A foreign object in the osteomeatal complex

Objectives: The objective for this case study was to determine the nature of the radio-opague object in the osteo-meatal complex.
Methods: Case study
Results: A 40-year-old Caucasian female was referred from a general dental practitioner to an oral and maxillofacial (OMF) surgeon to place an implant in the area of tooth number 25 and to evaluate a neighbouring tooth (24) which had a poor prognosis. The cone-beam CT scan confirmed the radio-opaque area in the right OMC, with it bulging into the ethmoid infundibulum. The differential diagnosis of the radio-opaque area in the OMC was that of either a fungus ball or foreign object. The root rest of 24 was removed atraumatically and 2 implants were placed.An endoscopic evaluation of the right OMC was performed and the foreign body was subsequently removed transnasally via an endoscopic sinus approach. The foreign body was carefully removed from the area to avoid injury to the orbital floor. The macroscopic investigations of the biopsy specimen revealed three grey-yellowish fragments which were each 3–5 mm in cross section. The presence of a black pigmented foreign body was noted. The black pigmented material was suggestive of tooth restorative material and it had the appearance of dental amalgam. The biopsy taken from the present case was not chemically analyzed to confirm the presence of dental amalgam; therefore it can only be assumed that the foreign body which was removed was in fact amalgam taken the macroscopic description thereof. A postulated mechanism of the amalgam migrating to the OMC can be explained by the explanation provided in the case reported by Raman and Padgham, 2007. The dental amalgam could have entered the maxillary sinus during the restorative procedure. It the abovementioned case, the patient started experienced symptoms shortly after the dental procedure.
Conclusions: The present case highlighted the importance of imaging as an important adjunct to clinical assessment of the dental patient. Cone Beam Computed Tomography has become indispensable to the surgical planning of dental implantology since it describes detail of anatomical structures in the vicinity of the surgical site and supersedes the limited view of 2 dimensional x-rays. This underlines the importance of a full radiological evaluation before any implant surgery is contemplated.