Correlation of cone beam computed tomography (CBCT) findings in the maxillary sinus with dental diagnoses: a retrospective cross-sectional study

Unilateral Sinus Disease: What Is, and Is Not Odontogenic Sinusitis?

The differential diagnosis of unilateral sinus disease (USD) is broad, and while concerning etiologies like sinonasal neoplasia, invasive fungal sinusitis, and cerebrospinal fluid rhinorrhea should always be considered, most cases are due to noninvasive inflammatory or infectious conditions. To diagnose USD appropriately, clinicians must integrate the clinical history and examination, nasal endoscopy, computed tomography (CT), and possibly MRI. Odontogenic sinusitis (ODS) is the most common cause of unilateral maxillary sinus opacification on CT, with 45% to 75% of such cases being odontogenic in nature. This study provides USD diagnostic considerations and reinforces the diagnostic approach to ODS.

Increased risks of maxillary sinus mucosal thickening in Chinese patients with periapical lesions

Objectives

This study aimed to evaluate the effects of factors related to periapical lesions (PALs) on sinus membrane thickening (SMT) in the Chinese population using cone-beam computed tomography (CBCT).

Methods

In this retrospective study, CBCT images (n = 512) of maxillary sinuses of 446 patients were evaluated by two examiners for SMT and PALs, PAL size, and the distance between the maxillary sinus floor (MSF), and the PAL's edge/root apex. The data were analyzed using analysis of variance, the Kruskal-Wallis test, χ²-test, and logistic regression.

Results

A binary logistic regression model showed that the prevalence and severity of SMT > 2 mm were significantly associated with older age (>60 years) (odds ratio [OR]: 4.03, 95% confidence interval [CI]): 2.24-7.72, P < 0.001], male sex (OR: 2.08, 95% CI: 1.21-3.56, P < 0.006), and PALs (OR: 6.89, 95% CI: 3.93-12.08, P < 0.001). The type of contact and penetration between the MSF and PALs or root apex showed a more significant relation with SMT > 2 mm than did distance after adjusting for confounding factors, including age and sex (PALs: OR = 10.17 and 14.57, P < 0.001; root apex: OR = 3.49 and 5.86, P < 0.001).

Conclusions

The prevalence and severity of SMT were significantly associated with older age, male sex, PALs, PAL size, and the distance between the MSF and PALs/root apex. Therefore, communication between dental surgeons and an otolaryngology specialist is important for the timely diagnosis and treatment of SMT of dental origin.

CBCT Evaluation of Periapical Pathologies in Maxillary Posterior Teeth and Their Relationship with Maxillary Sinus Mucosal Thickening

In modern dentistry, radiographic imaging is crucial for examining the connection between the maxillary sinus floor and the root apices of the maxillary posterior teeth, particularly when the periapical region is affected by pathology that could result in infectious, inflammatory, or traumatic changes in the maxillary sinus. This study aimed to investigate the prevalence of periapical pathologies in the maxillary posterior teeth and their relationship with maxillary sinus mucosal thickening by using cone-beam computed tomography scans. This retrospective study was conducted on 420 digitized CBCT images which were scanned in sagittal, axial, and coronal views. Out of 420 total images, 223 (53.1%) were of males and 197 (44.9%) were of females. The data were analyzed using SPSS version 28. A total of 2936 posterior maxillary teeth were tested for periapical pathology (PP), 1477 on the right side and 1459 on the left side. In terms of gender, there was no significant relationship between PP in maxillary posterior teeth on both sides and mucosal thickness of the maxillary sinus (p > 0.05). A significant relationship was found between PP in maxillary posterior teeth on both sides and maxillary sinus mucosal thickening (p < 0.05). This study concluded that the prevalence of periapical pathology in the maxillary posterior teeth was significantly associated with a rise in the incidence of maxillary sinus mucosal thickening. Moreover, the primary causative factor for the pathophysiology of the odontogenic maxillary sinus was the periapical pathology in both maxillary first molars.

Association between Periodontitis and Chronic Rhinosinusitis Involving Maxillary Sinus Measured by Lund Mackay Staging System

This study aimed to evaluate the association between periodontitis and chronic rhinosinusitis (CRS) via cone-beam-computed tomography (CBCT) using the Lund–Mackay staging system. CBCT images from different departments of the school of dentistry, at Prince Sattam University were evaluated for the presence of rhinosinusitis. All the CBCT scans were exposed for multiple indications, and no patients had a scan exposed solely for this study. The Lund–Mackay staging system was used to measure the CRS in the CBCT. Descriptive statistics for the frequencies and percentages were used to summarize the data. Logistic regression was used to examine the associations between periodontitis and CRS. Each variable was assessed individually by using multivariable analysis. Collinearity issues among the variables were solved to select a limited set of factors using a stepwise variable selection procedure. A total of 399 CBCT images were included in the current research. Logistic regression showed that only gender was significantly associated (p = 0.0001) with the presence of CRS. However, a stepwise variable selection procedure included gender and bone loss as significantly associated with CRS. No significant difference was observed between unilateral vs. bilateral CRS in gender, bone loss, medical status, and periodontitis. However, only gender showed a significant difference in both bilateral vs. no CRS and unilateral vs. no CRS. Periodontitis is not associated with CRS. However, gender has a significant influence on CRS.

Effect of field of view (FOV) positioning and shielding on radiation dose in paediatric CBCT

OBJECTIVE

To investigate the effect of two different large field of view (FOV) positions in the vertical dimension and shielding (thyroid collar and eyeglasses) on the effective dose and the local doses of various sites of the craniofacial complex.

METHODS

Organ doses and effective doses were calculated based on the measured doses using 27 pairs of thermoluminescent dosemeters in a paediatric tissue-equivalent of a 10-year-old anthropomorphic phantom. The large FOV of the 3D Accuitomo F170 CBCT scanner was used to image parts of the craniofacial complex. Six protocols were performed: (A) cranial position without shielding; (B) cranial position with shielding; (C) caudal position without shielding; (D) caudal position with shielding, (E) similar to C with 3600 rotation and (F) similar to D with 360° rotation. Measurements were obtained in duplicate, and the relative δ value (%) was applied to compare the average doses between the protocols.

RESULTS

Changing the FOV position from cranial to caudal without using shielding resulted in an increase of the effective dose of 18.8%. Use of shielding in the caudal position reduced the dose by 31.6%. Local absorbed dose of the thyroid had the most relevant impact on calculation of the effective dose, followed by oesophagus, bone marrow and bone surfaces, especially when comparing the different protocols.

CONCLUSIONS

Application of shielding devices for thyroid in combination with a most caudal positioning of FOV led to the lowest local absorbed doses as well as the effective dose in a child phantom model.

Evaluation of relationship between odontogenic infections and maxillary sinus changes: A Cone Beam Computed Tomography-based study

Introduction

Odontogenic infections affects the maxillary sinus mucosa. Cone Beam Computed Tomography (CBCT) is helpful in diagnosis of maxillary sinusitis of odontogenic origin. This cross-sectional study was planned with the aim to assess maxillary sinus changes associated with odontogenic infection by evaluating CBCT images.

Material and methods

In cross-sectional analytical study, total 213 patients (404 sinuses) were evaluated on CBCT after thorough clinical examination of the individuals and taking into consideration the history of rhino or allergic rhinitis. Based upon CBCT images and clinical examination, patients were divided into, study group (odontogenic infection) and control group (no associated odontogenic infection). Effect of the size of periapical lesion, spatial relationship of lesion to the sinus floor and periodontal bone loss on maxillary sinus changes were evaluated.

Results

Mucosal changes found in 200 sinuses (49.5%), mucosal thickening being the most prevalent and more commonly associated with odontogenic infections (p = 0.004). A significantly increased risk of mucosal thickening was observed with severe periodontal bone loss (p = 0.008). Size and spatial relationship of lesion to the maxillary sinus had no impact on the prevalence of mucosal thickening (p = 0.6, p = 0.4 respectively). Periodontal bone loss was 2.2 more likely to be associated with mucosal thickening than periapical or combined lesion.

Conclusions

Most prevalent sinus change was mucosal thickening. Periodontal bone loss was significantly associated with mucosal thickening. CBCT is an appropriate method for sinus evaluation.

The use of cone-beam computed tomography (CBCT) in radiocarpal fractures: a diagnostic test accuracy meta-analysis

OBJECTIVE

Occult radiocarpal fractures often present a diagnostic challenge to the emergency department. Accurate diagnosis of these injuries is crucial as a missed fracture can lead to significant morbidity. Cone-beam CT (CBCT) scan is a novel imaging modality, with minimal radiation exposure and comparatively fast acquisition time. Our aim was to evaluate its use in the diagnosis of cortical fractures in the upper limb extremity.

MATERIALS AND METHODS

We conducted a systematic review of literature and included all studies that evaluated the use of CBCT in the diagnosis of radiocarpal fractures. We used a mixed-effects logistic regression bivariate model to estimate the summary sensitivity and specificity and constructed hierarchical summary receiver operative characteristic curves (HSROC).

RESULTS

We identified 5 studies, with 439 patients, and observed CBCT to be 87.7% (95% CI 77.6-93.6) sensitive and 99.2% (95% CI 92.6-99.9) specific for scaphoid fractures. For carpal fractures, CBCT was observed to have a pooled sensitivity and specificity of 90.6% (95% CI 72.7-97.2) and 100% (95% CI 99-100) respectively. For distal radius fractures, CBCT sensitivity was 90% (95% CI 67-98) and specificity was 100% (95% CI 10-100). The overall inter-rater agreement effect was shown to be 0.89 (95% CI 0.82-0.96), which is deemed to be almost perfect.

CONCLUSION

CBCT is an accurate diagnostic tool for occult radiocarpal cortical fractures, which could replace or supplement radiographs. We believe CBCT has a promising role in the acute radiocarpal fracture diagnostic algorithm in both emergency and trauma departments.

Diagnosing odontogenic sinusitis of endodontic origin: A multidisciplinary literature review

PURPOSE

Endodontic disease is one of the most common causes of bacterial odontogenic sinusitis (ODS). Diagnosing ODS of endodontic origin involves otolaryngologists confirming sinusitis, and dental specialists confirming endodontic sources. The purpose of this study was to conduct a multidisciplinary literature review to highlight clinical and microbiological features of ODS, and the most optimal diagnostic modalities to confirm endodontic disease.

METHODS

An extensive review of both medical and dental literature was performed by rhinologists, endodontists, and an infectious disease specialist. Frequencies of various clinical and microbiological features from ODS studies were collected, and averages were calculated. Different endodontic testing and imaging modalities were also evaluated on their abilities to confirm endodontic disease.

RESULTS

ODS patients most often present with unilateral sinonasal symptoms for over 3 months, purulence on nasal endoscopy, and overt dental pathology on computed tomography (CT). Subjective foul smell, and maxillary sinus cultures demonstrating anaerobes and α-streptococci (viridans group) may be more specific to ODS. For endodontic evaluations, cold pulp testing and cone-beam CT imaging are most optimal for confirming pulpal and periapical disease.

CONCLUSION

Diagnosing ODS requires collaboration between otolaryngologists and dental specialists. Clinicians should suspect ODS when patients present with unilateral sinonasal symptoms, especially foul smell. Patients will generally have purulent drainage on nasal endoscopy, and both sinus opacification and overt dental pathology on CT. However, some patients will have subtle or absent dental pathology on CT. For suspected endodontic disease, endodontists should be consulted for at least cold pulp testing, and ideally cone-beam CT.

Imaging technologies for the detection of sinus pathologies of odontogenic origin. A review

Sinus pathologies of odontogenic origin (SPO) are common in the clinical consultation; however, the dentist has some complications to detect them because their discovery is usually incidental and through imaging studies that, in most cases, are of low quality. The objective of this review is to describe the pertinent imaging resources that allow the detection of the most frequent SPO and, at the same time, carry out an updated review of the scientific literature in order to recognize the imaging of both the maxillary sinus and the dental organs. The scientific literature focused on this topic, published between 2014 and 2020, was consulted. The review showed two important results: the first is that Cone Beam Tomography (CBCT) represents the imaging modality with the best performance for the detection of SPO by what can be considered the gold standard for this purpose. The second is that the most frequent SPO is sinus mucositis, which is related to odontogenic conditions such as periapical lesions and periodontal affectations. Although Cone Beam Computed Tomography (CBCT) is the most appropriate tool to detect SPO compared to images obtained by 2D devices, there are also other alternatives such as magnetic resonance imaging and ultrasonography, which seem to have a promising future.

Odontogenic infection as a predisposing factor for pathologic disorder development in maxillary sinus

OBJECTIVE

To investigate an association between odontogenic infections (OI) and maxillary sinuses pathologic disorder (MSPD). The distance between the sinus floor and the root apex of upper posterior teeth was also assessed.

METHODS

Out of 4,402 cone beam computed tomography scans, 230 were selected, and 431 teeth were evaluated regarding the presence of OI: bone loss with furcation involvement, periapical and endodontic-periodontal lesions. The maxillary sinuses were assessed regarding the presence of MSPD, which was considered as mucosal thickening, opacification of the sinus and mucous retention cyst.

RESULTS

There was a significant association between OI and MSPD (p < .001). Periodontal bone loss with furcation involvement, periapical lesions and endodontic-periodontal lesions increased the risk of opacification of the sinuses by 11.6, 34.1 and 228.8 times, respectively. The frequency of the different types of MSP showed not to be associated with a group of teeth or dental root. Conversely, the presence of MSP was associated with a significant shorter distance between the palatine root apex and the sinus floor (p < .001).

CONCLUSION

There is a relationship between infectious process of teeth and MSPD. The proximity between the apex of palatine roots and the maxillary sinus floor showed to be a predisposing factor for MSPD.

Association between maxillary sinus pathology and odontogenic lesions in patients evaluated by cone beam computed tomography. A systematic review and meta-analysis

Background

A study is made of the association between maxillary sinus pathology and odontogenic lesions in patients evaluated with cone beam computed tomography.

Material and Methods

A literature search was made in five databases and OpenGrey. Methodological assessment was carried out using the Newcastle-Ottawa tool for observational studies. The random-effects model was used for the meta-analysis.

Results

Twenty-one studies were included in the qualitative review and 6 in the meta-analysis. Most presented moderate or low risk of bias. The periodontal disease showed to be associated with the thickening of the sinus membrane (TSM). Mucous retention cysts and opacities were reported in few studies. The presence of periapical lesions (PALs) was significantly associated to TSM (OR=2.43 (95%CI:1.71-3.46); I2=34.5%) and to odontogenic maxillary sinusitis (OMS) (OR=1.77 (95%CI: 1.20-2.61); I2=35.5%).

Conclusions

The presence of PALs increases the probability of TSM and OMS up to 2.4-fold and 1.7-fold respectively. The risk differences suggests that about 58 and 37 of out every 100 maxillary sinuses having antral teeth with PALs are associated with an increased risk TSM and OMS respectively. The meta-evidence obtained in this study was of moderate certainty, and although the magnitude of the observed associations may vary, their direction in favor sinus disorders appearance, would not change as a result.

Key words:Sinus pathology, Odontogenic Sinusitis, Sinus membrane thickening, CBCT, Periapical lesions, Periodontal disease

French Otorhinolaryngology Society (SFORL) good practice guidelines for dental implant surgery close to the maxillary sinus

OBJECTIVES

To draw up guidelines for ENT management associated with dental implant surgery with or without sinus lift.

MATERIALS AND METHODS

The methodology followed the rules of laid down by the French Health Authority (HAS): "Methodological bases for drawing up professional recommendations by formalized consensus". The chosen method was the RAND/UCLA "RAND appropriateness method" (short version).

RESULTS

In the pre-implantation check-up, it is recommended to systematically screen for sinonasal pathology on medical interview and to favor 3D CT or cone-beam imaging. It is recommended that imaging include the entire maxillary sinus when the patient does not have sinonasal history or functional signs on interview. Otherwise, examination of all sinonasal cavities is recommended. This attitude enables simultaneous analysis of maxillary infrastructure for pre-implantation work-up and assessment of sinonasal cavity status. Sinus mucosal incidentalomas are very common in the healthy population and must be assessed with reference to the clinical, endoscopic and radiological context.

CONCLUSION

This formalized expert consensus establishes a common base of knowledge, to clarify the issues and clinical situations and to standardize practices.

Morphological variations of the maxillary sinus floor adjacent to periapical chronic injuries

Background

Today, there are several diagnostic methods to determine the exact size and nature of periapical lesions. Furthermore, there are studies that described thickening of the mucous membrane of the maxillary sinus (MS) in patients with periapical lesions and demonstrated a causal relation.

Aims

This study aims to evaluate the morphological variations of the MS floor (MSF) adjacent to chronic periapical lesions in molars and premolars using cone-beam computed tomography (CBCT).

Methods

Twenty-five CBCTs with periapical lesions adjacent to maxillary molars and premolars were evaluated. A total of 50 maxillary sinuses were analyzed (12 males and 13 women) taking into account density changes within the sinus cavity. The thickening of the sinus mucosa and the periapical lesions was measured in a caudal-cephalic direction. The axial and sagittal axis was taken as reference on the sagittal and coronal sections.

Statistical Analysis

Chi-square, Fisher exact, and the Mann-Whitney tests were used in this study.

Results

A significant association between the size of the periapical lesions (>4 mm) and the presence of MSF affectation was found on sagittal and coronal views (P < 0.001). No significant differences between the presence or absence of periapical lesions and the thickening of the sinus mucosa were found (P = 0.241). The presence of opacification on the MS had no direct associations with the periapical lesions.

Conclusions

Maxillary sinus floor affectation was associated with chronic periapical lesions >4 mm. The opacification or thickening of the sinus mucosa was not related with the periapical lesions.

Periapical and Endodontic Status Scale for Endodontically Treated Teeth and Their Association with Maxillary Sinus Abnormalities: A Cone-beam Computed Tomographic Study

INTRODUCTION

This retrospective cross-sectional study investigated the applicability of the periapical and endodontic status scale (PESS) to determine the association of endodontically treated teeth with maxillary sinus (MS) abnormalities through cone-beam computed tomographic imaging.

METHODS

A total of 631 endodontically treated teeth were analyzed. MS abnormalities were classified as mucosal thickening, sinus polyp, antral pseudocyst, nonspecific opacification, periostitis, and antral calcification. The PESS was used to evaluate the quality of endodontic treatment as well as periapical tissue conditions. The data were analyzed by chi-square tests (P < .05).

RESULTS

MS abnormalities were detected in 70.52% of the sample, with a greater prevalence of mucosal thickening (38.19%), whereas periapical lesions were observed in 55.94% of the cases. Treated root canals with unsatisfactory filling, homogeneity, and coronal sealing had an odds Ratio (OR) of 2.21, 2.88, and 2.99, respectively (P < .001). Periapical lesions larger than 5 mm (OR = 314.95), in more than 1 root (OR = 3.72), involving the furcation region (OR = 5.21), in contact with important structures (OR = 7.37), and with cortical bone destruction (OR = 4.09) were significantly related to the presence of MS abnormalities (P < .001). An OR of 99,668 was observed in periostitis lesions greater than 5 mm (P < .001).

CONCLUSIONS

The PESS proved to be an important tool for the analysis of endodontic and periapical conditions and was applicable to determine potential associations with MS abnormalities.

Comparison of cone-beam computed tomography and panoramic radiography in the evaluation of maxillary sinus pathology related to maxillary posterior teeth: Do apical lesions increase the risk of maxillary sinus pathology?

Purpose

The aims of this study were first, to compare panoramic radiography with cone-beam computed tomography (CBCT) for evaluating topographic relationships, such as the classification of maxillary posterior teeth and their distance to the maxillary sinus floor; and second, to determine the relationship between maxillary sinus pathology and the presence of apical lesions.

Materials and Methods

In total, 285 paired CBCT and panoramic radiography records of patients (570 maxillary sinuses) were retrospectively analyzed. Both imaging modalities were used to determine the topographic relationship of the maxillary posterior teeth to the sinus floor. Mucosal thickening >2 mm was considered a pathological state. Data were analyzed using the chi-square, Wilcoxon, and Mann-Whitney U tests. Odds ratios (ORs) and confidence intervals (CIs) were calculated.

Results

The closest vertical distance measurements made between posterior maxillary teeth roots and the maxillary sinus on panoramic radiography and CBCT scans showed statistically significant differences from each other (P<0.05). Compared to panoramic radiography, CBCT showed higher mean values for the distance between the maxillary sinus floor and maxillary posterior teeth roots. The CBCT images showed that at least 1 apical lesion adjacent to the right maxillary sinus increased the risk of maxillary sinus pathology by 2.37 times (OR, 2.37; 95% CI, 1.58-3.55, P<0.05).

Conclusion

Panoramic radiography might lead to unreliable diagnoses when evaluating the distance between the sinus floor and posterior roots of the maxillary teeth. Periapical lesions anatomically associated with maxillary sinuses were a risk factor for sinus mucosal thickening.

Evaluation of Odontogenic Maxillary Sinusitis with Cone Beam Computed Tomography: A Retrospective Study with Review of Literature

Aim and Objectives:

The purpose of this study was to describe the radiographic characteristics of odontogenic maxillary sinusitis as seen on cone beam computed tomography (CBCT) scans and determine whether any tooth or any tooth root, was more frequently associated with this disease.

Materials and Methods:

The present study included 500 CBCT images that included the entire maxillary sinus of both the sides in all the three planes. The modified classification of Abrahams and Glassberg was used to assess maxillary sinusitis of odontogenic origin. Furthermore, the proximity of the tooth root to the sinus floor, periapical pathology, and the septae within the maxillary sinus were also assessed.

Results:

In the present study, 1000 hemimaxillas were analyzed. Majority of the cases (74.9%) the apex of either tooth was touching the floor of the sinus. While 16.9% were in close relationship to the sinus while 8.2% of the cases, the apices were present within the sinus. Furthermore, in the present study, 38 of the total cases had an odontogenic cause of maxillary sinusitis, whereas 273 of them had a nonodontogenic cause, 96 have an undetermined cause, and the rest 593 cases had healthy sinus.

Conclusion:

The incidence of odontogenic sinusitis is likely under-reported in the available literature. The introduction of low-dose CBCT is particularly useful to establish a definitive diagnosis to augment in the treatment of chronic maxillary sinusitis of odontogenic origin.

What are the risk factors for maxillary sinus pathologies? A CBCT study

OBJECTIVE

Some anatomic variations may interfere with proper airflow in the maxillary sinus and predispose to maxillary sinus pathologies. It was also reported that as a result of the transport of microorganisms from infected periapical tissues, maxillary sinus pathologies can develop. The objective of this study was to determine the potential relationships of maxillary sinus septa, concha bullosa, nasal septal deviation, and teeth with periapical lesion to maxillary sinus pathologies.

METHODS

200 cone beam computed tomography scans obtained at Necmettin Erbakan University, Faculty of Dentistry from 2013 to 2018 were retrospectively reviewed for the presence of maxillary sinus septa, concha bullosa, nasal septal deviation, teeth with periapical lesions, and maxillary sinus pathologies. When maxillary sinus mucosal thickening exceeded 2 mm, it was considered as a pathological condition. Logistic regression analysis was used to determine the risk factors for maxillary sinus pathologies. p < 0.05 considered statistically significant.

RESULTS

185 (46.2%) of the 400 maxillary sinuses showed maxillary sinus pathologies. Maxillary sinus septa, concha bullosa, and nasal septal deviation were not found to be as a risk factor for the maxillary sinus pathologies (p > 0.05). At least one apical lesion adjacent to the maxillary sinus increased the maxillary sinus pathology by 5.24 times on the right (OR 5.24, p < 0.001) and by 4.67 times on the left side (OR 4.67, p < 0.001).

CONCLUSION

To prevent maxillary sinus pathologies, it is important for the teeth adjacent to the maxillary sinus to be healthy.

Incidental Findings in TMJ Imaging

For years, the conventional imaging modalities are generally used in dental practice routine. They provide precious information about dentomaxillofacial region; they also have some limitations such as superimpositions, magnifications, distortions, and low-image quality. Because of these limitations, some pathologies, calcifications, and anatomical variations may be missed. Any findings on a radiographic image which are not related to the research areas of interest could be a description of “incidental findings.” Calcifications are one of these incidental findings. They are asymptomatic and also common in TMJ images. Although most of the calcifications require no treatment, correct identification will reduce further diagnostic assessments. Incidental findings on TMJ images were rare, while examining images for temporomandibular disorders and associated issues, it is important not only to examine the TMJ structures but also to look at the nearby anatomical features to check for evidence of incidental findings pathologies that may have mimicked signs and symptoms of TMJ disorders.

Analysis of association between periodontal disease and thickness of maxillary sinus mucosa using cone beam computed tomography - A retrospective study

Purpose

The aim of this study was to measure the thickness of the mucous membrane lining the maxillary sinus and to correlate this thickening of the Schneiderian membrane with the presence or absence of periodontal bone loss of adjacent teeth, by using cone beam computed tomography (CBCT).

Methods

255 CBCT images were analyzed of which 140 images were selected for the study. Based upon the absence of radiographic periodontal bone loss and presence of 50% or more bone loss, these CBCT images were respectively divided into two groups viz. Group I (Healthy) and Group II (Periodontal Bone Loss Group), each group consisting of 70 images each. The thickening of the mucous membrane lining of the floor of maxillary sinus was measured at four points on the CBCT. These points were the anterior most point of the thickened mucosa, the posterior most point of the thickened mucosa, at the midpoint (MP) (point midway between the anterior most and the posterior most point) and the point of maximum thickness of the sinus mucosa.

Results

The age adjusted mean thickness for Group II was significantly greater than that of Group I (p < 0.001) at all the four points. There was a positive association between presence of periodontal bone loss and thickening of Schneiderian membrane at the floor of the sinus. There was a weak positive association between age and mucosal thickness. Of all the four points measured, the maximum correlation between age and thickness was obtained at MP (r = 0.171), which was statistically significant (p = 0.044).

Conclusion

The present study concluded that there is a positive association between presence of periodontal bone loss and thickening of mucosa of floor of maxillary sinus and also exhibited a weak positive relation between age and increased mucosal thickening of floor of maxillary sinus.

Effect of periodontal therapy on maxillary sinus mucous membrane thickening in chronic periodontitis: A split-mouth study

Background. This study evaluated the effect of periodontal therapy on mucous membrane thickening in maxillary sinus in chronic periodontitis patients using radiovisiography (RVG) and cone-beam computed tomography (CBCT).

Methods. The study population included 30 patients diagnosed with chronic periodontitis, exhibiting bilateral mucosal thickening of maxillary sinus. The selected sites were randomly assigned to group I (control group - not receiving periodontal therapy) and group II (test group - receiving periodontal therapy). The clinical parameters and mucosal thickening of the maxillary sinus were evaluated at baseline and after 9 months.

Results. There was a significant decrease in the PPD, CAL as well as mucosal thickening in group II while, group I showed an increase in these parameters. In group II at the end of 9 months the mean mucosal thickening reduction as assessed by CBCT was 0.76±0.18, 0.73±0.24, 0.88±0.42 and 1.13±0.43 mm at the most anterior point (AP), the most posterior point (PP), the mid-point (MP), point of maximum thickness (MT) as well as in the length of the thickened mucosal lining, respectively.

Conclusion. The results of our study indicated a reduction in the mucosal thickening of the maxillary sinus after surgical periodontal therapy. The trial was registered with the Clinical Trial Registry of India (Trial REF/ 2016/02/010805).

Retrospective Analysis of Sinus Membrane Thickening: Profile, Causal Factors, and Its Influence on Complications

PURPOSE

To retrospectively determine the profile of the sinus membrane (SM), potential factors affecting SM thickening (SMT), and the correlation between SMT and sinus augmentation (SA) complications.

MATERIALS AND METHODS

In the patients who received lateral SA, SMT was classified in sagittal sections of cone-beam computed tomography according to its thickness and morphology. The correlation between SMT and the following factors was analyzed: age, sex, endodontic and periodontic statuses of neighboring teeth, and shape of the sinus inferior border. The association between SMT and SA complications was investigated.

RESULTS

SMT of ≤2 mm was prevalent (60%). Irregular SM was mostly observed for SMT of >2 mm. There was no statistically significant association between SMT and the included factors. SMT did not significantly correlate with either perforation or postoperative complications. There was a statistically significant increase in implant failure when SMT was >2 mm, but it was hard to determine that the failure was solely affected by SMT.

CONCLUSION

SMT was not influenced by the factors included in this study, and it might not be a risk factor for SA and implant failure.

The Effect of Original and Invert Enhanced Panoramic Modality on the Assessment of the Relationship Between the Maxillary Posterior Roots and the Maxillary Sinus Floor

Background:

Having knowledge about the anatomical and pathological relationship between the maxillary posterior root tip and the maxillary sinus floor is very significant for preoperative treatment planning.

Aims and Objectives:

The purpose of the present study was to compare the accuracy of original panoramic radiographs and digital panoramic images over cone beam computed tomography (CBCT) images in evaluating the relationship between the maxillary posterior teeth and the maxillary sinus floor, and to verify the accuracy of the signs of the relationship between the roots of the maxillary posterior teeth and maxillary sinus on the panoramic radiographs over CBCT images.

Materials and Methods:

From 106 subjects (47 males and 59 females; mean age = 39 years; range = 18-67 years) referred to our university, a pair of panoramic and CBCT images was selected for further analysis. The relationship between the maxillary posterior teeth, the maxillary sinus, and panoramic radiography signs (root projection into the sinus, interruption of the maxillary sinus floor cortex, absence of lamina dura, darkening of the root apex, and curvature of the sinus floor on the root apex) associated with the protrusion of root apexes into the sinus was evaluated.

Results:

The P values of the data obtained from the original and invert enhanced panoramic images were .53 and .52, respectively, and there was no statistically significant difference in the accuracy of the 2 methods ( P > .05).

Conclusion:

The root projection into the sinus is an indicative sign of root protrusion into the sinus on CBCT.

Three-dimensional CAD/CAM imaging of the maxillary sinus in ageing process

OBJECTIVES

During the physiological ageing process atrophy of the alveolar bone appears in vertical direction. This bone resorption causes pushing the limits of the maxillary sinus at the expense of a degraded bone. The sinus volume increases due to the facial development in children and adolescents or during the ageing process due to the loss of teeth and bone mass. The main aim of this study is to determine the sinus shape and sinus floor morphology related to age.

MATERIALS AND METHODS

Human adult male and female cadaveric heads (aged 37 to 83 years) with different dental status were used. The three-dimensional CAD/CAM software was used to scan the solid impressions of the maxillary sinus to visualize the real sinus shape and sinus floor. Subsequently, other findings are shown in tables and evaluated graphically.

RESULTS

The maxillary sinus morphology, its relationship to the nasal cavity, the sub sinus alveolar bone height, displacement of the lowest and highest points of sinus, and the sinus relationship to the roots of the upper teeth were studied and evaluated. Some septa, crests, and the prominent infraorbital canal were also found in the area of the sinus floor.

CONCLUSIONS

This paper provides a unique view on the maxillary sinus and its changes during the ageing process with preserved topographical relations in a representative sample of the Slovak population. The visualization of the maxillary sinus anatomy is necessary in the diagnosis and treatment plans for dental implants and during current surgical procedures.

Association between odontogenic conditions and maxillary sinus mucosal thickening: a retrospective CBCT study

OBJECTIVES

This study aimed to assess the maxillary sinus mucosal thickening and to associate them with odontogenic conditions using cone-beam computed tomographic (CBCT) images.

MATERIALS AND METHODS

CBCT images of 294 patients (143 female, 151 males; age range 18-78 years) with 588 maxillary sinuses were evaluated retrospectively. The anatomic relationship between maxillary sinuses and teeth was determined and classified. The presence of root canal fillings and the periapical lesions of these teeth was also recorded. Sinus mucosal thickenings were classified as grade 1 (normal) (< 2 mm), grade 2 (moderate) (2-10 mm), and grade 3 (severe) (> 10 mm). Alveolar bone loss was measured on all maxillary premolar/M teeth.

RESULTS

More than 2-mm mucosal thickening (grade 2 and grade 3) in either one or both maxillary sinuses was found in 172 (58.5%) of the patients. The prevalence of mucosal thickening (> 2 mm) for maxillary sinuses with and without any periapical lesions was 42.1 and 53.6%, respectively (p < 0.05). The prevalence of mucosal thickening increased in patients with periodontal alveolar bone loss (p < 0.05). There was a significant correlation between mucosal thickening with age, gender and missing teeth (p < 0.05).

CONCLUSIONS

Multiple conditions, including periapical infection, root canal treatment, and close relationship maxillary teeth and sinus, may have a precursor effect on the occurrence of mucosal thickening in the maxillary sinus. Periodontal status and its role as a risk factor in triggering maxillary sinus infections should be also considered by not only dental professionals but also the medical professionals to plan for the treatment of maxillary sinus lesions.

CLINICAL RELEVANCE

Maxillary sinuses are significantly influenced by various odontogenic conditions, including periodontal bone loss, periapical lesions, and missing teeth, which may result in thickening of the maxillary sinus mucosa.

Association of dental and maxillary sinus pathologies with ear, nose, and throat symptoms

OBJECTIVES

To investigate the correlation between cone-beam computerized tomography (CBCT) findings in the maxillary sinus, ear-nose-throat (ENT) symptoms and dental pathologies in asymptomatic patients.

MATERIALS AND METHODS

A total 81 patients were referred for CBCT and filled a standard ENT visual analog scale (VAS) questionnaire. CBCT images were analyzed for sinus ostium obstruction, Schneiderian membrane thickening, sinus floor turbidity, and the presence of polyps. Dental pathologies were evaluated with the aid of CBCT images, periapical X-rays, and clinical examination. A possible correlation between the CBCT findings and the ENT/dental parameters was examined by applying Student's t test and the chi-squared test.

RESULTS

Despite being asymptomatic, most of the 81 patients reported ENT symptoms in the questionnaire, thereby indicating that these symptoms were mainly subclinical. A significant correlation was found between the presence of polyps in the sinus and a decrease in smell/taste. Obstruction of the sinus meatus was associated with coughing; turbidity was associated with ear congestion. Thickening of the Schneiderian membrane showed an association with both coughing and ear congestion. The mean number of missing posterior teeth correlated with postnasal drip and nasal congestion. Periapical pathology was associated with nasal discharge/runny nose.

CONCLUSION

The results emphasize the need to evaluate ENT symptoms when radiographic findings are identified in CBCT.

Correlation between Endodontic Infection and Periodontal Disease and Their Association with Chronic Sinusitis: A Clinical-tomographic Study

INTRODUCTION

The proximity of the roots of maxillary posterior teeth to the maxillary sinus floor can be associated with the development of chronic maxillary sinusitis (CMS). Therefore, this study evaluated the correlation between the presence of endodontic infection and periodontal disease in maxillary posterior teeth and the presence of CMS.

METHODS

A total of 83 patients (159 maxillary sinuses) were selected and underwent clinical dental examination to assess tooth mobility and pulp condition. In addition, cone-beam computed tomography was performed to evaluate the presence of periapical lesion and periodontal bone loss, and measure the distance from the root apex to the cortical of the maxillary sinus. The maxillary sinuses were divided into 2 groups: CMS and no maxillary sinusitis. Data were analyzed using χ² test and binary logistic regression analysis (P < .05).

RESULTS

Periodontal disease was positively associated with CMS, leading to a 3.45-fold higher association between these disorders (P < .05). CMS was significantly more common in patients with periodontal disease or endodontic infection in close proximity with the maxillary sinus. Periodontal disease or endodontic infection that was more distant from the maxillary sinus was more common in patients with no maxillary sinusitis (P < .05). To the extent that the tooth is more distant from the maxillary sinus floor, the chance of presenting CMS is reduced up to 2.5-fold (P < .05).

CONCLUSION

Periodontal disease and proximity to the maxillary sinus are more common in cases of CMS, requiring a dental assessment and cone-beam computed tomography evaluation in patients with CMS with ineffective treatment.

Association between demographic and radiographic characteristics of the schneiderian membrane and periapical and periodontal diseases using cone-beam computed tomography scanning: A retrospective study

Background. This study was undertaken to assess the pathological and spatial associations between periapical and periodontal diseases of the maxillary first molars and thickening of maxillary sinus mucosa with cone-beam computed tomography.

Methods. A total of 132 CBCT images of subjects 20‒60 years of age were evaluated retrospectively. The patients' sex and age and demographic and pathologic findings of the maxillary sinus in the first molar area were recorded, graded and analyzed.

Results. Approximately 59% of patients were male and 41% were female, with no significant difference in the thickness of schneiderian membrane between males and females. Based on the periapical index scoring, the highest frequency was detected in group 1. Based on the results of ANOVA, there were no significant differences in the frequencies of endodontic‒periodontal lesions and an increase in schneiderian membrane thickness. There were significant relationships between periapical and periodontal infections (P<0.001) and schneiderian membrane thickness. Furthermore, a significant relationship was detected between the thickness of the schneiderian membrane and the distance between the sinus floor and the root apices (P=0.38).

Conclusion. A retrospective inspection of CBCT imaging revealed that periapical lesions and periodontal infections in the posterior area of the maxilla were associated with thickening of the schneiderian membrane. In addition, there was a significant relationship between the location of maxillary posterior teeth, i.e. the thickness of bone from the root apex to the maxillary sinus floor, and schneiderian membrane thickness.

Transcrestal sinus floor augmentation with immediate implant placement applied in three types of fresh extraction sockets: A clinical prospective study with 1-year follow-up

BACKGROUND

Immediate implant insertion and transcrestal sinus augmentation both can provide a lot of advantages for patients and clinicians.

OBJECTIVE

This prospective study aims to verify the use of a modified technique for immediate implant insertion simultaneously with sinus augmentation in different types of sockets.

MATERIALS AND METHODS

Thirty-seven patients were recruited for the clinical study and were divided into 3 groups according to the relationship of their maxillary molar roots and sinus floor: group 1 with none of the teeth roots contacts sinus floor; group 2 as at least 1 teeth root contacting sinus floor, but no root is observed penetrating into sinus cavity; group 3 with at least 1 teeth root penetrating into sinus cavity. Implants were inserted after transcrestal sinus floor augmentation and immediately after tooth extraction. The change of mucosa thickness, diagnosis of rhinosinusitis, marginal bone loss (MBL), pocket depth (PD), and sulcus bleeding index were examined through radiographic measurement or clinical monitoring.

RESULT

During the study period, no implants failed. The relationship of the root of maxillary molars and sinus floor may have an effect on the bone height of the interradicular crest. Sinus mucosa was observed thicker after surgery. After healing period, sinus mucosa returned as thin as presurgery. At the time of 1-year follow-up, MBL was measured on X-ray (group 1: mesial: 0.63 ± 0.20 mm, distal: 0.70 ± 0.14 mm; group 2: mesial: 0.67 ± 0.21, distal: 0.65 ± 0.22 mm; group 3: mesial: 0.70 ± 0.15 mm, distal: 0.73 ± 0.19 mm). No statistical difference was found in MBL and PD as well as bleeding index among 3 groups.

CONCLUSION

In consideration of the advantages of sinus floor augmentation and immediate implant placement, our clinical result confirms that it is promising to combine the 2 techniques for replacing maxillary molars especially when using residual roots as implant orientation and taking full advantage of the interradicular crest bone.

Incidental Findings in Cone-Beam Computed Tomographic Images: Calcifications in Head and Neck Region

Background/Aim: The use of CBCT in dentistry has been increasing popularity nowadays. CBCT images provide valuable information from anatomic structures and pathologies. Images obtained with CBCT allow for more appropriate treatment planning. The purpose of this study was to assess the calcifications which were found incidentally on CBCT images and to reveal the frequency and characteristics. Material and Methods: A total of 691 CBCT images which obtained from the patients were assessed. Demographic data and calcifications which were found out of primarily interest area were noted. The incidental findings were categorized and analyzed using descriptive statistics. Results: 945 calcifications were discovered on 318(46.02%) of the 691 patients’ images. 373(53.98%) scans showed no calcificated findings. The age range of patients was from 5 to 84 years. The most common calcification was tonsillolith (86.03%), followed by stylohyoid calcifications (6.24%), antrolith and subdermal calcifications (2.33%). Conclusion: Calcified lesions in head and neck region were commonly seen in CBCT images. Although the most of the calcifications are asymptomatic and require no treatment but correct identification of these findings will reduce unnecessary further diagnostic assessments and will provide more appropriate treatment plans. It will also provide the ability comprehensively evaluation of underlying diseases and practitioners will have life-saving information by early diagnosis.

What is the frequency of anatomical variations and pathological findings in maxillary sinuses among patients subjected to maxillofacial cone beam computed tomography? A systematic review

Background

When considering dental implant rehabilitation in atrophic posterior sectors, the maxillary sinuses must be evaluated in detail. Knowledge of the anatomical variations and of the potential lesions found in these structures conditions the outcome of sinus lift procedures and therefore of the dental implants. A systematic review is made to determine the frequency of anatomical variations and pathological findings in maxillary sinuses among patients subjected to cone beam computed tomography (CBCT).

Material and Methods

A PubMed (MEDLINE) literature search was made of articles published up until 20 December 2015. The systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). The quality of the studies included in the review was assessed using the Methodological Index for Nonrandomized Studies (MINORS).

Results

The combinations of search terms resulted in a list of 3482 titles. Twenty-three studies finally met the inclusion criteria and were entered in the systematic review, comprising a total of 11,971 patients. The most common anatomical variations were pneumatization and sinus septa. The prevalence of maxillary sinus disease ranged from 7.5% to 66%. The most common pathological findings of the maxillary sinus were mucosal thickening, sinusitis and sinus opacification.

Conclusions

Although the main indication of CBCT of the maxillary sinus in dentistry is sinus floor elevation/treatment planning and evaluation prior to dental implant placement, this imaging modality is increasingly also used for endodontic and periodontal purposes. There is no consensus regarding the cutoff point beyond which mucosal thickening of the maxillary sinus should be regarded as pathological, and the definition of maxillary sinusitis moreover varies greatly in the scientific literature. In this regard, international consensus is required in relation to these concepts, with a clear distinction between healthy and diseased maxillary sinuses.

Key words:Maxillary sinus, cone beam computed tomography, dental implant, maxillary sinus floor augmentation, sinus membrane, sinus floor elevation.

Incidental findings on cone-beam computed tomographic images: paranasal sinus findings and nasal septum variations

OBJECTIVE

CBCT applications have received widespread acceptance in dentistry. CBCT scans provide three-dimensional information on anatomic structures and characteristics of pathologies, rather than the two-dimensional information obtained with the conventional techniques. The purpose of this study was to evaluate incidental findings in out-of-interest areas on CBCT images and to reveal their frequency and characteristics.

METHODS

A total of 691 CBCT scans from 691 patients were assessed. Demographic data, CBCT indications, and incidental findings outside the primary area of interest, such as anatomical variations and pathologies, were noted. The incidental findings were categorized and analyzed using descriptive statistics.

RESULTS

In total, 1109 incidental findings in paranasal sinuses were noted on 548 of the 691 CBCT scans. The highest rate of incidental findings was maxillary sinus findings, followed by concha bullosa and septum deviation. The most frequently observed pathology was mucosal thickening, followed by polypoid mucosal thickening in the maxillary sinus.

CONCLUSIONS

While most incidental findings require no treatment, some conditions will necessitate modification of the treatment plan. Therefore, dental practitioners should be aware of incidental findings and anatomical variations. Correct identification of these findings will reduce unnecessary further diagnostic assessments and allow selection of more appropriate treatment plans.

Dental implants and grafting success remain high despite large variations in maxillary sinus mucosal thickening

Background

Although mucosal thickening is the most common radiographic finding observed regarding sinus pathology, the knowledge regarding its clinical significance on the outcomes of dental implants and grafting in the maxillary sinuses is still limited. We hypothesized that mucosal thickening would not alter the predictability for sinus floor augmentation and dental implant placement. The purpose of this retrospective study was to evaluate the outcomes of dental implant placement in sinus-augmented areas with preexisting sinus mucosal thickening.

Methods

This study involved the review of cone-beam computed tomographic (CBCT) scans taken on patients that underwent both maxillary sinus elevation with grafting and implant placement at the University of Michigan School of Dentistry from 2004 to 2014. Cases with documented radiographic and clinical follow-up were included. The data analyses revealed the following.

Results

A total of 29 CBCT scans met the inclusion criteria for evaluation, and 93.1% of them had maxillary sinus mucosal/tissue thickening. Specifically, 6.9% of cases exhibited no thickening, 6.9% had minimal thickening (1–2 mm), 20.7% of cases had moderate thickening (2–5 mm), and 65.5% had severe thickening (>5 mm). We propose these categorical measurements of tissue thickening as a new “mucosal thickening index.” The tissue thickening did not vary based on gender, age, or smoking status, nor did it relate to the underlying alveolar ridge height. However, patients with a history of periodontal diseases demonstrated a significant association with mucosal thickening (p = 0.0043). These data indicate that there is high implant and grafting success rate (100%) in the maxillary sinus despite large and varied physiologic sinus mucosal/tissue thickening.

Conclusions

Based on study findings, this research will help guide dental practitioners regarding cases that exhibit mucosal thickening. These data support the concept that physiologic mucosal thickening in varied ranges is not associated with implant or grafting failure in the maxillary sinus.

Do periapical and periodontal pathologies affect Schneiderian membrane appearance? Systematic review of studies using cone-beam computed tomography

OBJECTIVES

This systematic review analyzed the relationship between periapical and periodontal pathologies in the posterior maxilla and the appearance of the Schneiderian membrane in cone-beam computed tomography (CBCT) compared with sound dentitions.

METHODS

Five electronic databases (Cochrane Library, Embase, OpenGrey, PubMed, Web of Science), complemented by hand searching, were screened up to May 9, 2016. Human clinical studies that used CBCT and contained information on the periapical/periodontal status in the posterior maxilla and Schneiderian membrane appearance were included. A weighted vote counting (WVC) method was applied to summarize results across studies.

RESULTS

Out of 413 records, 20 studies were included. In the WVC, the studies that observed a positive association between periapical lesions and the appearance of the Schneiderian membrane outweighed those that found no such association (WVC 51 % and WVC 33 %, respectively), with some studies yielding indeterminate results (WVC 16 %). Regarding the relation between periodontal pathologies and the appearance of the Schneiderian membrane, WVC produced a tie between studies demonstrating a positive association (WVC 46 %) and those showing no association (WVC 44 %); one study (WVC 10 %) reported indeterminate results.

CONCLUSIONS

On CBCT scans, periapical lesions in the posterior maxilla are likely to be associated with Schneiderian membrane thickening. In contrast, current evidence regarding the relation between periodontal diseases and the appearance of the Schneiderian membrane in CBCT is inconclusive.

CLINICAL RELEVANCE

Incidental maxillary sinus findings on CBCT scans warrant thorough differential diagnosis. Frequently, they may be related to dental pathologies.

Incidental paranasal sinusitis on routine brain magnetic resonance scans: association with atherosclerosis

BACKGROUND

Incidental paranasal sinusitis (IPS) is common on imaging for non-sinusitis disorders, usually without symptoms or obstructive features, and possibly arising from periodontitis (PD). PD associations with atherosclerosis have been widely reported. We test if IPS may also be associated with atherosclerosis.

METHODS

IPS was scored retrospectively in a random sample of 180 magnetic resonance (MR) brain scans and compared with chart review for atherosclerosis (all subtypes), rhinosinusitis, and related factors (smoking, asthma, and relevant surgery). IPS was scored out of 30, from all sinuses, with maxillary sinuses weighted double volumetrically. Significant IPS (Sig IPS) was designated as 6 or more out of 30. Bivariate logistic regression was used to test for associations of Sig IPS to the clinical data, with multivariate analysis then testing for potential confounders.

RESULTS

A total of 173 subjects were analyzed (7 exclusions). MR indications included suspected acute/prior stroke (22.0%). Sig IPS found in 20 (11.6%). Positive histories for atherosclerosis were cerebral, 57 (32.9%); coronary, 48 (27.7%); and peripheral arterial disease, 14 (8.1%). IPS ≥6 was strongly associated with cerebrovascular disease (odds ratio [OR] 6.0, p < 0.001), and less robustly to smoking (OR 2.9, p = 0.07) and rhinosinusitis (OR 2.4, p = 0.09). No associations with coronary or peripheral artery diseases were found. After controlling for smoking and rhinosinusitis, yielding significant subclinical sinusitis, the link of Sig IPS to cerebrovascular disease persisted (modified OR 5.2, p = 0.002).

CONCLUSION

Significant incidental sinusitis, which is mostly subclinical sinusitis, is associated with cerebrovascular disease but not other atheroscleroses. This suggests possible common causation of both by PD.

Association between Odontogenic Conditions and Maxillary Sinus Disease: A Study Using Cone-beam Computed Tomography

INTRODUCTION

The maxillary sinus can be affected by dental infections because of its close relationship with upper teeth. This study aimed to assess the most common types of maxillary sinus alterations and to associate them with odontogenic conditions using cone-beam computed tomographic (CBCT) images.

METHODS

CBCT scans of 400 patients showing sinus disease in 1 or both maxillary sinuses were evaluated. Sinus alteration was considered as follows: generalized or localized mucosal thickening (MT), maxillary sinusitis (MS), and retention cysts (RCs). The odontogenic conditions evaluated were inadequate endodontic treatment, periapical lesions, and periodontal bone loss. Descriptive and multiple logistic regression analyses were performed.

RESULTS

Sinus diseases were observed in 85.9% of the maxillary sinuses. The most prevalent condition was generalized MT (65.2%) followed by localized MT (24.8%), MS (6.4%), and RCs (3.6%). Generalized MT was more related to males (odds ratio = 1.45, P < .05) and periodontal bone loss (P < .05). Localized MT was associated with periapical lesions (odds ratio = 3.09, P < .05) and showed a close anatomic relationship between teeth and the sinus floor (odds ratio = 2.77, P < .05). There were no statistically significant associations between either MS or RCs and the odontogenic conditions studied.

CONCLUSIONS

The most prevalent sinus diseases were the generalized and localized MT, and they were the only ones related to odontogenic conditions (periodontal bone loss and periapical lesions, respectively). We emphasize that CBCT imaging is an appropriate method for evaluating the maxillary sinus findings and their associated odontogenic conditions.

Do CBCT scans alter surgical treatment plans? Comparison of preoperative surgical diagnosis using panoramic versus cone-beam CT images

Cone beam CT and/or panoramic images are often required for a successful diagnosis in oral and maxillofacial surgery. The aim of this study was to evaluate if 3D diagnostic imaging information had a significant impact on the decision process in six different classes of surgical indications.

MATERIAL AND METHODS

Records of all patients who had undergone both panoramic X-ray and CBCT imaging due to surgical indications between January 2008 and December 2012 were examined retrospectively. In February 2013, all surgically relevant diagnoses of both conventional panoramic radiographs and CBCT scans were retrieved from the patient's charts. It was recorded whether (1) 3D imaging presented additional surgically relevant information and (2) if the final decision of surgical therapy had been based on 2D or 3D imaging.

RESULTS

A total of 253 consecutive patients with both panoramic radiographs and CBCT analysis were eligible for the study. 3D imaging provided significantly more surgically relevant information in cases of implant dentistry, maxillary sinus diagnosis and in oral and maxillofacial traumatology. However, surgical strategies had not been influenced to any significant extent by 3D imaging.

CONCLUSION

Within the limitations of this study it may be concluded that CBCT imaging results in significantly more surgically relevant information in implant dentistry, maxillary sinus diagnosis and in cases of oral and maxillofacial trauma. However, 3D imaging information did not alter significantly the surgical plan that was based on 2D panoramic radiography. Further studies are necessary to define indications for CBCT in detail.

Proximity of maxillary posterior teeth roots to maxillary sinus and adjacent structures using Denta scan®

Aim:

The study aimed to investigate the proximity of maxillary posterior teeth roots to maxillary sinus and measure the distance of maxillary posterior teeth roots and the sinus floor as well as the thickness of bone between the roots and alveolar cortical bone using Denta scan^®.

Materials and Methods:

The study samples include Denta scan^® images of fifty patients with normally erupted bilateral maxillary first premolar to maxillary second molar. The vertical relationship of each tooth root with maxillary sinus is classified into four types of Denta scan^® images (based on the classification by Jung in 2009). The distance between the sinus floor and root, and the bone thickness between the root and alveolar cortical plate will be measured and analyzed.

Conclusion:

The buccal root of the maxillary molars was more commonly protruded into the maxillary sinus. Among the roots of maxillary posterior teeth, mesiobuccal root of first molar and palatal root of second premolar were found in close proximity to the floor of maxillary sinus. The bone thickness on the buccal aspect to the root was significantly thinner in the maxillary first premolar and maxillary first molar as compared to other maxillary posterior teeth roots.

Clinical Significance:

Knowledge of anatomical relationship between the maxillary posterior teeth and maxillary sinus guides us not only in proper preoperative treatment planning but also avoids the possible complications encounter while performing the minor oral surgical procedures involving maxillary posterior teeth, which are close to the maxillary sinus.

Association between maxillary sinus pathologies and healthy teeth

INTRODUCTION

The proximity of the roots to the maxillary sinus can create a variety of risks.

OBJECTIVE

To evaluate the relationship between the roots of healthy teeth and the maxillary sinus, as well as the occurrence of sinus pathologies.

METHODS

Three radiologists analyzed 109 cone beam computed tomography (CBCT) images. The Kappa test was used to assess the intra- and inter-rater agreement. The chi-squared test and prevalence ratio were used to test the hypothesis that roots of healthy teeth in the maxillary sinus favored the occurrence of sinus pathologies (p=0.01).

RESULTS

Intra- and inter-rater agreement ranged from good to excellent. The chi-squared test demonstrated a statistically significant difference (p=0.006) between the tooth roots in diseased maxillary sinuses (6.09%) and those in normal sinuses (3.43%). The prevalence ratio test showed a statistically significant higher prevalence of tooth roots in diseased sinuses than in normal sinuses (p<0.0001). Roots in the maxillary sinus were 1.82 times more associated with diseased sinuses.

CONCLUSION

Dental roots in the maxillary sinus are almost twice as likely to be associated with diseased sinuses than normal sinuses. Healthy teeth whose roots are inside the maxillary sinus may induce an inflammatory response in the sinus membrane. It is suspected that dental procedures may exacerbate the condition.

Evaluation of Periapical Lesions and Their Association with Maxillary Sinus Abnormalities on Cone-beam Computed Tomographic Images

INTRODUCTION

Periapical inflammation is often responsible for distinct maxillary sinus (MS) changes. This retrospective, cross-sectional study evaluated the association between the clinical characteristics of periapical lesions (presence, size, and distance) in maxillary posterior teeth and the presence of sinus abnormalities by evaluating cone-beam computed tomographic (CBCT) images obtained from an archived collection. Apart from sex, no other patient information was available.

METHODS

The study sample was composed of CBCT images of 143 MSs of patients with at least 1 maxillary posterior tooth with a periapical lesion and 178 MSs of patients without periapical radiolucent lesions. Sinus abnormalities were classified as mucosal thickening, sinus polyp, antral pseudocyst, nonspecific opacification, periostitis, and antral calcification; periapical radiolucent areas were classified using the CBCT periapical index, and the distance between the periapical lesion edge and the MS floor was measured. Data were analyzed using chi-square tests at a level of significance set at α = 0.05.

RESULTS

Most sinus abnormalities were associated with at least 1 maxillary posterior tooth with a periapical lesion (P > .05). The most frequent sinus abnormality in the presence of a periapical lesion was mucosal thickening. All teeth with a CBCT periapical index score of 5 were associated with sinus abnormalities. The highest frequency of abnormalities was found when the radiolucent area was subjacent to the sinus floor.

CONCLUSIONS

Maxillary posterior teeth with periapical radiolucent lesions had the highest frequency of sinus abnormalities. The size of a periapical lesion was not associated with the frequency of sinus abnormalities. A close spatial relationship between periapical lesions and sinuses resulted most frequently in sinus abnormalities.

Evaluation of the maxillary sinus in panoramic radiography-a comparative study

BACKGROUND

The aim of this study was to evaluate the validity and the inter- and intra-examiner reliability of panoramic-radiograph-driven findings of different maxillary sinus anatomic variations and pathologies, which had initially been prediagnosed by cone beam computed tomography (CBCT).

METHODS

After pairs of two-dimensional (2D) panoramic and three-dimensional (3D) CBCT images of patients having received treatment at the outpatient department had been screened, the predefinition of 54 selected maxillary sinus conditions was initially performed on CBCT images by two blinded consultants individually using a questionnaire that defined ten different clinically relevant findings. Using the identic questionnaire, these consultants performed the evaluation of the panoramic radiographs at a later time point. The results were analyzed for inter-imaging differences in the evaluation of the maxillary sinus between 2D and 3D imaging methods. Additionally, two resident groups (first year and last year of training) performed two diagnostic runs of the panoramic radiographs and results were analyzed for inter- and intra-observer reliability.

RESULTS

There is a moderate risk for false diagnosis of findings of the maxillary sinus if only panoramic radiography is used. Based on the ten predefined conditions, solely maxillary bone cysts penetrating into the sinus were frequently detected differently comparing 2D to 3D diagnostics. Additionally, on panoramic radiographs, the inter-observer comparison demonstrated that basal septa were significantly often rated differently and the intra-observer comparison showed a significant lack in reliability in detecting maxillary bone cysts penetrating into the sinus.

CONCLUSIONS

Panoramic radiography provides the most information on the maxillary sinus, and it may be an adequate imaging method. However, particular findings of the maxillary sinus in panoramic imaging may be based on a rather examiner-dependent assessment. Therefore, a persistent and precise evaluation of specific conditions of the maxillary sinus may only be possible using CBCT because it provides additional information compared to panoramic radiography. This might be relevant for consecutive surgical procedures; consequently, we recommend CBCT if a precise preoperative evaluation is mandatory. However, higher radiation dose and costs of 3D imaging need to be considered.

Assessment of the relationship between the maxillary sinus floor and maxillary posterior teeth roots using cone beam computed tomography

AIM

This study was conducted to assess the vertical and horizontal relationship between the maxillary sinus floor and maxillary posterior teeth roots using cone beam computed tomography.

MATERIALS AND METHODS

In this cross-sectional study, the CBCT images presented in the radiology department of Hamadan dental school was used. From 450 observed CBCT, 340 of them did not have the inclusion criteria of the study and ultimately 110 CBCT were selected. Totally 214 first premolars, 217 second premolars, 220 first molars and 220 second molars were included. For evaluating the relationship between the maxillary sinus floor and the posterior maxillary teeth, the classification implemented in the study of Jung in 2009 was used. The relation was evaluated by two radiologists twice with a 2-week time interval.

RESULTS

One hundred and ten patients with a mean age of 31.06 ± 9.7 years were assessed. Type 0 relationship (the maxillary sinus floor is located above the root tip) was most frequently observed with the first and second premolars. The most common type observed in the first and second molars was type 3 (apical protrusion is seen over the maxillary sinus floor). The relation between different types and gender was statistically meaningful, while no statistically significant difference was found between the right and left side assessments.

CONCLUSION

This study showed that although most of the teeth did not have contact with the sinus floor, but the more posterior the maxillary teeth, the more probability for root protruding into the maxillary sinus. It also confirmed that protrusion of teeth roots into the maxillary sinus is more common in male than female.

CLINICAL SIGNIFICANCE

Knowing the anatomical relation between the posterior teeth and the maxillary sinus, help the clinician in preoperative treatment planning of the posterior maxillary teeth and avoid problems that may occur during dental practice.

Evaluation of the relationship between the maxillary posterior teeth and the sinus floor using cone-beam computed tomography

AIM

The aim of this study was to evaluate the relationship between each root of maxillary premolars and molars and the maxillary sinus floor according to sex, sinus position, and age by decade in a Turkish population by using cone-beam computed tomography (CBCT) scanning.

METHODOLOGY

We evaluated a database of 5,166 (2,680 maxillary premolars and 2,486 maxillary molars) CBCT scans obtained from 849 patients. The vertical relationship between each root of the molar and premolar teeth to the sinus floor was classified into three types: type 1, the roots penetrated into the sinus floor; type 2, the roots contacted the sinus floor; and type 3, the roots extended below the sinus floor.

RESULTS

The results of the classification of each root in relationship to the sinus floor were as follows: type 3 occurred most frequently in the first (92.4 %) and second (71.6 %) premolar teeth, type 1 (34.2 %) occurred most frequently in the palatinal roots of the first molar teeth, type 3 occurred most frequently in the mesiobuccal (39.9 %) and distobuccal (39.7 %) roots of the first molar teeth, and type 2 (36.7 %) occurred most frequently in the mesiobuccal roots of the second molar teeth. No significant differences were found between the left and right sides, but several differences were found between males and females. The relationship between the posterior teeth and the sinus floor differed according to the age decade interval (p < 0.05).

CONCLUSIONS

The maxillary first premolars have no relationship with the maxillary sinus floor, but the maxillary second molars are closer to the sinus floor. Also the second decade and males were most susceptible to undesirable results.

Residual ridge dimensions at edentulous maxillary first molar sites and periodontal bone loss among two ethnic cohorts seeking tooth replacement

OBJECTIVES

To study residual ridge dimensions at edentulous first molar sites in relation to periodontal bone loss among cohorts of partially edentulous Asian Indian and Hong Kong Chinese subjects seeking tooth replacement.

MATERIALS AND METHODS

A total of 628 edentulous maxillary first molar sites were analyzed on Cone Beam Computed Tomography scans of 225 Asian Indian (I) and 232 Hong Kong Chinese (C) partially edentulous adults seeking tooth replacement. Age, ethnicity, gender, total tooth loss, the presence or absence of adjacent teeth, categories of periodontal status defined according to radiographic alveolar bone loss (P0: periodontal health, P1: incipient to moderate disease, P2: severe periodontal disease) and sinus membrane abnormalities were noted. Alveolar ridge height (RH), widths at 1 and 3 mm from crest (RW1; RW3), and relative position of the bone crest (RR) were measured.

RESULTS

Prevalence of P2 status was most frequent in both cohorts(C: 50.4% I: 49.2%). P2 had lowest ridge heights; 13.1% C P2 and 14%I P2 had RH < 2 mm. Sites with both RH <8 mm and RW1 < 6 mm occurred at 59%C P2 and 68%I P2. Sinus membrane abnormalities were most frequent in P2. Periodontal status and sinus membrane abnormality increased the odds of RH <5 mm and RH <8 mm more than 2-fold; additionally, gender and ethnicity significantly impacted RH <8 mm. Gender and adjacent tooth status significantly affected RW1.

CONCLUSION

Incident advanced periodontal disease was common among Asian Indian and Hong Kong Chinese subjects seeking tooth replacement and associated with lower available bone heights. Ethnicity, gender, sinus membrane thickening affected available bone height in the subsinus region, while the presence of adjacent teeth- and age-affected residual ridge width.

Location of the mandibular canal and thickness of the occlusal cortical bone at dental implant sites in the lower second premolar and first molar

The objective of this study was to evaluate the location of the mandibular canal and the thickness of the occlusal cortical bone at dental implant sites in the lower second premolar and lower first molar by using dental cone-beam computed tomography (CBCT). Seventy-nine sites (47 second premolar and 32 first molar sites) were identified in the dental CBCT examinations of 47 patients. In this study, 4 parameters were measured: (1) MC—the distance from the mandibular canal to the upper border of the mandible; (2) CD—the distance from the mandibular canal to the buccal border of the mandible; (3) MD—the distance from the mandibular canal to the lingual border of the mandible; (4) TC—the thickness of the cortical bone at the occlusal side. A statistical analysis was employed to compare the size and differences between these 4 parameters at the lower second premolar and lower first molar. Regarding the MC and MD, the experimental results showed no statistical difference between the first molar and second premolar. However, the TC for the second premolar was greater than that of the first molar. Thus, careful consideration is necessary in choosing the size of and operation type for dental implants.

Association between periapical lesions and maxillary sinus mucosal thickening: a retrospective cone-beam computed tomographic study

INTRODUCTION

Odontogenic infections are a common cause of maxillary sinusitis. This study aimed to evaluate the relationship between teeth with periapical lesions or periodontal disease and sinus mucosal thickening using cone-beam computed tomography (CBCT) imaging.

METHODS

CBCT scans of 243 patients (485 sinuses) were evaluated retrospectively for the presence of periapical lesions and/or periodontal disease in posterior maxillary teeth and associated sinus mucosal thickening. Thickening >2 mm was considered pathological and was categorized by degree (2-5 mm, 5-10 mm, and >10 mm) and type (flat or polypoid). Descriptive, bivariate, and multivariate statistical analyses were performed.

RESULTS

Mucosal thickening >2 mm was observed in 147 (60.5%) patients and 211 (44.6%) sinuses and was mostly of a "flat" type. Bivariate analysis revealed significant associations between mucosal thickening >2 mm and sex (males), age (>60 years), and teeth with periapical lesions and periodontal disease (P ≤ .027). Multivariate regression analysis identified only sex (males, odds ratio = 1.98, P = .004) and teeth with periapical lesions (odds ratio = 9.75, P < .001) to be associated with mucosal thickening >2 mm.

CONCLUSIONS

Sinus mucosal thickening is a common radiographic finding, which is more likely to be observed in males (2×) and in relation to teeth with periapical lesions (9.75×).

Assessment of the relationship between the maxillary molars and adjacent structures using cone beam computed tomography

Purpose

This study investigated the relationship between the roots of the maxillary molars and the maxillary sinus using cone beam computed tomography (CBCT), and measured the distances between the roots of the maxillary molars and the sinus floor as well as the thickness of the bone between the root and the alveolar cortical plate.

Materials and Methods

The study sample consisted of 83 patients with normally erupted bilateral maxillary first and second molars. A total of 332 maxillary molars were examined using CBCT images. The vertical relationship of each root with the maxillary sinus was classified into four types on CBCT cross-sectional images. The distance between the sinus floor and root and the bone thickness between the root and alveolar cortical plate were measured.

Results

In the buccal roots of the maxillary molars, a root protruding into the sinus occurred most frequently. A root projecting laterally along the sinus cavity was most common in the palatal roots of the maxillary first molars. The mesiobuccal roots of the maxillary second molar were closest to the sinus. The mesiobuccal roots of the first molars were closest to the cortical plate.

Conclusion

The relationship between the roots of the maxillary molars and the sinus differed between the buccal and palatal roots. A root protruding into the sinus occurred more frequent in the buccal roots of the maxillary molars. The mesiobuccal root of the maxillary second molar was closest to the maxillary sinus floor and farthest from the alveolar cortical plate.