A Fractured Molar, a Broken Instrument and a Sinus in the Way: How We Replaced the Tooth in a Single Visit

The patient and the problem

The patient came to us with a fractured upper first molar that had previously undergone root canal treatment. Radiographs showed two critical findings: the crown had broken beyond a restorable level, and a fragment of an endodontic instrument was lodged inside the palatal root.

Why not simply retrieve the instrument and save the tooth?

Retrieving a separated file from the palatal root of an upper molar is sometimes possible. It becomes unpredictable when the fragment lies deep or beyond a curve, because removing it can require cutting away so much root dentine that the tooth is left weaker than before. Combined with the crown fracture, the prognosis was poor. In that situation the most honest advice is to remove the tooth and plan a replacement that protects the bone, rather than keep repairing something that will fail.

The anatomical challenge: the maxillary sinus

Above the roots of upper molars lies the maxillary sinus, an air-filled cavity. After a molar is lost, the bone between the socket and the sinus floor often shrinks. If an implant of adequate length is placed without preparation, it can push through into the sinus. The usual answer is a sinus lift, in which the sinus membrane is gently raised and the space is filled with bone graft.

In this case, assessment of the available bone allowed an indirect sinus lift, which spared the patient a second, more invasive surgery.

The procedure, step by step

1. Local anaesthesia. The entire procedure was carried out with local anaesthesia, and the patient stayed awake and comfortable throughout.
2. Atraumatic extraction. The fractured molar and the separated instrument inside it were removed with care to preserve the surrounding bony walls of the socket. Preserving these walls matters because they hold the graft and later support the implant.
3. Socket preparation and indirect sinus lift. Working through the socket floor, the sinus membrane was lifted gently and without perforation to create room beneath it.
4. Bone grafting. Graft material was placed beneath the lifted membrane and around the socket, building the bone that the implant would need to anchor in.
5. Immediate implant placement. An implant was placed in the same visit, positioned along the path of the prepared bone and engaging the grafted site.
6. Suturing. The tissue was closed to protect the graft and to allow undisturbed healing.

What the X-rays show during and after treatment

Why this case matters for patients

• One visit, not several. Extraction, grafting and implant placement were combined, which shortens the overall treatment timeline compared with waiting months between stages.
• Bone preserved, not lost. Grafting at the time of extraction helps limit the bone shrinkage that normally follows tooth loss.
• Comfort. Local anaesthesia alone was sufficient.
• Planning is everything. A case like this depends on careful radiographic assessment of bone height, sinus position and root anatomy before the first incision.

Complex implant cases succeed through teamwork, precise planning and respect for anatomy. Our approach at Dental Arch, Gurgaon is to explain every option honestly, including when a tooth should and should not be saved.

Frequently asked questions

Is a sinus lift painful?

With local anaesthesia, the procedure itself is not painful. Mild swelling or tenderness afterwards is common and is managed with medication and care instructions.

Can an implant really be placed on the same day as the extraction?

In suitable cases, yes. It depends on the condition of the socket, the amount of bone, and the absence of active infection. Not every tooth qualifies, which is why assessment comes first.

What happens to a broken instrument left in a root?

Many separated fragments are managed without harm. When the tooth is also structurally compromised, as here, extraction and replacement may be the most predictable path.