Prevalence of pathologic findings in the maxillary sinus in cone-beam computerized tomography

Radiographic assessment of maxillary sinus membrane and lateral wall thickness using cone-beam CT in different facial types in southwestern Saudi Arabia

The anatomy of the edentulous posterior maxilla and maxillary sinus possess unique challenges in implant dentistry. The purpose of this study was to assess maxillary sinus membrane thickness (MT) and lateral wall thickness (LWT) in different facial index profiles and to describe the clinical implications. A retrospective image analysis of 75 CBCT scans was done, which yielded a total of 150 sinus images. The facial index was calculated as per the formula given in the text and grouped as euryprosopic, mesoprosopic and leptoprosopic. The images obtained were of 36 women (48%) and 39 men (52%), with maximum subjects in 30-39 years age group. MT and LWT were measured at three different points on the radiograph at every 3mm from the base of the sinus floor in premolar and molar regions of each image. Results showed females had significant differences from males in LWT in both premolar and molar regions (p = 0.018 and 0.032 respectively). Subjects in 40-49 years of age had significant differences (p = 0.021) in MT in premolar region only. Also, difference in MT in premolar and molar regions were also statistically significant. Lastly, the present study did not find any statistically significant difference in MT and LWT in all three facial indices groups. It can be concluded that different facial indices have no positive correlation with maxillary sinus membrane thickness and lateral wall thickness. Hence, surgical complications are avoidable with proper detailed knowledge and appropriate identification of the anatomic structures characteristic to the maxillary sinus.

Anatomical variations and abnormalities of the maxillary region and clinical implications: A systematic review and metaanalysis

OBJECTIVE

The objective of this review is to investigate and analyze the anatomical variations present in the maxillary sinus (MS), through the examination of the prevalence of these variations, as well as the corresponding prevalence of clinically significant pathologies and complications associated with them.

METHODS

The search process was carried out in the following databases; MEDLINE, SCIELO, WOS, CINHAL, SCOPUS, and GOOGLE SCHOLAR, using as search terms; "Maxillary bone," "Maxillary sinus," "Paranasal sinus," "Anatomical variations," "Sinusitis" and "Clinical anatomy."

RESULTS

A total of 26 articles and 12969 samples were included, from which 12,594 subjects had their sex recorded giving a total of 5802 males and 6792 females. The variants reported by the included were Haller cells, Concha Bullosa, Number of septa, Hypoplastic sinus, Agger Nasi, Thickening of the MS mucosa, Deviation of the nasal septum, Accessory ostium, and Onodi cells. Among the mentioned, the ones that presented the greatest number of studies (between 8 and 10 studies included) were: the Haller Cells, the Concha Bullosa, and the Number of septa, where prevalence was 0.30, 0.36, 0.39 respectively. These variations can lead to sinusitis, cause some types of tumors, or affect neighboring structures that could be compromised by this variation.

CONCLUSION

As a result, it is certainly complex to distinguish the presence of anatomical variations from pathological abnormalities. Therefore, knowledge of the different variations and their clinical relationships could be a useful asset for clinicians dedicated to this region.

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.

Sphenoid sinuses' volume and area analysis of Brazilian individuals' CBCTs, related to sex, age, skin color, and nutritional status using DDS-Pro™ software

The purpose of this study was to analyze the volume and area of sphenoid sinuses of Brazilian individuals' cone-beam computed tomography (CBCT) images using the beta version of the DDS-Pro™ 2.14.2_2022 software (DPP Systems, Czestochowa, Poland), to assess a potential correlation to sex, age, skin color, and nutritional status, and to evaluate differences between the right and left sides. Three-dimensional volume and area measurements were made with the software using CBCT images of 113 living Brazilian individuals of both sexes (67 females and 46 males). TEM, rTEM, and R were used to assess the reproducibility of inter- and intra-examiner measurements. The measurement means were estimated with 95% confidence intervals according to sex and age group. There were no significant differences between the left and right sides for both volume and area and between the sexes and black and white individuals. Volume and area were significantly higher in 18 years or older (p < 0.05) and in individuals with normal body mass index (BMI) (p < 0.05). The obtained results do not allow indicating the use of sphenoid sinuses volume and area measurements to estimate sexual dimorphism, and the same occurred for skin color. However, such measures can help to estimate age. Further studies are suggested with a larger sample, especially for the nutritional status variable.

Analysis of risk variables for association with maxillary sinus mucosal thickenings: a cone-beam computed tomography-based retrospective study

PURPOSE

This study aimed to determine which patient-related, anatomical, pathologic, or iatrogenic variables may be directly associated with and which may have a modifying effect on the generation of maxillary sinus (MS) mucosal thickenings.

METHODS

A total of 278 cone-beam computed tomography (CBCT) scans obtained from 114 males and 164 females were evaluated. The protocol included the assessment of 21 candidate variables, of which 18 were bilateral and 3 were unique. The relationship among the study variables and the mucosal thickenings were examined individually and adjusted for confounding using univariate and multivariate binary logistic regression models.

RESULTS

The prevalence of mucosal thickenings was 71.20% at patient level and 53.40% at sinus level. The ostium height > 28.15 mm, the infundibulum length ≤ 9.55 mm, the infundibulum width ≤ 0.50 mm, along the occurrence of periapical lesions and slight-to-severe periodontal bone loss acted as strong/independent risk variables for MS mucosal thickenings. Confounding and interaction relationships between MS height and depth, and between the alveolar process type and the presence of foreign materials with respect to age stratum > 47.50 years might be also associated with the mucosal thickenings.

CONCLUSIONS

While increased ostium height, decreased infundibulum length/width, the presence of periapical lesions and periodontal involvement might be the foremost indicator variables for MS mucosal thickenings, there are synergistic relationships among the increased sinus height and depth as well as aging regarding atrophic/partially atrophic alveolar process status and the presence of foreign materials that may be also associated with a greater proportion of these mucosal abnormalities.

Comparison of Diagnostic Accuracy of Panoramic Radiography to CBCT in Maxillary Sinus Diseases

We aimed to compare the effectiveness of panoramic radiography (PR) and cone beam computed tomography (CBCT) in radiographic diagnosis of maxillary sinus (MS) diseases. MS diseases (mucosal thickening, mucus retention cyst, polyp sinusitis, mucocele and tumoral formations) was carried out on both PR and CBCT images belonging to 625 patients. Analyzes were performed separately for right and left maxillary sinus, and total of 1250 PR and CBCT images. While a diagnosis of disease was made in 42.96% of a total of 1250 MS according to CBCT. According to PR, diagnosis was made in 58.72%. The 537 diagnoses where lesion presence was determined on CBCT in our study were compared over PR, and it was observed that, there was the right diagnosis (true positive) in 106 (19.73%) of these including respectively mucus retention cyst (n = 88), polyp (n = 16), 1 sinusitis and 1 tumor, and there was an incorrect diagnosis (false positive) in 221 (41.15%). In 42.92% of the MS that were identified as healthy based on CBCT, the correct diagnosis was also made on PR (true negative). The use of CBCT instead of PR in the diagnosis of pathological or inflammatory diseases contributes to a more accurate radiographic differential diagnosis.

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.

Incidental Paranasal Sinus Findings on Computed Tomography Images of Pediatric Patients: A Cross-sectional Prevalence Study

Objectives

The study was conducted to assess the prevalence of incidental paranasal sinus pathologies in children on computed tomography (CT) scans.

Materials and methods

A nonrandomized retrospective study was done on CT scans of 232 pediatric patients taken in the past 6 months duration. These scans were evaluated in different age groups from 0-13 years who had visited or were admitted to the hospital for various other head and neck-related problems. Each scan was examined for incidental pathologic findings in all the paranasal sinuses. The data were analyzed using descriptive statistics and Fisher's exact test to determine non-random associations between variables.

Results

A total of 232 subjects were examined, amongst which 72 (31.03%) had incidental sinus pathologies. Multiple sinus pathologies were found in 36 subjects, 28 had single sinus involvement, and four showed no development of frontal sinus at the age of 11 years. Four subjects had pathology in multiple sinuses as well as no development of frontal sinus at the age of 6-7 years age range.

Conclusion

Sinus pathologies are not unusual in the asymptomatic children population, and the incidence is almost equivalent to that of the adult population. Early identification can aid in diagnosing orofacial pain of unknown origin and also if children are susceptible to upper respiratory tract infections and their secondary effects like sleep apnea, mouth breathers, etc.

How to cite this article

Talwade P, Deshpande PS, Pene S, et al. Incidental Paranasal Sinus Findings on Computed Tomography Images of Pediatric Patients: A Cross-sectional Prevalence Study. Int J Clin Pediatr Dent 2023;16(2):292-294.

Maxillary Sinus Pathology and its Relationship with Pathology and Dental Treatments. Systematic Review

Introduction and objective: The aim of this review is to evaluate to what extent sinus pathology originates from dental pathology or treatment, and to assess the occurrence frequency of sinus pathology in its different forms using cone beam computed tomography (CBCT). Method: The literature review was conducted using PubMed, Scopus and the Cochrane Library. Forty-two articles were included (25 case series, ten cross- sectional studies, three case-control studies, two cohort studies, one prospective study, and one retrospective study). Results: Forty-two articles involving a total of 13,191 patients and 17,374 CBCTs were included in this review. The most frequent pathological findings were, by a considerable degree, inflammatory diseases, which represented 75.16% of the total findings, followed by infection (12.13%), tumours (6.88%), and high pneumatisation (2.07%). Within dental pathology, there is a direct Pearson correlation with polyps (1) and opacification (0.999), and an almost direct correlation with retention cysts (0.981) and sinus-associated dental elements (0.972). Conclusions: Our results further support the argument that dental modifications and treatments are an important cause of sinus pathology. For this reason, dental aetiologies must be taken into account by both dentists, maxillofacial surgeons and ENT when considering the most appropriate treatment for patients with maxillary sinusitis.

Cone-beam computed tomography texture analysis can help differentiate odontogenic and non-odontogenic maxillary sinusitis

Purpose

This study aimed to assess texture analysis (TA) of cone-beam computed tomography (CBCT) images as a quantitative tool for the differential diagnosis of odontogenic and non-odontogenic maxillary sinusitis (OS and NOS, respectively).

Materials and Methods

CBCT images of 40 patients diagnosed with OS (N=20) and NOS (N=20) were evaluated. The gray level co-occurrence (GLCM) matrix parameters, and gray level run length matrix texture (GLRLM) parameters were extracted using manually placed regions of interest on lesion images. Seven texture parameters were calculated using GLCM and 4 parameters using GLRLM. The Mann-Whitney test was used for comparisons between the groups, and the Levene test was performed to confirm the homogeneity of variance (α=5%).

Results

The results showed statistically significant differences (P<0.05) between the OS and NOS patients regarding 3 TA parameters. NOS patients presented higher values for contrast, while OS patients presented higher values for correlation and inverse difference moment. Greater textural homogeneity was observed in the OS patients than in the NOS patients, with statistically significant differences in standard deviations between the groups for correlation, sum of squares, sum of entropy, and entropy.

Conclusion

TA enabled quantitative differentiation between OS and NOS on CBCT images by using the parameters of contrast, correlation, and inverse difference moment.

[Maxillary sinus lesions and their association with apical lesions observed by cone beam computed tomography. A retrospective cross-sectional study]

Introduction

Through cone beam computed tomography, alterations in the maxillary sinuses, such as opacities, space occupation and thickening of the mucosa, can be observed. Some factors contribute to this thickening, standing out among dental factors, periodontitis, apical pathology and endodontic treatments.

Objective

To evaluate the association between changes observed in the maxillary sinuses and apical lesions using cone beam computed tomography.

Materials and methods

It was a descriptive study with a retrospective and cross-sectional, correlational, field, non-experimental design. The sample consisted of 115 tomographic volumes obtained using Planmeca ProMax 3D Classic equipment (Planmeca, Helsinki, Finland). The presence/absence of endodontic treatment in the present posterior teeth, presence/absence of periapical lesion associated with these teeth, the size of the periapical lesion, presence/absence of alteration in the maxillary sinus and its thickness were evaluated.

Results

Apical lesions were observed that averaged a size of 3.32 ± 1.82 mm, and almost half (44.35%) presented between 2 and 4 mm in size. The main alteration of the maxillary sinus that was observed was the thickening of the mucosa (58.26%). The average thickness of the thickening of the sinus mucosa was 3.51 ± 1.78 mm, with 72.17% of the cases with thickening greater than 2 mm.

Conclusion

There was an association between the changes observed in the maxillary sinuses and apical lesions. The larger and closer the lesion was to the sinus, the greater the thickening of the sinus mucosa.

The Relationship Between an Accessory Maxillary Ostium and Variations in Structures Adjacent to the Maxillary Sinus without Polyps

Introduction  The maxillary sinus and its variations are very important to dentistry and rhinology.

Objective  To investigate the effect of the accessory maxillary ostium (AMO) on the variations of adjacent structures of the maxillary sinus.

Methods  The computed tomography (CT) images of 400 patients were retrospectively evaluated. The prevalence of AMO was calculated. The relationship between morphological variations of adjacent structures of maxillary sinus such as agger nasi cell (ANC), Haller cell (HC), nasal septum deviation (NSD), hypertrophy of inferior concha (HIC), pneumatization of middle concha (PMC), mucus retention cyst (MRC), mucosal thickening (MT), and maxillary sinusitis (MS), as well as the presence of AMO, were investigated.

Results  Presence of AMO was diagnosed in 42 patients (10.5%), having been found in 4.5% of the patients only on the right side, in 1.25% of the patients only on the left side, and in 4.75% of the patients on both sides. There is an increasing incidence of ANC, HC, NSD, HIC, and PMC in the presence of AMO and MS. There is a decreasing incidence of MRC in the presence of AMO. Furthermore, AMO does not affect the incidence of MT.

Conclusion  This study showed that most parameters, except for MRC and MT, had increasing incidence in the presence of AMO. It is important for radiologists and rhinologists to have knowledge about the location of AMO and the presence of variations of MS adjacent structures to avoid surgical complications.

Application of a Cone-Beam Computed Tomography-Based Index for Evaluating Surgical Sites Prior to Sinus Lift Procedures-A Pilot Study

OBJECTIVES

Radiography-based indices can help surgeons perform detailed examinations of the surgical site and predict the surgical difficulty of cases. We aimed to develop and validate a novel CBCT-based index that can predict the surgical difficulty of sinus-augmentation procedures.

MATERIALS AND METHODS

In the first stage, five experienced dental specialists performed a review of the literature and closed group discussions and designed the novel index. In the next stage, the index was validated. CBCT scans of 30 patients scheduled for sinus-augmentation procedures were evaluated and assigned presurgical CBCT evaluation scores (PSCESs) by five examiners. Subsequently, one oral surgeon performed sinus augmentation using the lateral antrostomy technique and assigned surgical difficulty scores (SDSs) to each of the 30 cases along with 2 observers. The PSCESs and SDSs were statistically analysed to determine the interrater reliability and validity of the index.

RESULTS

The interrater agreement of the PSCES among the five presurgical evaluators was 0.85. The PSCES of the five evaluators had highly significant correlation (P < 0.001, r = 0.68 to 0.76) with the SDS. Regression analysis revealed that for every unit increase in the PSCES, there is 0.46 to 0.57 increase in the SDS value.

CONCLUSION

The results of this pilot study revealed that a novel CBCT-based index can be used as a reliable tool for predicting the surgical difficulty of sinus-augmentation procedures. However, the novel index needs to be tested on a larger sample of patients and evaluators for a more concrete validity and reliability.

Linear and Volumetric Analysis of Maxillary Sinus Pneumatization in a Sri Lankan Population Using Cone Beam Computer Tomography

Objective

The objectives of this study were to evaluate the linear and volumetric measurements of the maxillary sinus in relation to sex and side on cone beam computer tomographic (CBCT) images in a Sri Lankan population.

Methods

A total of 20 sets of CBCT images selected from the database at the Division of Oral Medicine and Radiology, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka, were evaluated. Linear measurements were obtained in a craniocaudal (height), anteroposterior (length), and mediolateral (width) dimensions. Volume was computed by using the same data using a computerized 3D modeling software developed for 3D measurements and calculations.

Results

The maximum mean craniocaudal dimension was at the level of the 1st and the 2nd molar tooth bilaterally. The largest average craniocaudal, mediolateral, and anteroposterior extensions of the maxillary sinus using CBCT were 31.71 ± 5.44 mm, 21.28 ± 5.09 mm, and 32.92 ± 4.31 mm, respectively. The differences between the sides and sex showed no statistical significance (P > 0.05), except for the maximum average value in craniocaudal dimension which showed a statistically significant difference in relation to gender (P = 0.02).

Conclusion

There is no significant difference in the largest average craniocaudal, mediolateral, and anteroposterior extensions of the maxillary sinus when gender and side were compared. However, the maximum average value in craniocaudal dimension had a statistically significant difference in relation to gender. This study provides valuable knowledge of the anatomical dimensions of the maxillary sinus which may help clinicians in treatment planning.

Changes in Maxillary Sinus Mucosal Thickening following the Extraction of Teeth with Advanced Periodontal Disease: A Retrospective Study Using Cone-Beam Computed Tomography

Objectives

To explore the alterations in maxillary sinus mucosal thickening after extracting teeth with severe periodontal disease using cone-beam computed tomography (CBCT).

Methods

30 patients with severe periodontal disease of maxillary posterior teeth that needed to be extracted and who were radiographically diagnosed with mucosal thickening (MT) in the maxillary sinus participated in the study. CBCT scans were taken before tooth extraction and 2-29 months after tooth extraction. The postextraction follow-up time was divided into two groups: group 1 (<4 months) and group 2 (≥4 months). Dimensions of maxillary sinus MT, including the MT zone length (SL) and the maximum thickness of the MT zone (ST), were evaluated preextraction and postextraction; the residual ridge height (RRH) was evaluated at the sites of extracted and nonextracted teeth.

Result

Of the 24 patients with unilateral tooth extraction, there was a statistically significant difference in MT between the extraction and nonextraction sides (p < 0.05). The RRH at the site of the extracted teeth was significantly lower than that of the nonextracted teeth (p < 0.05). MT decreased significantly after tooth extraction on the extraction side but not on the nonextraction side. There was no significant difference between group 1 and group 2 regarding the reduction in mucosal thickness over time.

Conclusions

Severe periodontitis can cause MT in the maxillary sinus. The RRH was lower at the sites of extracted teeth. MT reduced quickly by a thorough debridement after tooth extraction in 4 months. MT will not decrease further over time.

Agreement between cone-beam computed tomography and functional endoscopic sinus surgery for detection of pathologies and anatomical variations of the paranasal sinuses in chronic rhinosinusitis patients: A prospective study

Purpose

The diagnosis of chronic rhinosinusitis requires a comprehensive knowledge of the signs and symptoms of the disease and an accurate radiographic assessment. Computed tomography (CT) is the superior imaging modality for diagnosis of chronic rhinosinusitis. However, considering the lower dose and higher resolution of cone-beam computed tomography (CBCT) compared to CT, this study aimed to assess the agreement between the findings of CBCT and functional endoscopic sinus surgery (FESS).

Materials and Methods

This descriptive prospective study evaluated 49 patients with treatment-resistant chronic rhinosinusitis who were candidates for FESS. Preoperative CBCT scans were obtained before patients underwent FESS. The agreement between the CBCT findings and those of FESS was determined using the kappa correlation coefficient. The frequency of anatomical variations of the paranasal sinuses was also evaluated on CBCT scans.

Results

Significant agreement existed between pathological findings on CBCT scans and those of FESS, such that the kappa correlation coefficient was 1 for mucosal thickening, 0.644 for nasal deviation, 0.750 for concha bullosa, 0.918 for nasal polyp, 0.935 for ostiomeatal complex (OMC) obstruction, and 0.552 for infundibulum thickening. Furthermore, 95.9% of patients had 1 or more and 79.6% had 2 or more anatomical variations, of which nasal deviation was the most common (67.3%).

Conclusion

Considering the significant agreement between the findings of CBCT and FESS for the detection of pathological changes in the paranasal sinuses, CBCT can be used prior to FESS to detect chronic rhinosinusitis and to assess anatomical variations of the OMC.

Anatomical Study of the Innervation of the Masseter Muscle and Its Correlation with Myofascial Trigger Points

Background and Purpose

Myofascial pain syndrome (MPS) is widely prevalent in the general population; some reports estimate its prevalence ranges from 9 to 85%. Among the different locations where MPS may arise, pain related to the masseter muscle is referred as masticatory myofascial pain. MPS is characterized by myofascial trigger points (MTPs), which represent tender anatomical areas of a muscle where painful symptoms are elicited whenever stimulated. Previous publications have found MTPs to coincide with neuromuscular junctions at the motor end plate, at the innervation zone (IZ). Our study aimed to describe the innervation of the masseter muscle and relate it to clinically described myofascial trigger points (MTPs).

Materials and Methods

We mapped the nerve fiber distribution into the masseter muscles from 16 cadavers by anatomical dissection. We divided the muscle into six regions, three superior (I–III) and three inferior (IV–VI), and classified the nerve’s branches distribution according to these predetermined areas. Statistical analyses was made by Poisson distribution and logarithm link function followed by Bonferroni multiple comparisons (P<0.05).

Results

All six areas received branches from the masseteric nerve. Areas I and II (upper posterior and upper intermediate, respectively) had a significant higher number of nerve entries as compared to the remaining areas.

Conclusion

The penetration areas of the masseteric nerve have been established and MTPs are found in the innervation zones, clinicians should focus initially on the regions of the penetration points, for diagnostics and therapeutic measures, such as injections, dry needling and soft tissue interventions. Anatomical study of nerve supply to the masseter muscle can provide useful additional knowledge to further understanding masticatory myofascial pain and to direct therapeutic interventions and diagnostic studies of temporomandibular junction dysfunction.

Evaluation of factors affecting the association between thickening of sinus mucosa and the presence of periapical lesions using cone beam CT

AIM

To evaluate the effect of various parameters of periapical lesion(s) on the amount and type of mucosal thickening using cone beam CT images.

METHODOLOGY

CBCT scans of 1000 patients were evaluated retrospectively for the presence of apical lesions in maxillary posterior teeth associated with sinus mucosal thickening. The number of cases with pathological mucosal thickening was recorded and classified according to the amount and type of mucosal thickening. The parameters evaluated as the cause of mucosal thickening were the type and number of posterior teeth, number of root(s), diameter of the periapical lesion and distance between maxillary sinus and lesion. Descriptive statistics and multiple logistic regression was used for data analyses. Spearman's correlation coefficient was used for pair-wise comparisons. Intrarater reliability was tested by Cohen's kappa.

RESULTS

Mucosal thickening associated with periapical lesions was determined in 48% of 202 cases. The most frequently detected extent of mucosal thickening was type 3 (42%), whereas flat type thickening (59%) was the most frequent type. The tooth most frequently associated with mucosal thickening was the maxillary first molar (44%). Parameters significantly affecting the extent of mucosal thickening were gender, number of roots, number of teeth with periapical lesions and diameter of periapical lesions (P < 0.05). The single parameter with an association with the type of mucosal thickening was the number of roots with an apical lesion (P < 0.05).

CONCLUSION

Mucosal thickening associated with periapical lesions was observed in almost 50% of all mucosal thickening cases. Therefore, collaboration amongst endodontists and otolaryngologists is mandatory to provide successful treatment and prevent recurrence of maxillary sinusitis.

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.

Incidental findings detected on cone beam computed tomography in an older population for pre-implant assessment

OBJECTIVES

The aim of this retrospective study was to record incidental findings in CBCT scans taken in an older population for pre-implant assessment, and to examine whether these findings would influence the intended dental implant placement.

METHODS

300 consecutive CBCT scans over the age of 40 years was carried out. The incidental findings were grouped into regions as follows: dentoalveolar structures, maxilla and mandible, paranasal sinuses, temporomandibular joint (TMJ), naso/oral-pharyngeal airway, cervical spine and neurovascular canals. The incidental findings are further categories into their significance towards the intended treatment plan.

RESULT

Incidental findings were noted on all of the scans. 555 incidental findings (1.85 findings/scan) were identified. The highest number of incidental findings was in the sinuses (34%), followed by dentoalveolar structures (31%), nasal/oral-pharyngeal airway (12%), maxilla and mandible (10%), TMJ (6%), cervical spine (4%) and neurovascular canals (3%). A total of 37% of findings required follow-up. In 12% of cases detection of the incidental findings lead to amendment or abortion of the intended implant treatment plan.

CONCLUSION

Incidental findings within and beyond the region of interest are common in CBCT scans. The numbers of incidental findings per scan in an older population is higher than in a younger population.

Thickening of Schneiderian membrane secondary to periapical lesions: A retrospective radiographic analysis

Aim:

The aim of this study was to investigate the possible correlation between adjacent periapical lesions of maxillary teeth and Schneiderian membrane thickness (SMT).

Materials and Methods:

An analytical study of case-control study design was conducted. From the archives, cone beam computed tomography (CBCT) images of 83 patients with periapical lesion in any of the maxillary posterior teeth were randomly selected as the case group. The normal, contralateral teeth in the same patient were considered in the control group. Eighty-eight teeth were considered in each group, comprising a total sample of 176. For each sample in case group, the distance from the border of the periapical lesion to the cortical bone of the bony floor of the maxillary sinus and SMT were measured. SMT on the contralateral side adjacent to the healthy (control) teeth was also measured. Data were presented in mean ± standard deviation and inferential statistics was performed using independent t test and analysis of variance (ANOVA). Later Pearson correlation and multiple linear logistic regression were carried out using Statistical Package for the Social Sciences software program, version 21.0 at 95% confidence interval.

Results:

Teeth with periapical lesion were found to have significantly (P < 0.001) increased SMT when compared with that of adjacent to healthy teeth. On the contrary, nonsignificant differences were found in SMT when genders and age groups were compared (P = 0.295 and 0.060, respectively). A strong negative correlation was observed between distance of the lesion to the sinus and SMT (P = 0.003).

Conclusion:

Neighboring periapical lesions of maxillary teeth are associated with SMT that is worsened when the lesion is close to the sinus.

Associations between Periapical Health of Maxillary Molars and Mucosal Thickening of Maxillary Sinuses in Cone-beam Computed Tomographic Images: A Retrospective Study

INTRODUCTION

This retrospective study aimed to assess the radiologic characteristics of the possible associations between mucosal thickening of the maxillary sinuses (MSs) and periodontal and anatomic conditions of healthy and diseased maxillary teeth.

METHODS

The periapical health of the maxillary molars in cone-beam computed tomographic (CBCT) images from 50 patients (mean age = 40.60±14.59 years) was evaluated using the CBCT-periapical index. Anatomic associations between maxillary molars and the inferior wall of the MSs and periodontal bone loss and its relation to MS pathology were assessed. The possible effects of these conditions on mucosal thickening of MSs were analyzed. Kruskal-Wallis, Mann-Whitney U, chi-square, and logistic regression (for relative risk) tests were used for statistical analysis.

RESULTS

CBCT-periapical index 4 was the most frequently encountered apical periodontitis (AP) lesion. The risk for pathologic changes in the MSs was significantly higher in the presence of AP (P < .001). This risk was 62.364 times greater than that in areas of MSs adjacent to healthy teeth of the same patient (95% confidence interval, 7.968-488.14). Thicker MS mucosae were detected when the molar roots with AP were closer to the MSs (P < .004). No statistically significant difference was found between periodontal status and MS pathology.

CONCLUSIONS

The findings of this study showed that MSs were affected by the endodontic health of adjacent molar teeth. Dental and medical practitioners should take into consideration the possible odontogenic causes while examining pathologic changes in the MS.

Evaluation of maxillary sinus anatomical variations and lesions: A retrospective analysis using cone beam computed tomography

INTRODUCTION

The residual bone height in the posterior edentulous maxilla is frequently limited by the maxillary sinuses. Sinus floor elevation (SFE) is then considered to restore sufficient bone height. The preoperative analysis of the maxillary sinus is necessary for the success of this surgery. Therefore, we investigated the frequency of maxillary sinus anatomic variations and lesions by using cone beam computed tomography (CBCT).

MATERIALS AND METHODS

We retrospectively analysed all CBCTs performed at a private radiological center between January and November 2014. The following anatomical variations and lesions were assessed: sinus ventilation, sinus septa, the sinus totally compartmentalized, the hypoplastic sinus, sinus aplasia, the prolapsed sinus, thickness of the anterolateral wall, the position of antral artery, mucosa thickening, sinus opacity, the polyps and the cysts.

RESULTS

A total of 300 cone beam images were analyzed. The findings consisted in: ventilation 91%, septa 34.66%, total compartmentalized sinus 6%, hypoplastic sinus 5%, aplastic sinus 0%, prolapsed sinus 1.66%, endorsed position of the antral artery 53%, submucosa position 43%, thickening of the sinus mucosa 41%, sinus opacity 4%, polyps and the cysts 20.33%. The average thickness of the anterolateral wall was about 1.16±0.48mm.

CONCLUSION

The maxillary sinus has great interindividual anatomical variability. The cone beam is highly beneficial for the analysis of the anatomical structures in relationships with any sinus surgery.

Evaluation of the Relationship of Dimensions of Maxillary Sinus Drainage System with Anatomical Variations and Sinusopathy: Cone-Beam Computed Tomography Findings

OBJECTIVE

The aim of this study was to evaluate the correlation between the length of the infundibulum and ostium height with the anatomic variations of osteomeatal complex (OMC) and sinus pathology using cone-beam computed tomography (CBCT).

METHODS

CBCT images of 204 patients (408 maxillary sinuses) were evaluated retrospectively. The height of the ostium and the length of the infundibulum were measured. The presence of maxillary sinus pathology, nasal septal deviation, Haller cells, concha bullosa, and sinus septa were analyzed. The correlation between the size of the maxillary sinus drainage system and anatomic variations was compared using the t test, Fisher's exact test, and χ2 test. The effect of tooth loss on the length of the infundibulum and ostium height was also analyzed using ANOVA.

RESULTS

The height of the ostium and the maximal septal deviation angle were found to be significantly greater in males (p < 0.05). As ostium height increased, the presence of maxillary sinus septa increased (p < 0.05). No statistically significant association was detected between other variations and the length of infundibulum or ostium height. The relationship between tooth loss and both the length of the infundibulum and ostium height were found to be insignificant (p > 0.05).

CONCLUSIONS

Radiographic examination, especially on CBCT images, is important for an evaluation of maxillary sinuses. here, we demonstrated a significant relationship between ostium height and the presence of maxillary sinus septa. However, it was found that nasal septal deviation, concha bullosa, Haller cells, and other sinusopathies did not have a major effect on the size of the maxillary sinus drainage system.

Prevalence of Maxillary Sinus Pathology Based on Cone-Beam Computed Tomography Evaluation of Multiethnicity Dental School Population

OBJECTIVE

The goal of the study was to evaluate prevalence of maxillary sinus pathology among populations considered for possible sinus augmentation procedures for dental implants.

STUDY DESIGN

Eight hundred twenty-one cone-beam computed tomography (CBCT) scans were retrospectively evaluated for prevalence of maxillary sinus pathology. Scans were classified based on the type of sinus pathology detected. Categories of sinus findings were healthy, mucosal thickening larger than 3 mm, polypoidal mucosal thickening, partial opacification, complete opacification, and others. Age, sex, ethnicity, and dentition status were evaluated to determine associated relationships with the incidence of pathology.

RESULTS

Sixty-two percent (62.79%) of scans presented with bilateral healthy sinuses and 37.21% of scans exhibited pathology. 73.38% of sinuses were classified as clinical healthy, 14.93% presented with mucosal thickening, 8.53% with polypoidal mucosal thickening, 2.13% with partial opacification, 0.66% with complete opacification, and 0.37% with a foreign body. Sex is found to be a significant factor with higher pathology incidence rates in male patients. Age is a significant factor with higher pathology incidence rates in older subjects. Dentition status and ethnicity did not have a significant association with pathology incidence rates.

CONCLUSIONS

The prevalence of maxillary sinus pathologies and associations with age, sex, ethnicity, and dentition status were obtained. Thirty-seven percent of scans would require further medical consultation before proceeding with maxillary sinus augmentation surgery for dental implants.

Relationship Between the Posterior Superior Alveolar Artery and Maxillary Sinus Pathology: A Cone-Beam Computed Tomography Study

PURPOSE

The purpose of the present study was to assess the relationship between the posterior superior alveolar artery (PSAA), which plays an important role in the maxillary sinus blood supply, and maxillary sinus pathologic entities using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

The CBCT data from 325 patients (650 sinuses), aged 18 to 55 years, who had been referred to the Department of Dentomaxillofacial Radiology from 2015 to 2017 were evaluated retrospectively. For the PSAA examination, the axial, coronal, and sagittal CBCT images were evaluated for detection of an osseous canal in the lateral wall of the maxillary sinus and the prevalence, position, and location of the canal. In addition, the presence of maxillary sinus pathologic features was analyzed, and the relationship with the PSAA was investigated. The relationship among the categorical variables was tested using the χ² test.

RESULTS

The study group consisted of 325 patients, including 155 men (47.7%) and 170 women (52.3%). The PSAA was observed in 80.6% of the patients. Of the detected PSAAs, 79.0% were bilateral and 21.0% were unilateral and 56.3% were intraosseous and 40.7% were submembranous. A significant positive correlation was detected between the presence of a PSAA and patient age (P < .05). The prevalence of sinus pathologic entities was 73.2% of all patients. The most common sinus pathologic finding was localized mucosal thickening (53.5%). A significant relationship was found between the presence of PSAA and maxillary sinus pathologic entities (P < .001).

CONCLUSIONS

The presence of a PSAA might be a predisposing factor that increases the susceptibility to maxillary sinus pathologic entities. CBCT is an effective imaging method in the evaluation of the maxillary sinuses.

Evaluation of the survival of implant placement simultaneously with sinus augmentation: relationship in maxillary sinus pathologies

OBJECTIVES

This retrospective study aimed to evaluate the effects of existing maxillary sinus pathologies on the survival rates of dental implants placed simultaneously with sinus augmentation.

METHODS

Cone-beam computed tomography images of 88 patients (34 females, 54 males), who underwent sinus augmentation, were retrospectively analyzed and the patients were divided into two groups: with (pathology group) and without pathology (control group). All maxillary sinus pathologies were recorded and categorized into mucosal thickening ( ≥ 3 mm), antral pseudocyst (polypoid mucosal thickening), and complete opacification. Implant survival rates were evaluated after a mean follow-up period of 28.2 ± 9.8 months based on the patient's records and control radiographs.

RESULTS

A total of 115 maxillary sinuses of 88 patients with 168 dental implants were included in the study. Maxillary sinus pathology was detected in 45 patients in the pathology group and 43 patients in the control group. In the pathology group, one implant was lost out of 82 implants during the 27.8 ± 9.5 months follow-up period, while in the control group, 5 implants were lost out of 86 implants during the 25.1 ± 10 months follow-up period. There was no statistically significant difference in the survival rates between the two groups.

CONCLUSIONS

The study concluded that the presence of pathology in the maxillary sinus before surgery does not affect the survival rates of dental implants placed simultaneously with sinus augmentation. The most common pathology noted included mucosal thickening (61.4%), which was detected in 35 patients.

Effects of clinical local factors on thickness and morphology of Schneiderian membrane: A retrospective clinical study

BACKGROUND

It was informed that the thickness of maxillary sinus membrane may be affected by the local and patient-related factors in the literature.

PURPOSE

The aim of this retrospective study is to evaluate factors that may have an influence of the thickness and morphology of the maxillary sinus membrane.

MATERIALS AND METHODS

A total of 414 cone beam computed tomography images of 207 patients were evaluated. Radiographic parameters were evaluated at each maxillary premolar and molar tooth regions. Statistical analysis was performed to assess the association between the maxillary sinus mucosa thickness and morphology. The following factors including gender, periodontal bone loss (PBL), bone density, amount of residual alveolar bone at the edentulous space, vitality of the teeth present, and anatomical relationship between the sinus floor and posterior teeth were evaluated.

RESULTS

The mean thickness of maxillary sinus membrane ranged between 1.47 to 2.92 mm and was significantly thicker in male subjects (P < .05). Positive correlation was detected between the sinus membrane thickness values in each posterior tooth region (P < .05). Thickening of the membrane was noted in 53% of the scans. The most commonly observed morphological change was flat thickening of the membrane (21%). No correlation was found between the evaluated local factors on the thickness and morphology of the maxillary sinus membrane (P > .05).

CONCLUSIONS

Tooth vitality, residual alveolar bone height, and PBL seem to have no effect on the thickness and morphology of the maxillary sinus membrane.

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.

Investigation on the relationship of dimensions of the maxillary sinus drainage system with the presence of sinusopathies: a cone beam computed tomography study

OBJECTIVE

This study sought to assess the relationship between the dimensions of the maxillary sinus drainage system with the content of sinuses.

DESIGN

Three-hundred cone beam computed tomography images were selected from a database (105 males and 195 females). The images were assessed by a single investigator, trained and calibrated, performing image analysis. The length of the infundibulum and the ostium height in both maxillary sinuses were measured. The data were analyzed using Minitab 16, using 5% as a critical p-value.

RESULTS

A significant gender difference was also found for presence in the normal content of sinus for females and presence of antral pseudocyst for males (p < 0.05). Subjects with normal content in the maxillary sinus present lower ostium height values. There were statistically significant with presence of and higher ostium height values and antral pseudocyst (p < 0.01).

CONCLUSION

The current study results demonstrated that some sinusopathies were significantly related to dimensions of maxillary sinus drainage.

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.

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.

Characterization of the Maxillary Sinus Using Cone Beam Computed Tomography. A Retrospective Radiographic Study

PURPOSE

To analyze the anatomical findings and alterations of the maxillary sinus in asymptomatic patients observed by cone beam computed tomography.

MATERIALS AND METHODS

A cross-sectional retrospective study of the anatomical variations and alterations of the maxillary sinus was made in 160 patients-71 males (44.3%) and 89 females (55.6%), with an age range of 18 to 74 years-measuring the thickness of the Schneiderian membrane and the cortical thickness of the lower margin of the maxillary sinus (in its most caudal portion), and correlations among the different study variables were assessed.

RESULTS

Sinus pneumatization was the most frequent anatomical finding (81.3%). A negative correlation was observed between the thickness of the Schneiderian membrane and the presence of Underwood septa (P < 0.005). Mucosal thickening of more than 2 mm was directly correlated with the presence of maxillary sinus lesions (opacification, discontinuity of the floor of the sinus, polypoid lesions, or air-liquid levels).

CONCLUSION

The presence or absence of septa seems to be related to the thickness of the Schneiderian membrane.

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.

Evaluation of symptomatic maxillary sinus pathologies using panoramic radiography and cone beam computed tomography-influence of professional training

Background

A comparison of panoramic radiography (PAN) alone and PAN together with small field of view cone beam computed tomography (sFOV-CBCT) for diagnosis of symptomatic pathologies of the maxillary sinus was carried out by clinicians of different experience.

Methods

Corresponding radiographic images (PAN/sFOV-CBCT) of 28 patients with symptomatic maxillary sinus pathologies were chosen and analyzed by two general practitioners (GP), two junior maxillofacial surgeons (MS1), and three senior maxillofacial surgeons (MS2) via questionnaire.

Results

Visibility of maxillary pathologies in PAN was significantly different between the groups (GP 39%, MS1 48%, MS2 61%; p < 0.05). The number of incidental findings varied within examiner groups in PAN with a significant increase in MS2 (p = 0.027). The majority of examiners rated an additional sFOV-CBCT as “reasonable”/“required” with a significant influence of the examining groups (GP 98.2%, MS1 94.6%, MS2 80.9%; p = 0.008). In 58% of cases, an additional sFOV-CBCT was seen as “affecting therapy” with significant differences between the groups (GP 68%, MS1 50%, MS2 55%; p < 0.001).

Conclusions

PAN alone is not sufficient for the evaluation of pathologies of the maxillary sinus. But, depending on the examiners’ clinical experience, it remains a useful diagnostic tool. Along with the observers’ training, significant benefits of an additional sFOV-CBCT for evaluation of symptomatic maxillary sinus pathologies were detected.

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.

Evaluation of the Prevalence of Maxillary Sinuses Abnormalities through Spiral Computed Tomography (CT)

Introduction Maxillary sinus disease is common and numerous disorders can affect this anatomical area. Abnormalities can be classified as: non-neoplastic, neoplastic benign, and neoplastic malignant.

Objective Evaluate through CT the prevalence of diseases in maxillary sinuses, using the Radiology Department's database of a hospital in São Paulo city.

Methods The sample consisted of 762 facial CT scans that we divided into three groups: Group A (12–19 years old); Group B (20–49 years old); Group C (above 50 years old); and male or female. We considered the following pathological processes: I - Mucoperiosteal Thickening; II - Chronic Sinusitis; III - Chronic Odontogenic Sinusitis; IV - Rhinosinusitis; V - Polypoid Lesions; VI - Bone Lesions; VII - Neoplasms; VIII - Antrolith; IX - Foreign Bodies; X - Oroantral Fistula.

Results Our study found that 305 exams (40.02%) were normal and 457 exams (59.97%) were abnormal. We found the following disease frequencies: focal mucoperiosteal thickening (21.25%); polypoid lesions (10.76%); chronic sinusitis (7.48%); chronic odontogenic sinusitis (2.29%); neoplasms (2.03%); rhinosinusitis (1.77%); bone lesions, foreign bodies and oroantral fistula in 0.65%; 0.13% and 0.06% respectively. There was no significant difference between male and female, and Groups A, B, or C when relating the frequencies of abnormalities found. There was no significant difference between male and female and the age group for the side of the altered maxillary sinus.

Conclusion We observed a high prevalence of sinus maxillary diseases. Mucoperiosteal thickening; acute, chronic, and odontogenic sinusitis; polypoid lesions and neoplasms have high prevalence in maxillary sinuses. Thus, facial CT exam was effective for the evaluation of diseases in maxillary sinuses.

Three-dimensional cone beam computed tomography analysis of maxillary sinus and alveolar bone anatomy in the restorative axis of dental implants using radiopaque drill guides

The objectives were to assess the sinus anatomy and alveolar ridge dimensions and to identify clinical factors and morphological relationships that may predict the characteristics of the sinus anatomy. A total 336 edentulous molar and 168 edentulous premolar regions were analyzed. The mediolateral maxillary sinus (5mm and 10mm above alveolar bone), lateral maxillary sinus wall, ostium height, and alveolar ridges were measured. Measurement regions were defined by radiopaque simulation of the restoration goal. Mean molar mediolateral dimensions were >10mm: first molar, 11.8mm (range 3.8-21.1mm); second molar, 12.2mm (range 7.9-20.1mm). The extent of the sinus differed significantly between premolars and molars (P<0.001). The first molar region had the highest mean value for the lateral sinus wall (2.4mm, range 0.2-7.9mm) and the greatest distance between the alveolar crest and simulated restorative goal (8.1mm, range 1.1-16.3mm). Septum prevalence was 46% in the molar region and 27% in the premolar region. A lower alveolar ridge height was associated with a wider transverse extent of maxillary sinus and consequently longer distances between the crest and restorative goal. Systematic three-dimensional analysis of the maxillary sinus yields precise preoperative information about sinus configurations. There were significant variations and relationships among characteristics of the maxillary sinus, ridge, and the restorative goal.