of root tip dislocation into the maxillary sinus. 2. Broken root tips of upper molar roots protruding into the maxillary sinus need not to be removed when it concerns healthy vital pulps. 3. Retrieval attempts of broken root tips can lead to dislocation of the root tip into the maxillary sinus if the roots were protruding into the maxillary sinus or if an insufficient bony barrier separates the maxillary sinus from the alveolar socket. 4. Cone beam ct is the radiological exam of preference to locate a dislocated root tip in the upper jaw. 5. A root tip stuck at the ostium of the maxillary sinus is best removed with a FESS-procedure.

Root tip migration into the infundibulum of the maxillary sinus after complicated first molar extraction