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Management of a perplexing sinus lift complication.

BACKGROUND
This case report describes a dilemma that occurred after a maxillary right lateral window sinus lift was performed. The patient developed a gnawing pain in the sinus region but manifested no signs of sinusitis, and the subjacent teeth were asymptomatic. Differentiating between a pain that could be originating in the maxillary sinus or adjacent premolars was problematic.


METHODS
After several weeks, a CT scan revealed no signs of sinusitis, despite the patient's belief that her discomfort was caused by her sinus lift. By the process of elimination, the decision was made to extract subjacent, asymptomatic premolars that had 50% bone loss and were previously endodontically treated.


RESULTS
Extraction of asymptomatic premolars resulted in total elimination of her pain.


CONCLUSIONS
A differential diagnosis with regard to the source of the patient's pain had to be arrived at by the process of elimination rather than by validation. Confirmation that there was no sinus infection facilitated making the decision to remove asymptomatic premolars.