How to tell if root of molar extends into sinus cavity?!

How to tell if root of molar extends into sinus cavity?

I am having an upper 2nd molar extracted tomorrow (#2). I was told if the oral surgeon determines the root of the molar to extend into the sinus cavity it would require oral surgery for removal, which will cost more. I have an xray of my tooth from my dentist. How can I tell if it is in the sinus cavity or not? I have tried to google for pictures, but have had no luck. Just getting a little anxious about the bill... not so worried about the removal, I trust my doctor very much.

Thank you.

5 days ago
This tooth never had a root canal. It had a cavity that spread and part of my tooth broke off. I had an abscess earlier last month, and after finishing a round of clindamycin my dentist referred me to an oral surgeon to have it removed.

With Dr. Albert being the exception, I am a bit puzzled with the responses I am seeing.

Here are the facts, because I am a licensed dentist and I look at X-rays every day:

1 - You CAN see the entire tooth, including the roots, if the periapical X-ray (the "little ones") is taken properly. The borders of the sinus can be visible on PAs of maxillary molars.

2 - Maxillary molars can be very close to the sinuses, yes. Sometimes right under the periosteum (the layer of soft tissue that lines the sinus cavities) if the person has pneumatized sinuses. Again, this can be seen on properly-taken PA x-rays.

3 - There are two dangers in extracting a maxillary molar that is right under the sinuses' periosteum. The first is that when the tooth is pulled, it might pull a piece of that periosteum out with the tooth root, creating an opening between the sinus and the oral cavity (what we call an oral-antral fistula), which can lead to a sinus infection. The second is that a root might break, and in the action of trying to retrieve the broken root, the practitioner might accidentally shove the root tip into the sinus, also causing a sinus infection.

How can a dentist manage the dangers? Experience and judgment. Most upper-jaw molars are not difficult to extract because the maxillary bone is spongy and it is easy to elevate a tooth out of there with minimal trauma. It is the ones that had previous root-canal treatments that worry us, because those do get broken roots quite frequently (with the potential for shoving a broken tooth root into the sinus). For those teeth, dentists often refer those to oral surgeons for extraction.

Basically, your oral surgeon is just warning you of the possibility that a tooth root might be shoved into your sinus in the process of extraction. It does not happen often, but they want you to hope for the best but be prepared for the worst. That's all.