Characteristics and dimensions of the Schneiderian membrane and apical bone in maxillary molars referred for apical surgery: a comparative radiographic analysis using limited cone beam computed tomography. J Endod. 2012;38:51-57. [PMID: 22152620 DOI: 10.1016/j.joen.2011.09.023]

Dental maxillary sinus pathology: a CBCT-based case-control study

This study evaluated the association between dental infection and maxillary sinus pathology, and the influence of age, sex, type of tooth, root proximity to the sinus floor, the condition of the primary maxillary ostium, and the presence of an accessory maxillary ostium in this process. Computed Tomography scans were selected, and upper posterior teeth were evaluated for the presence of apical periodontitis (AP), bone loss with furcation involvement, and endoperiodontal lesion (EPL), subsequently, sinuses were evaluated for mucosal thickening (MT) and opacification of the maxillary sinus (OMS). Logistic regression models were constructed, and Chi-squared and Fisher's tests were applied. Patients with AP were 15.63 times (7.576;32.268) and, 25.97 times (16.22,41.56) more likely to have MT and OMS, respectively. No teeth were associated with EPL in the group without sinus pathology, indicating a strong association with OMS. Male patients were 1.30 times more likely to have MT, and 5.86 times more likely to have OMS than female patients. The condition of the ostium, presence of an accessory ostium, type of tooth, and proximity of the root to the sinus floor were not associated with MT or OMS. In conclusion, male sex and the presence of AP and EPL are associated with maxillary sinus pathology.

Expert consensus on apical microsurgery

Apical microsurgery is accurate and minimally invasive, produces few complications, and has a success rate of more than 90%. However, due to the lack of awareness and understanding of apical microsurgery by dental general practitioners and even endodontists, many clinical problems remain to be overcome. The consensus has gathered well-known domestic experts to hold a series of special discussions and reached the consensus. This document specifies the indications, contraindications, preoperative preparations, operational procedures, complication prevention measures, and efficacy evaluation of apical microsurgery and is applicable to dentists who perform apical microsurgery after systematic training.

The relation between Schneiderian membrane thickening and radiodiagnostic features of periapical pathology

This study aimed to assess the relationship between Schneiderian membrane thickening and periapical pathology in a retrospective analysis of Cone Beam Computed Tomography (CBCT) images. For this, 147 CBCT scans containing 258 sinuses and 1,181 teeth were assessed. Discontinuation of the lamina dura, widening of the periodontal ligament space, apical periodontitis (AP), and partly demineralized maxillary sinus floor associated with AP were considered periapical pathology. Maxillary sinus mucosal thickening (MSMT) was classified as odontogenic or non-odontogenic. An irregular band with a focal tooth associated thickening and local thickening related to a root were considered odontogenic types of MSMT. The relation between the imaging features of periapical pathology and the type and thickness of MSMT was determined by logistic regression and linear mixed model, respectively. In addition, linear regression and Mann Whitney test evaluated the relation and demineralization of the AP lesion towards the sinus floor (p≤0.05). The odds of having an odontogenic type of MSMT were significantly higher when a periapical pathology was present in the maxillary sinus. Eighty-two percent of AP partly demineralized towards the sinus floor were associated with an odontogenic MSMT. Both AP lesions partly demineralized towards the sinus floor and, with increased diameter, led to increased MSMT. In conclusion, there is an 82% risk of having an odontogenic type of MSMT with the presence of AP partly demineralized towards the sinus floor. More thickening of the maxillary sinus mucosa is seen with larger AP lesions and partial demineralization of the sinus floor.

Sinus membrane thickness of healthy endodontically treated maxillary molars

OBJECTIVE

The study aimed to investigate the sinus membrane thickness (SMT) adjacent to healthy endodontically-treated maxillary molars with or without protruded apical foramen into the sinus cavity using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

Images of 207 non-smoker patients aged 18-40 were retrospectively analyzed, 140 were endodontically treated, and 136 were without endodontic treatment. Patients with any sinus pathology, teeth that have symptoms, or poor root filling were excluded. Study groups consisted of Group EM-I (endodontically treated and protruded apical foramen), Group EM-C (endodontically treated and contacted apical foramen), and similarly without endodontic treatment; Group M-I and Group M-C. SMT upon the mesial, distal, and palatal roots was measured. One-way ANOVA and Student's t-tests were performed.

RESULTS

Group EM-I had the thickest sinus membrane compared to other groups (p = 0.013). SMT values were 2.37-2.60 mm in Group EM-I, and 1.34-1.58 mm in other groups. Thickening (> 2 mm) percentages were 33.45% in Group EM-I and between 4.25 and 8.25% in other groups. No statistical difference was detected between first and second molars and genders (p > 0.05).

CONCLUSION

When the apical foramen protruded into the sinus cavity, the conventional root canal treatment caused a minimal (between 2.37 mm and 2.60 mm) sinus membrane thickening with a rate of 33.45% based upon CBCT examinations.

Utilizing a Novel AI Tool to Detect the Posterior Superior Alveolar Artery's Location's Impact on Maxillary Sinus Mucosal Thickening in the Presence of Periapical Lesions

Periapical lesions have been implicated in sinus-related complications, but the precise influence of anatomical variations in the posterior superior alveolar artery (PSAA) on mucosal thickening remains an uncharted aspect. The new AI tool employed in this research utilizes advanced image processing algorithms to enhance image visualization. Background and Objectives: This study examines the accuracy of a new cone beam computed tomography (CBCT) software (eVol DXS, version 1.0.1.0) employing AI to detect the PSAA's location and the effect of that on maxillary sinus thickening in the presence of periapical lesions. Materials and Methods: This retrospective study included 120 CBCT cases with posterior maxillary periapical lesions and 120 without odontogenic infections. Teeth with proximity (<2 mm) to the sinus were excluded in both groups to eliminate the sinus floor's perforation effect. Both the PSAA locations and maxillary sinus thickening were classified and compared. Results: The mucosal thickening differs significantly (p < 0.001) between the study group and the control group. The study showed that an increased sinus thickness occurred when the PSAA was beneath the sinus membrane in the study group (62.5% compared to 8.6%; p < 0.001 *). The AI tool helped to achieve a 100% identification rate in determining the PSAA locations. Conclusions: AI algorithms for PSAA localization, which affects mucosal thickness in response to periapical lesions, yield excellent results.

Odontogenic Factors Associated with Maxillary Sinus Schneiderian Membrane Thickness and their Relationship to Chronic Sinonasal Symptoms: An Ambispective Cohort Study

Odontogenic sinusitis is a common maxillary sinus disease. It develops due to the violation of the Schneiderian membrane due to pathological, iatrogenic, or traumatic causes from dental and dentoalveolar structures. The aim of this cohort study was to investigate local and systemic factors associated with Schneiderian mucosal thickening (MT) in patients referred for evaluation of apical periodontitis (AP) and examine their relationship with chronic sinonasal symptoms. Cone-beam computed tomography (CBCT) scans of 197 patients referred for evaluation of endodontic diseases were reviewed. Mucosal thickening in relation to the affected tooth was measured in the coronal section in millimeters at the maximum area perpendicular to the bone. Based on this measurement, the sinus floor was categorized for MT as present (>1 mm) or absent (<1 mm). The sociodemographic and clinical characteristics of the study participants were assessed and compared according to the presence or absence of MT. Furthermore, the relationship between odontogenic sinusitis and chronic sinonasal symptoms was assessed using a chronic sinusitis survey. Male patients had a higher MT than female patients. The presence of periapical lesions and inadequate endodontic treatment were significantly associated with MT. The multivariate logistic regression model showed that the presence of AP increased the odds of MT by approximately 2.5 times (p = 0.028), and nasal obstruction was significantly higher in patients diagnosed with mucosal thickness at different times of their follow-up period (p = 0.018). MT was 2.5 times more likely in the presence of apical periodontitis, and nasal obstruction was the most significant factor associated with the presence of MT.

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.

The Use of CBCT in Evaluating the Health and Pathology of the Maxillary Sinus

The use of cone-beam computed tomography (CBCT) has been increasing in dental practice. This narrative review summarized the relevance and utilizations of CBCT to visualize anatomical structures of the maxillary sinus and common pathologies found in the maxillary sinus. The detection/visualization rate, the location and the morphometric characteristics were described. For sinus anatomy, the reviewed features included the posterior superior alveolar artery, sinus pneumatization, sinus hypoplasia, sinus septa, and primary and accessory sinus ostia. For pathology, the following items were reviewed: membrane thickening associated with periapical lesions/periodontal lesions, mucous retention cyst, and antrolith. The visualization and assessment of the maxillary sinus is very important prior to procedures that take place in close proximity with the sinus floor, such as tooth extraction, implant insertion, and sinus floor elevation. Some sinus pathologies may be associated with odontogenic lesions, such as periapical diseases and periodontal bone loss.

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.

Study of Elevation Forces and Resilience of the Schneiderian Membrane Using a New Balloon Device in Maxillary Sinus Elevations on Pig Head Cadavers

Background: Although elevation of the sinus can be considered a predictable procedure, it is nonetheless not free of complications, for which reason there is a constant search for new tools and techniques that may reduce these complications. The present study focused on maxillary sinus lifts performed on pig heads cadavers, using a new device with the balloon technique. Materials and Methods: Fifteen ex vivo adult pig heads were used in this experimental study. Sinus floor elevation was performed using the new balloon elevation control system, which consists of a syringe containing latex and serum as well as a system of burs for membrane access and control. Each lift was performed within a 3 min time frame while constant pressure was applied to allow the tissue to adapt to the tension. Results: In 100% of cases, perforations do not occur during aperture or in the elevation of the wall. In the global sample, there was histological elevation in 73.33% compared to 26.66% non-elevation (p = 0.0268). Conclusions: Within the limits of this study, the maxillary sinus lifts employing the new device and the balloon technique were minimally invasive procedures. The elevations achieved proved sufficient to allow future placement of implants of varying lengths and diameters without risk of perforating the membranes, even in the presence of crests of less than 1 mm.

Proximity of maxillary molar apexes to the cortical bone surface and the maxillary sinus

Objectives

Materials and Methods

Results

Conclusions

Effect of Schneiderian Membrane Thickening on the Maxillary Sinus Augmentation and Implantation Outcomes: A Systematic Review

Background

Schneiderian membrane thickness may influence the final clinical outcome of sinus augmentation and dental implantation. Mucosal thickening has been regarded as a contributing factor for post-treatment complications. This study aimed to systematically review the available literature on the association between mucosal thickening and potential complications related to sinus augmentation and implant placement.

Methods

An electronic search was carried out in MEDLINE, Embase, and Web of Science by two independent reviewers. It was complemented by manual search of the reference lists of all relevant studies. The studies reporting on sinus augmentation and dental implantation in cases with preoperative mucosal thickening were considered eligible for this study.

Results

The initial search yielded 1032 articles. Five hundred and sixty-four records were screened by title and abstract, and 57 studies succeeded the inclusion criteria for full-text evaluation. Finally, 10 records remained for data extraction. The included studies assessed sinus augmentation and implantation procedures in 765 patients, 324 (42.3%) of them showed mucosal thickening. Increased membrane thickness did not significantly elevate the frequency of sinus augmentation complications. In addition, the overall implant survival rate was 99.03%.

Conclusions

Within the limitations of the present study, the presence of mucosal thickening might not be a risk factor for sinus augmentation and implant survival rate.

Prevalence, risk factors, and repair mechanism of different forms of sinus membrane perforations in lateral window sinus lift procedure: A retrospective cohort study

OBJECTIVES

To evaluate prevalences, affecting risk factors and efforts for repair mechanism for different forms of sinus membrane perforations (SMP) during sinus floor elevation (SFE) using the lateral window technique (LWT).

MATERIAL AND METHODS

For 334/434 patients, SFE undergoing LWT prevalence of SMP was retrospectively evaluated including a subselection based on membrane perforation size (<10 mm: small-moderate/≥10 mm: large) and biotype (BT; thick BT/thin BT) into four subgroups (SMP1: thick BT/small-moderate; SMP2: thin BT/small-moderate; SMP3: thick BT/large; SMP4: thin BT/large). For the various subgroups, patient- and surgery-related/anatomic risk factors affecting SMP were evaluated and the scope of sinus membrane repair (SSMR) mechanisms rated with 1 (easy) to 5 (complex) was compared.

RESULTS

For 103/434 SMP (27.6%) in 93/334 patients (30.8%) the prevalence of various forms of SMP differed significantly (p < 0.001) among the four subgroups. SMP4 with a prevalence of 45.6% (n = 47) was the most frequent type, while SMP3 had low prevalence with 4.85% (n = 5). Small/moderate SMPs with thick (SMP1: n = 26) or thin BT (SMP2: n = 23) were seen in 26.2% and 23.3%, respectively. Univariate analysis showed significant differences between subgroups with large perforations (SMP3/SMP4) and those with small/moderate perforations (SMP1/SMP2) regarding anatomic risk factors such as residual ridge height (p = 0.023) and history of previous oral surgical interventions (OSI; p = 0.026). Most evidently, multivariate analysis showed that induction of large SMP with thin biotype (SMP4) was significantly affected by the presence of sinus septa (p < 0.022, OR: 2.415), reduced residual ridge height (p < 0.001, OR: 1.842), and previous OSI (p < 0.001, OR: 4.545). SSMR differed significantly (p < 0.001) between SMP4 (4.62 ± 0.49) and the subgroups SMP1 (1.11 ± 0.32), SMP2 (1.08 ± 028), and SMP3 (2.2 ± 0.55).

CONCLUSION

The most frequently found type of SMP had characteristics of thin biotype and large size associated with risk factors such as sinus septa, reduced residual ridge, and previous surgical interventions and required challenging repair mechanisms assessing clinical impact.

Influence of maxillary antrolith on the clinical outcome of implants placed simultaneously with osteotome sinus floor elevation: A retrospective radiographic study

BACKGROUND

Large antroliths and those located adjacent to the sinus floor can affect clinical interventions and increase the difficulty of implant placement performed simultaneously with osteotome sinus floor elevation surgery.

PURPOSE

This retrospective study investigated the clinical outcomes of implants placed simultaneously with osteotome sinus floor elevation subjacent to maxillary antroliths.

MATERIAL AND METHODS

Twenty implants inserted subjacent to or intruding into the antrolith after sinus floor elevation were evaluated in 18 patients. Cone-beam computed tomography (CBCT) was used to measure antrolith size and membrane thickness at sites of osteotome sinus floor elevation. Periapical radiographs were used to assess the height of grafted bone. Generalized estimating equation (GEE) analysis was performed to correlate the occurrence of antroliths with patient background characteristics and dental outcomes, based on a sample population of 239, among whom 33 presented antroliths.

RESULTS

The 20 implants remained clinically stable over a mean follow-up period of 42.4 months. The mean thickness of the sinus membrane at osteotome sites was 5.4 ± 3.3 mm. None of the cases presented sinus membrane perforation or sinus symptoms following osteotome intervention. The mean gain in the height of grafted sinus bone was 4.0 ± 1.4 mm at the last follow-up. The occurrence of antroliths was higher among females and the elderly (>49 years old). The multivariable GEE analysis showed that the adjusted odds ratio for the occurrence of antroliths with root canal fillings was significantly lower than those without root canal fillings (odds ratio = 0.33; 95% confidence interval = 0.11-0.96).

CONCLUSION

Our findings indicate that osteotome sinus floor elevation is a surgical procedure with a risk <17%. Thorough planning based on CBCT and careful management during surgery can eliminate the negative effects of antroliths on implant performance.

Association between Odontogenic and Maxillary Sinus Conditions: A Retrospective Cone-Beam Computed Tomographic Study

Odontogenic infections can directly trigger maxillary sinusitis. CBCT is an excellent choice for precise examination of maxillary sinuses and hard tissues within the oral cavity. The objective of this retrospective and the cross-sectional study was to analyze the influence of odontogenic conditions on the presence and intensity of maxillary sinus mucous membrane thickening using CBCT imaging. Moreover, periodontal bone loss and anatomic relationship between adjacent teeth and maxillary sinuses were assessed to evaluate its possible impact on creating maxillary thickening. The study sample consisted of 200 maxillary sinuses of 100 patients visible on CBCT examination with a field of view of 13 × 15 cm. The presented study revealed a significant influence of periapical lesions, inappropriate endodontic treatment, severe caries, and extracted teeth on the presence of increased thickening of maxillary sinus mucous membrane. In addition, an increase in the distance between root apices and maxillary sinus floor triggered a significant reduction of maxillary sinus mucous membrane thickening. The presence of periodontal bone loss significantly increases maxillary sinus mucous membrane thickening.

Anatomical characteristics of maxillary sinus antroliths and their influence on sinus membrane thickness: a retrospective cone beam computed tomography analysis

The purpose of this study was to assess the anatomy of antroliths and its influence on the thickness of the maxillary sinus membrane. Cone beam computed tomography (CBCT) was performed on 239 patients (478 sinuses). The prevalence of antroliths per sinus was 8.4%. Regarding their distribution, antroliths were predominantly unilateral (82.5%), single (67.5%), and in a dentate area (60.0%). The antroliths were mainly located in the molar region (95.0%) and in the sinus floor (77.5%). The measured dimensions of the antroliths were as follows: length 5.6±4.4mm, width 4.1±2.9mm, height 3.5±2.1mm. The relationships between the antroliths and the sinus membrane (type 1, 34.1%; type 2, 52.3%; type 3, 13.6%) indicated that sinus membranes tended to encircle antroliths, which resulted in a gradual increase in membrane thickness. The sinus membrane was found to be significantly thicker in the presence of antrolith(s) (P<0.001). Antroliths which are sufficiently large or are located adjacent to the sinus floor or lateral wall increase the risk of sinus membrane perforation during sinus augmentation procedures. Therefore, a thorough CBCT evaluation is needed to minimize the risk of complications prior to sinus augmentation procedures.

Perforation of the maxillary sinus floor during apical surgery of maxillary molars: A retrospective analysis using cone beam computed tomography

This retrospective analysis assessed a possible correlation of perforation of the maxillary sinus floor during apical surgery of maxillary molars and the distances from the treated apices/periapical radiolucencies to the sinus floor. The material included 168 apical surgeries of maxillary first or second molars performed from 1999 to 2016. In 22 (out of 33) perforation cases, a preoperative cone beam computed tomography (CBCT) was available. These cases were defined as the test group. From the pool of operated cases without sinus floor perforation, matching cases - that is, same treated tooth, similar age and same gender - were selected as a control group (N = 26). Mean linear distances from root apices or radiolucencies to sinus floor were significantly shorter in the test group compared to the control group. In conclusion, perforation cases were significantly closer to the sinus floor than cases without perforation.

Endodontic management of the maxillary first molar with special root canals: A case report and review of the literature

BACKGROUND

As the complex anatomy of maxillary first molars is one of the major challenges in endodontic therapy, knowledge of the complicated root canal anatomy and configuration is crucial to ensure the success of endodontic treatment and prognosis. This article presents an endodontically managed left maxillary first molar with an unusual palatal root morphology. The available literature on the anatomic variation of maxillary first molars is also reviewed.

CASE SUMMARY

A 36-year-old man with no medical history presented to the Stomatology Department of Peking University Third Hospital complaining of a toothache during mastication in the maxillary left posterior region for approximately 3 mo. He had a spontaneous and intermittent toothache that had worsened, particularly at night. The diagnosis based on clinical examination, X-ray imaging, and cone beam computed tomography (CBCT) was symptomatic irreversible pulpitis. Nonsurgical endodontic therapy was performed for the left maxillary first molar. Five root canals revealed by CBCT included a special palatal root canal (1-2-1-shaped), two mesiobuccal root canals, and one distobuccal root canal. Evaluation of the CBCT images confirmed the root canal morphology and the clinician performed more effective cleaning, obturation, and therapy. Finally, the tooth was restored using composite resin, and the patient was satisfied with the result.

CONCLUSION

CBCT and a complete review of the literature may be beneficial for investigating the root canal system to achieve a biological and functional therapeutic effect.

Cone-beam Computed Tomographic Analysis to Detect the Association between Primary and Secondary Endodontic Infections and Mucosal Thickness of Maxillary Sinus

INTRODUCTION

This retrospective study used cone-beam computed tomographic (CBCT) imaging to evaluate the differences in the mucosal thickness of the Schneiderian membrane in primary and secondary endodontic lesions.

METHODS

A total of 121 CBCT scans were analyzed. Clinical features such as sex, age, size and volume of the periapical lesion, dimension of the bone, morphology, and relationship between the roots and the mucosal thickness were recorded and analyzed in primary and secondary endodontic lesions in CBCT sagittal and coronal planes. Data were analyzed using the chi-square test, the Mann-Whitney U test, and multiple logistic regression (P < .05).

RESULTS

Statistical analysis revealed no significant differences in membrane thickness between the primary and secondary lesions in the sagittal and coronal planes (P = .08 and .06). Differences between age groups were statistically significant in both groups (P < .05). The volume of the periapical lesions of the secondary endodontic lesions were statistically greater than that of the primary lesions (P < .05). Mucosal thickness prevalence increased when the volume of the lesion was greater, and the bone dimension was narrower in maxillary second premolars and first and second molars. Teeth with 2 or more affected roots were directly related to increased sinus mucosa thickening.

CONCLUSIONS

CBCT images showed no differences in mucosal thickening between primary and secondary endodontic lesions.

Assessment of relationship between maxillary sinus membrane thickening and the adjacent teeth health by cone-beam computed tomography

Background/purpose

Maxillary posterior teeth have close anatomical proximity to the maxillary sinus floor. The aim of this retrospective study was to evaluate the associations between maxillary sinus membrane thickening and the adjacent teeth health by cone-beam computed tomography (CBCT).

Materials and methods

CBCT images were collected from 235 Taiwanese patients. The sinus mucosal thickening >2 mm is considered a pathologic sinus membrane. Demographic data such as sex, age, the thickness of sinus membrane, and the adjacent teeth health were recorded, graded, and analyzed.

Results

A total prevalence of maxillary sinus membrane thickening of 36.6% (86/235) was found in this study. The sinus membrane thickening was significantly associated with periodontal bone loss (p < 0.001) and periapical lesions (p < 0.001), respectively. A multivariate logistic regression model demonstrated that males had a significantly higher risk of sinus membrane thickening than females (OR: 2.08, 95% CI = 1.21–3.56). The patients in the age group ≥60 years showed a 4.35-fold increased risk of sinus membrane thickening compared with the patients in the age group ≤35 years (95% CI: 1.94–9.77). Severe periodontal bone loss was significantly associated with mucosal thickening with an OR of 4.78 as compared with normal to mild group (95% CI: 1.69–13.58). The patients having teeth with apical lesions had a 5.04 time OR for sinus membrane thickening than those having teeth without apical lesions (95% C.I.: 2.37–10.69).

Conclusion

The prevalence of maxillary sinus membrane thickening was more frequently occurred in male and older people. Periodontal bone loss and periapical lesions were significantly associated with maxillary sinus membrane thickening.

Schneiderian membrane thickness variation following endodontic procedures: a retrospective cone beam computed tomography study

BACKGROUND

To assess the change of the Schneider membrane thickness measured by CBCT before and after root canal treatment, retreatment and pulp capping procedures.

METHODS

This retrospective study was conducted on CBCT scans of a patient population of Guy's Hospital NHS Foundation Trust, London. Three groups of patients were studied: Group 1 consisted of patients referred for primary endodontic treatment; Group 2 for endodontic retreatment; Group 3 for indirect pulp capping procedures (serving as a control group). Follow up scans were carried out 1 year after treatment. Measurements were carried out on CBCT scans and data were analysed statistically by Wilcoxon Signed Rank Test. Linear regression was used to assess predictive parameters for membrane thickness.

RESULTS

A statistically significant reduction of the Schneider membrane thickness was observed one year after endodontic treatment and retreatment (P < 0.05) but no significant reduction was observed after pulp capping procedures. Linear regression showed that age and gender were significant predictors influencing the Schneider membrane thickness.

CONCLUSIONS

Within the limitations of this retrospective study, following root canal treatment and re-treatment a Schneiderian membrane thickness reduction occurred at 1-year follow-up. The removal of odontogenic infection following endodontic treatment may help reducing the thickness of the Schneider membrane.

Association between the dimensions of the maxillary sinus membrane and molar periodontal status: A retrospective CBCT study

BACKGROUND

The information of the association between residual alveolar bone height and mucosal thickening is sparse. This study aimed to explore the effect of maxillary molar periodontal status on sinus mucosal thickening using cone-beam computed tomography (CBCT).

METHODS

One hundred ninety-four CBCT images were evaluated for the following parameters: age, sex, alveolar bone loss, maximum mucosal thickness (maxMT), minimum residual alveolar bone height (minRABH), and vertical infrabony pockets. The presence of mucosal thickening (maxMT > 2 mm) of the maxillary sinus was recorded. The parameters that could influence the dimensions of the maxillary sinus membrane were assessed. The data were analyzed using logistic regression, and multivariate linear regression with the significant level at α = 0.05.

RESULTS

Mucosal thickening was present in 32% of the analyzed CBCT images and increased in frequency as the periodontal status of the corresponding molar progressed from mild (2.6%) to moderate (14.9%) to severe (75.5%). Mucosal thickness was significantly increased in cases of moderate (odds ratio = 5.73, P < 0.05) and severe (odds ratio = 82.06, P < 0.001) alveolar bone loss. Multivariate linear regression revealed that alveolar bone loss and minRABH had a statistically significant influence on maxMT (P < 0.05).

CONCLUSIONS

Alveolar bone loss and minRABH were significantly associated with mucosal thickening of the maxillary sinus.

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

Maxillary Sinus and Surrounding Bone Anatomy With Cone Beam Computed Tomography After Multiple Teeth Loss: A Retrospective Multicenter Clinical Study

PURPOSE

The aim of this multicenter study was to examine the residual alveolar bone anatomy and sinus mucosa pattern at maxillary sinus regions in multiple teeth loss.

MATERIALS AND METHODS

This study was conducted with cone beam computed tomography images of 518 patients (267 females and 251 males) with multiple posterior maxillary teeth loss. Variables associated with sinus membrane (SM), sinus dimensions, ostium, septa, sinus neighborhood, alveolar bone height and ridge width, posterior superior alveolar artery, and adjacent roots were evaluated.

RESULTS

No (58.2%) or flat (19.3%) thickening morphology was detected at most of the SMs. Membrane thickening and mucosal-like morphology was more prevalent for male patients (P = 0.005). The mean sinus width was relatively low (3.64 ± 3.33 mm) at the 5-mm level and showed an expected increase toward upper levels. Most of the sinus spaces were dimensionally average (39.5%) or wide (44.7%), and no effect of gender was observed in terms of sinus dimensions (P > 0.05).

CONCLUSION

Multiple teeth loss plays a role in creating an imaginary sinus anatomy constituted of a relatively narrow space compared with single-tooth loss cases, from 3.6-mm mean coronal width to 11.3 mm in the apical portion.

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.

Cone beam computed tomography in Endodontics - a review of the literature

The use of cone beam computed tomography (CBCT) in the diagnosis and/or management of endodontic problems is increasing and is reflected in the exponential rise in publications on this topic in the last two decades. The aim of this paper is to: (i) Review current literature on the endodontic applications of CBCT; (ii) Based on current evidence make recommendations for the use of CBCT in Endodontics; (iii) Highlight the areas in which more research is required.

Evaluation of the Characteristics and Association Between Schneiderian Membrane Thickness and Nasal Septum Deviation

OBJECTIVE

Nasal septum deviation (NSD) is an anomaly that disturbs normal mucus drainage in sinuses, leading to recurrent sinusitis. Sinusitis, infections, and mucosal irritations are the potential causes of Schneiderian membrane thickening (SMT). The aim of this study was to evaluate the characteristics and association between NSD and SMT along with factors such as age, gender, and tooth groups using cone-beam computed tomography (CBCT) imaging.

METHODS

The maxillary sinus and nasal cavity of 249 patients (136 females and 113 males) were examined retrospectively using CBCT. The statistical analysis was performed to determine the association between SMT, NSD, gender, and age.

RESULTS

No statistically significant relation was detected between NSD and SMT. The NSD was found in 50.6% of patients without gender predilection. Age was not associated with the presence of NSD. The mean thickness of the membrane was least in the third molar region and highest in the first molar region. The average SMT was found to be higher in males for all the examined tooth areas (P ≤ 0.05).

CONCLUSION

A retrospective evaluation of CBCT images emphasized the concept that NSD was not a factor that affected the thickening of maxillary sinus mucosa. The CBCT imaging could be used for evaluating the maxillary sinuses and nasal septum.

Evaluation of Single Tooth Loss to Maxillary Sinus and Surrounding Bone Anatomy With Cone-Beam Computed Tomography: A Multicenter Study

BACKGROUND

Posterior maxillary tooth loss may complicate the implant treatment due to the alterations in alveolar anatomy and maxillary sinus pneumatization. This study aimed to comprehensively examine the anatomical structure of this region from cone-beam computed tomography (CBCT) images.

MATERIALS AND METHODS

The posterior maxilla regions with single tooth loss were analyzed by dividing the variables into 3 subgroups from images of 597 patients chosen from 1160 CBCTs. Variables associated with sinus membrane (SM), sinus dimensions, ostium, septa, sinus neighborhood, alveolar bone height (ABH) and width (RW), posterior superior alveolar artery (PSAA), and adjacent roots were evaluated.

RESULTS

The majority of the patients demonstrated 0 to 5 mm membrane thickness. Irregular SM thickening was lower for female patients. While females showed higher number of narrow sinus, males had higher RW than females. Sinus augmentation classification showed negative correlation with ABH, root-tip sinus floor and edentulous site classification. Posterior septa height was correlated with number of septa and ABH. PSAA diameter and location were also correlated between each other.

CONCLUSION

The present results define formation of a sinus space with 11 mm coronal and 16 mm apical width after single tooth loss. A flat or semispherical thickening around 4 mm is usual in most cases with 51% possibility of anterior septum existence. A ridge anatomy, around 7.5 mm ABH and 7.2 to 9.3 RW from coronal to apical, complements this anatomy. Further studies are needed to clarify the reasons behind the SM and crestal anatomy variations between genders.

Use of cone beam computed tomography in implant dentistry: current concepts, indications and limitations for clinical practice and research

Diagnostic radiology is an essential component of treatment planning in the field of implant dentistry. This narrative review will present current concepts for the use of cone beam computed tomography imaging, before and after implant placement, in daily clinical practice and research. Guidelines for the selection of three-dimensional imaging will be discussed, and limitations will be highlighted. Current concepts of radiation dose optimization, including novel imaging modalities using low-dose protocols, will be presented. For preoperative cross-sectional imaging, data are still not available which demonstrate that cone beam computed tomography results in fewer intraoperative complications such as nerve damage or bleeding incidents, or that implants inserted using preoperative cone beam computed tomography data sets for planning purposes will exhibit higher survival or success rates. The use of cone beam computed tomography following the insertion of dental implants should be restricted to specific postoperative complications, such as damage of neurovascular structures or postoperative infections in relation to the maxillary sinus. Regarding peri-implantitis, the diagnosis and severity of the disease should be evaluated primarily based on clinical parameters and on radiological findings based on periapical radiographs (two dimensional). The use of cone beam computed tomography scans in clinical research might not yield any evident beneficial effect for the patient included. As many of the cone beam computed tomography scans performed for research have no direct therapeutic consequence, dose optimization measures should be implemented by using appropriate exposure parameters and by reducing the field of view to the actual region of interest.

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.

The effect of demographic and disease variables on Schneiderian membrane thickness and appearance

OBJECTIVES

The purpose of this study was to evaluate the prevalence of sinus mucosal thickening (MT) and mucosal appearance (MA) in a patient population as detected with cone beam computed tomography (CBCT) and to determine the effects of various disease and demographic factors on MT and MA.

STUDY DESIGN

The retrospective study consisted of CBCT images of 1000 maxillary arches in 500 patients. The arches were divided into 3 groups (atrophic, partially atrophic, and nonatrophic) according to the type of the maxillary dental crest. The CBCT scans were assessed to detect the prevalence of maxillary sinus MT and MA. χ² analysis was used to determine the significance of association of periodontal bone loss (PBL), periapical (PA) status, alveolar crest type, age, and gender on sinus MT and MA.

RESULTS

MT was significantly associated with PBL (P = .004), PA status (P = .001), and gender (P < .01). MA was significantly associated with PBL (P = .038), PA status (P = .009), and gender (P < .020). There were no significant associations between age or crest type and either MT or MA.

CONCLUSIONS

Periodontal bone loss, PA lesions, and gender may have an association with MT of the maxillary sinus.

A Comparison of 2- and 3-dimensional Healing Assessment after Endodontic Surgery Using Cone-beam Computed Tomographic Volumes or Periapical Radiographs

INTRODUCTION

The aim of this study was to compare the assessment of healing after endodontic microsurgery using 2-dimensional (2D) periapical films versus 3-dimensional (3D) cone-beam computed tomographic (CBCT) imaging.

METHODS

The healing of 51 teeth from 44 patients was evaluated using Molven's criteria (2D) and modified PENN 3D criteria. The absolute area (2D) and volume (3D) changes of apical lesions preoperatively and at follow-up were calculated by segmentation using OsiriX software (Pixmeo, Bernex, Switzerland) and ITK-Snap (free software).

RESULTS

There was a significant difference between the mean preoperative lesion volumes of 95.34 mm³ (n = 51, standard deviation [SD] ±196.28 mm³) versus 6.48 mm³ (n = 51, SD ±17.70 mm³) at follow-up (P < .05). The mean volume reduction was 83.7%. Preoperatively, mean lesion areas on periapical films were 13.55 mm² (n = 51, SD ±18.80 mm²) and 1.83 mm² (n = 51, SD ±.68 mm²) at follow-up (P < .05). According to Molven's criteria, 40 teeth were classified as complete healing, 7 as incomplete healing, and 4 as uncertain healing. Based on the modified PENN 3D criteria, 33 teeth were classified as complete healing, 14 as limited healing, 1 as uncertain healing, and 3 as unsatisfactory healing. The variation in the distribution of the 2D and 3D healing classifications was significantly different (P < .05). Periapical healing statuses incomplete healing or uncertain healing according to Molven's criteria could be clearly classified using 3D criteria.

CONCLUSIONS

CBCT analysis allowed a more precise evaluation of periapical lesions and healing of endodontic microsurgery than periapical films. Significant differences existed between the 2 methods. Over the observation period, the mean periapical lesion sizes significantly decreased in volume. Given the correct indications, the use of CBCT imaging may be a valuable tool for the evaluation of healing of endodontic surgery.

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.

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.

Schneiderian Membrane Thickness and Clinical Implications for Sinus Augmentation: A Systematic Review and Meta-Regression Analyses

BACKGROUND

Schneiderian membrane thickness (SMT) has been regarded as a key factor for influencing membrane perforation, which may jeopardize the final clinical outcome of sinus augmentation. Hence, this systematic review aims at studying the mean SMT and further investigating patient-related factors that may affect SMT. As a secondary goal, the association between SMT and membrane perforation rate was studied.

METHODS

Three independent reviewers in several databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register databases, conducted electronic and manual literature searches. This review was written and conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MECIR (Methodological Expectations of Cochrane Intervention Reviews) guidelines. Quantitative assessment was performed for articles that met the inclusion criteria to investigate the mean SMT, its contributing factors, and the influence on membrane damage and surgical complications.

RESULTS

Thirty-one studies that reported maxillary SMT were considered for qualitative analysis. Nineteen were further meta-analyzed. Overall mean ± SE SMT was 1.17 ± 0.1 mm (95% confidence interval [CI] = 0.89 to 1.44). Although mean SMT for the three-dimensional radiography (3DR) group was 1.33 mm (95% CI = 1.06 to 1.60), for the histology group, it was 0.48 mm (95% CI = 0.12 to 1.1). Random-effects model showed that, although there is a trend for thicker SMT as determined using 3DR compared with histologic analysis, such difference did not reach statistical significance (P = 0.15). Also, regression analyses demonstrated that the variables periodontitis (P = 0.13) and smoking (P = 0.11) showed thicker SMT. Inconclusive data were obtained when correlating SMT and perforation rate, although it seems that thicker SMT might be more prone to perforation (P = 0.14).

CONCLUSIONS

SMT is, on average, 1 mm in patients seeking sinus augmentation. Three-dimensional technologies overestimate approximately 2.5 times SMT when compared with histologic analysis. Periodontitis and smoking may result in thickening of the sinus membrane. However, current data were inconclusive to link SMT to the rate of membrane damage.

Accuracy of Schneiderian membrane thickness: a cone-beam computed tomography analysis with histological validation

OBJECTIVES

Cone-beam computed tomography (CBCT) has been used in the literature to evaluate Schneiderian membrane thickness (SMT), but its accuracy has never been validated. The primary aim of this study was to compare the SMT measured by CBCT to the gold standard histological assessment. The correlations between SMT and anatomical structures of the maxillary sinus and alveolar bone were also tested.

MATERIALS AND METHODS

Fourteen fresh cadaver heads were used for the study, and 28 sinus lift augmentation procedures were performed to obtain the membrane samples. Samples were fixed in formalin and stained with hematoxylin-eosine and Masson trichrome. Specimens were measured by optic microscope at three points, and a mean was obtained. Anatomical landmarks were used to accurately position the CBCT slice, so the SMT could be measured in predetermined locations. Wilcoxon signed-rank test was used to compare values of histological and CBCT measurements, and Spearman's correlation coefficient was calculated to examine the relationship between thickness and anatomical parameters.

RESULTS

A total of 597 histological measurements were performed, and the mean SMT thickness was 0.30 ± 0.17 mm. The mean CBCT membrane thickness was 0.79 ± 0.52 mm. A statistically significant difference from histological and radiological readings was observed (P = 0.000). Interestingly, 87.77% histological measurements had membrane less than 0.5 mm in thickness compared to 26.66% in CBCT assessment.

CONCLUSIONS

Within the limitation of this study, the median histological Schneiderian membrane thickness was 0.30 mm. Cone-beam computed tomography assessment was 2.6 times higher than the histological examination.

Maxillary Sinus Septa and Anatomic Correlation With the Schneiderian Membrane

Aim of this investigation is to evaluate prevalence, localization, and height of 114 maxillary sinus septa by using cone-beam computed tomography scans. The thickness of the mucosa has been measured together with the variations of the membrane in relation to those septa. A total of 228 maxillary sinuses have been considered. Septa were identified using "panorex" reconstructions and axial scans of cone-beam computed tomography using the software "eXamVision." The thickness of the mucosa has been evaluated in the paraxial scans and related to those septa where they were present. In the current study, the prevalence of sinus septa is 38.1%. Significant difference can be found in the height of primary and secondary septa. The mean height of primary septa was 5.5 mm (± 1.19) and of secondary septa 3.4 mm (± 1.6). Anterior and medium septa resulted significantly higher than posterior septa (P = 0.003). The medium thickness of the mucosa was 0.85 mm (± 0.58), whereas close to the septa it turned out to be 1.8 mm (± 1.87). The difference is statistically relevant (P = 0.003). There is no statistically significant proportional relation between dimensions of septa and thickness of mucosa (P = 0.53). Underwood septa are frequent anatomic variations of the maxillary sinus. Their presence may result in a thickening of the sinus membrane. The systematic study of radiographic anatomy of maxillary sinus is necessary before the sinus lift surgery planning.

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.

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.

Large Reactional Osteogenesis in Maxillary Sinus Associated with Secondary Root Canal Infection Detected Using Cone-beam Computed Tomography

Inflammatory injuries in the maxillary sinus may originate from root canal infections and lead to bone resorption or regeneration. This report describes the radiographic findings of 4 asymptomatic clinical cases of large reactional osteogenesis in the maxillary sinus (MS) associated with secondary root canal infection detected using cone-beam computed tomographic (CBCT) imaging. Apical periodontitis, a consequence of root canal infection, may lead to a periosteal reaction in the MS and osteogenesis seen as a radiopaque structure on imaging scans. The use of a map-reading strategy for the longitudinal and sequential slices of CBCT images may contribute to the definition of diagnoses and treatment plans. Root canal infections may lead to reactional osteogenesis in the MS. High-resolution CBCT images may reveal changes that go unnoticed when using conventional imaging. Findings may help define initial diagnoses and therapeutic plans, but only histopathology provides a definitive diagnosis. Surgical enucleation of the periapical lesion is recommended if nonsurgical root canal treatment fails to control apical periodontitis.

Proximity of Posterior Teeth to the Maxillary Sinus and Buccal Bone Thickness: A Biometric Assessment Using Cone-beam Computed Tomography

INTRODUCTION

The aims of this study were to evaluate the vertical and horizontal relationships between the maxillary sinus floor (MSF) and the root apices of maxillary posterior teeth with various root configurations and the distance from the root apex to the MSF and the buccal cortical plate.

METHODS

Serial axial, coronal, sagittal, and paraxial cone-beam computed tomographic images of 132 Korean patients with fully erupted bilateral maxillary posterior teeth were analyzed. The vertical and horizontal relationships between the roots of maxillary posterior teeth and the MSF were determined. Distances from the apex to the MSF and the buccal bone plate were measured. The data were correlated with age, sex, side, and tooth type.

RESULTS

In total, 2159 apices in 1056 teeth were evaluated. For the vertical relationships, the frequency in group 1, in which a root apex protruded into the MSF, significantly increased toward the posterior (first premolars: 1.5%, second premolars: 14.8%, first molars: 40.5%, second molars: 44.7%, P < .001). The apices of the mesiobuccal roots of the second molars were found frequently in group 1 (35.8%) and had the shortest mean vertical distance to the MSF (0.18 mm) and the thickest mean horizontal distance to the buccal cortical plate (4.99 mm) among buccal roots of 3-rooted molars (P < .001). The frequency of group 1 differed significantly by age (P < .05). No statistically significant difference was found in sex or side analysis. For the horizontal relationship between the molar roots and the MSF, most teeth were in group BP, in which the lowest point of the MSF was located centrally, relative to the roots (94.3% for first molars, 81.0% for second molars). For the first molars, no significant difference according to sex or side was found. However, the right side (P = .003) and males (P = .005) showed higher incidences for second molars.

CONCLUSIONS

The data in this study highlight the close proximity between the root apex of maxillary posterior teeth and the MSF and provide estimated distances from the root apex to the buccal cortical plate. Special care must be taken in treatment planning in the maxillary posterior region.

Proximity of premolar roots to maxillary sinus: a radiographic survey using cone-beam computed tomography

INTRODUCTION

The proximity of the roots of the posterior maxillary teeth to the maxillary sinus is a constant challenge to the dental practitioner. Because the majority of studies have assessed the relationship regarding molars, the present study focused on premolars.

METHODS

Cone-beam computed tomographic images of 192 patients were reconstructed in sagittal, coronal, and axial planes to quantify the distances between the root apices of the maxillary premolars and the adjacent maxillary sinus. Measurements were taken for each root, and data were correlated with age, sex, side, and presence of both or absence of 1 of the 2 premolars.

RESULTS

A total of 296 teeth (177 first and 119 second premolars) were evaluated. The mean distances from buccal roots of the first premolars to the border of the maxillary sinus in the sagittal, coronal, and axial planes ranged from 5.15 ± 2.99 to 8.28 ± 6.27 mm. From palatal roots, the mean distances ranged from 4.20 ± 3.69 to 7.17 ± 6.14 mm. The mean distances of second premolars were markedly shorter in buccal roots between 2.32 ± 2.19 and 3.28 ± 3.17 mm and in palatal roots between 2.68 ± 3.58 and 3.80 ± 3.71 mm, respectively. The frequency of a premolar root protrusion into the maxillary sinus was very low in first premolars (0%-7.2%) but higher in second premolars (2.5%-13.6%). Sex, age, side, and presence/absence of premolars failed to significantly influence the mean distances between premolar roots and the maxillary sinus.

CONCLUSIONS

Based on the calculated mean distances of the present study, only few premolars (and if so second premolars) would present a risk of violating the border of the maxillary sinus during conventional or surgical endodontic treatment or in case of tooth extraction.

Accuracy of digital radiography and cone beam computed tomography on periapical radiolucency detection in endodontically treated teeth

Objectives

The aim of the present study was to compare the accuracy of intraoral digital periapical radiography and cone beam computed tomography in the detection of periapical radiolucencies in endodontically treated teeth.

Material and Methods

Radiographic images (cone beam computed tomography [CBCT] scans and digital periapical radiography [PR] images) from 60 patients, achieved from September 2008 to July 2013, were retrieved from databases of the Department of Oral Diseases, Lithuanian University of Health Sciences. Twenty patients met inclusion criteria and were selected for further evaluation.

Results

In 20 patients (42.4 [SD 12.1] years, 65% men and 35% women) a total of 35 endodontically treated teeth (1.75 [SD 0.91]; 27 in maxilla and 8 in mandible) were evaluated. Overall, it was observed a statistical significant difference between the number of periapical lesions observed in the CBCT (n = 42) and radiographic (n = 24) examinations (P < 0.05). In molar teeth, CBCT identify a significantly higher amount of periapical lesions than with the radiographic method (P < 0.05). There were significant differences between CBCT and PR in the mean number of lesions identified per tooth (1.2 vs 0.66, P = 0.03), number of teeth with lesions (0.71 vs 0.46, P = 0.03) and number of lesions identified per canal (0.57 vs 0.33, P = 0.005). Considering CBCT as “gold standard” in lesion detection with the sensitivity, specificity and accuracy considering as score 1, then the same parameters of PR were 0.57, 1 and 0.76 respectively.

Conclusions

Within the limitations of the present study, it can be concluded that cone beam computed tomography scans were more accurate compared to digital periapical radiographs for detecting periapical radiolucencies in endodontically treated teeth. The difference was more pronounced in molar teeth.

Prevalence of sinus membrane thickening and association with unhealthy teeth: a retrospective review of 831 consecutive patients with 1,662 cone-beam scans

PURPOSE

The purposes of this retrospective review of cone-beam computed tomographic (CBCT) scans were to 1) determine the prevalence of sinus membrane thickening in a consecutive series of patients; 2) identify the prevalence of healthy or unhealthy teeth associated with sinus membrane thickening; and 3) document changes of the sinus membrane after the removal of unhealthy teeth.

MATERIALS AND METHODS

Consecutive patients had CBCT scans examined and the sinuses were graded. Grade 1 represented membrane thickening of 0 to less than 2 mm; grade 2 represented thickening of 2 to 5 mm; grade 3 represented membrane or material thickening greater than 5 mm to the level of the ostium; and grade 4 represented soft tissue material superior to the ostium. Cross-sectional images were examined using software by the manufacturer of the CBCT scanner. Unhealthy teeth were identified. The examiner used a standardized approach in viewing the CBCT scans. Intraexaminer error was determined.

RESULTS

Eight hundred thirty-one patients had 1,662 sinuses evaluated, with thickening of at least 1 sinus membrane in 46.7% (388 patients) and 30.1% (469) of all sinuses evaluated. The prevalence of patients and sinuses with sinus membrane thickening according to the grading criteria was grade 2 for 36.8% of patients and 24.3% of sinuses, grade 3 for 6.0% of patients and 3.7% of sinuses, and grade 4 for 3.6% of patients and 2.2% of sinuses. Unilateral sinus disease was more common than bilateral disease. Of those sinuses with thickening, 80.6% were grade 2, 12.2% were grade 3, and 7.2% were grade 4. Of the 469 sinuses with membrane thickening, 210 were adjacent to unhealthy teeth, 233 were adjacent to healthy teeth, and 26 were in edentulous maxillas. Of the 210 unhealthy teeth, 30 had postextraction CBCT scans available for evaluation. Grade 2 sinus membrane thickening showed a 75% resolution to grade 1 after adjacent tooth removal. Grade 3 sinuses resolved in 25% to grade 1 and grade 2, with 50% remaining at grade 3. There were 2 grade 4 sinuses with follow-up scans, with 1 resolving to grade 2 and the other remaining at grade 4.

CONCLUSIONS

Sinus membrane thickening is present in 46.7% of patients presenting to an oral and maxillofacial surgical practice. The prevalence of sinus membrane thickening was almost equal in association with unhealthy and healthy teeth. The removal of unhealthy teeth decreased, but did not completely resolve sinus membrane thickening.