Assessment of the relationship between the maxillary sinus floor and the upper posterior root tips: Clinical considerations

Cone-Beam Computed Tomography Evaluation of Maxillary Sinus Changes in Orthodontic Patients Treated With Extraction of Four First Premolars

The objective of this study was to assess alterations in maxillary sinus mucosa thickness and the distances between the apexes of specific teeth and the maxillary sinus base in adult patients undergoing orthodontic treatment with the extraction of four first premolars. Twenty-one adults, averaging 24.85 years of age, received orthodontic therapy involving the extraction of all four first premolars. Cone-beam computed tomography scans were conducted before and after treatment to evaluate changes. Notably, post-treatment scans revealed a significant increase (P= 0.044) in the distance between the apex of the second premolar and the maxillary sinus floor, with an average augmentation of 1.0141 millimeters. However, no notable alterations were detected in the distances between the apexes of other teeth and the maxillary sinus or in maxillary sinus mucosa thickness. These findings suggest that orthodontic treatment with the extraction of four first premolars may elevate the distance between the maxillary sinus floor and the second premolar apex, which provides a reference for risk assessment and surgical design of first premolar extraction during orthodontic treatment.

Dynamically guided transantral piezoelectric endodontic microsurgery: A case report with technical considerations

AIM

Endodontic microsurgery (EMS) of maxillary molars may represent a complex challenge to the clinician due to the location of the roots and the proximity of the maxillary sinus floor. This report aimed to describe the simultaneous use of a computer-assisted dynamic navigation (C-ADN) system and piezoelectric bony-window osteotomy for the transantral microsurgical approach of a maxillary left first molar with adequate root canal filling and symptomatic apical periodontitis.

SUMMARY

This case report highlights the importance of C-ADN to carry out a minimally invasive buccal surgical access to palatal roots affected by apical periodontitis and provides a practical example to help clinicians make treatment decisions based on the available evidence. Clinical and tomographic evaluations were performed before the surgical procedure and at 24-month follow-up. This case was treated using a C-ADN system fitted to a piezotome for the buccal approach of the buccal roots, maxillary sinus membrane lifting, and for transantral location, root-end resection, cavity preparation, and filling of the palatal root. The navigation system allowed to achieve an accurate apical canal terminus location and root-end filling of the three roots with a minimally invasive piezoelectric crypt approach. At the 24-month follow-up examination, the patient remains asymptomatic, with normal periapical structures, and regeneration of maxillary sinus walls. It was concluded that the combination of dynamic navigation with piezoelectric bony-window osteotomy offers enhanced accuracy, tissue preservation, diminished risk of iatrogenic complications, and could maximize success and survival rates in transantral EMS.

Characteristics of CBCT versus panoramic signs of the surrounding bone of molar root protrusions into the maxillary sinus

The study aimed to (a) investigate the amount and characteristics of the surrounding bone of protruded molar roots into the maxillary sinus using cone-beam computed tomography (CBCT) and (b) assess the correlation between the amount of bone with panoramic high-risk signs. Radiographs of 408 roots protruding beyond the sinus floor were evaluated. Axial CBCT images were used to investigate then classify eight characteristics of surrounding bone: no bone; bone < half the root girth in the proximal or buccal-palatal aspect; bone covering half the root girth in the proximal or buccal-palatal aspect; bone > half the root girth in the proximal or buccal-palatal aspect; and, complete bone. These were then grouped into four degrees of bone support: no bone; bone ≤ half the root girth; bone > half the root girth; and, complete bone. Panoramic signs were subclassified as: projection of root; interruption of the sinus floor; darkening of the root; upward curving of the sinus floor; absence of periodontal ligament space; and, absence of the lamina dura. Correlation between the degree of bone and the panoramic signs was evaluated using the Chi-square or Fisher's exact tests. Positive and negative predictive values, sensitivity, specificity, accuracy, and receiver operating characteristic analysis were calculated. Complete bone support was the most common. 'Projection of root' had a high negative predictive value and sensitivity. 'Absence of the periodontal ligament space and lamina dura' had a high positive predictive value, specificity, accuracy, and area under the curve. These two signs were significantly correlated with the degree of bone support.

Cone-Beam Computed Tomography (CBCT)-Based Assessment of the Alveolar Bone Anatomy of the Maxillary and Mandibular Molars: Implication for Immediate Implant Placement

Purpose This study aims to examine specific aspects of socket morphology, including buccal and palatal/lingual bone width, interradicular bone (IRB) width, and assessments of root apices and furcation proximity to the vital structures of the maxillary and mandibular first and second molars using cone-beam computed tomography (CBCT). Materials and methods The study involved the analysis of 400 maxillary and mandibular first and second molars. Various measurements were taken to assess socket morphology, including mesiodistal (MD) and buccolingual (BL) width, buccal and lingual bone thickness at 2 mm apical to the alveolar crest, IRB width at 2 mm from the furcation, and the distance between the root apices and furcation to vital structures, such as the floor of the maxillary sinus (FMS) and inferior alveolar nerve (IAN). Results The mesiobuccal (MB) root of the second molar commonly intruded into the sinus, followed by the palatal root of the maxillary first molar. The mean FMS-F distance was 7.17 + 3.98 mm, and it was 7.2 + 2.72 mm for maxillary first and second molars, respectively. The mean IRB width was 2.77 + 0.96 and 2.29 + 0.74 mm for the first and second molars. The mandibular second molar had the shortest distance to the IAN in comparison to the first molar. For maxillary teeth, 7% of the first and 4% of the second molars presented alveolar anatomy adequate for immediate implant placement, compared to 84% and 50% of mandibular first and second molars. Conclusion Understanding the local alveolar bone anatomy of molars and its relationship to vital structures is crucial for the effective planning of implant treatments.

Three-dimensional quantification of the relationship between the upper first molar and maxillary sinus

Objectives

The present study aims to describe the relationship between upper first molar roots and maxillary sinus, for the first time with a truly three‐dimensional approach.

Methods

From a retrospective cone‐beam computed tomography (CBCT) sample of the upper jaw, a total of 105 upper first molars in contact with maxillary sinus from 74 patients (male 24, female 50, mean age 42) were included in the present study. Segmentation of the upper first molar and maxillary sinus in CBCT was performed utilizing a semiautomatic livewire segmentation tool in MeVisLab v.3.1. The segmentations were analyzed in 3‐matic Medical 20.0 for root volume and the contact area between upper first molar roots and maxillary sinus. Analysis of variance test was applied to detect statistically significant differences between the roots.

Results

The palatal root had the largest contact area with maxillary sinus 27.8 ± 21.4 mm² (20% of the root area) followed by the mesiobuccal 20.5 ± 17.9 mm² (17% of the root area) and distobuccal root 13.7 ± 12 mm² (14% of the root area). A significant difference in the contact area of the different roots of the upper first molar was seen.

Conclusions

This study showed that 70% of the upper first molars were in contact with the maxillary sinus. The palatal root had on average a fifth of its root surface in contact with the sinus, while for mesiobuccal this was a sixth of its root surface and distobuccal roots this was somewhat less. The true 3D relationship could help to better understand maxillary anatomy in relation to occurring pathologies and treatment planning in this area.

CBCT-based assessment of the anatomic relationship between maxillary sinus and upper teeth

Objectives

To describe the relationship between maxillary sinus (MS) and upper teeth based on cone beam computed tomographic scans (CBCT).

Materials and methods

Based on CBCT maxillary imaging data of 147 patients, distance between MS and apices of canines and posterior maxillary teeth were assessed. Distances between tooth roots and sinus were classified into three groups: distant (>2 mm), close (<2 mm) or in contact with MS. Teeth with apical lesions and uncommon root configurations were excluded.

Results

In total, 1075 teeth of maxillary canines, upper premolars and upper molars were included in this study. Teeth most often in contact with MS were the second (89%) and first (81%) maxillary molar without any significant difference (p = 0.19). Roots most often in contact with MS were the mesiobuccal and distobuccal root of the second molar (85% and 76%; p = <0.01) followed by the palatal root of the first molar (73%). A fifth of the upper canines are situated less than 2 mm from MS.

Conclusions

More than four out of five upper molars (first and second) are in a close relationship to the MS. Knowledge of the anatomical relationship between posterior maxillary teeth and the MS is important for diagnosis and treatment in this area.

Comparison of panoramic radiography and cone-beam computed tomography for assessing radiographic signs indicating root protrusion into the maxillary sinus

Purpose

This study investigated correlations between findings on panoramic radiographs and cone-beam computed tomography (CBCT) to assess the relationship between the maxillary sinus floor and the roots of maxillary posterior teeth. In addition, radiographic signs indicating actual root protrusion into the maxillary sinus were evaluated on panoramic radiographs.

Materials and Methods

Paired panoramic radiographs and CBCT images from 305 subjects were analyzed. This analysis classified 2,440 maxillary premolars and molars according to their relationship with the maxillary sinus floor on panoramic radiographs and CBCT images. In addition, interruption of the sinus floor was examined on panoramic radiographs.

Results

Root protrusion into the maxillary sinus occurred most frequently in the mesiobuccal roots of the second molars. The classification according to panoramic radiographs and CBCT images was the same in more than 90% of cases when there was no contact between the root apex and the sinus floor. When the panoramic radiograph showed root protrusion into the sinus, the CBCT images showed the same classification in 67.5% of second molars, 48.8% of first molars, and 53.3% of second premolars. There was a statistically significant relationship between interruption of the sinus floor on panoramic radiographs and root protrusion into the sinus on CBCT images.

Conclusion

The presence of root protrusion into the sinus on panoramic radiographs demonstrated a moderate ability to predict root protrusion into the maxillary sinus. Interruption of the maxillary sinus floor could be considered an indicator of actual root protrusion into the maxillary sinus.

Determination of alveolar bone height according to the relationship between molar teeth and maxillary sinus

PURPOSE

This study aims to analyze alveolar bone height (ABH) in the maxillary molar area according to the anatomical relationship between maxillary sinus and maxillary molar teeth via cone beam computed tomography images.

METHODS

In 330 patients, 660 maxillary first molar (M1) and 648 maxillary second molar (M2) were evaluated. ABH measurements were made as to the shortest distance between the furcation midpoints of maxillary molars and the lowest point of the sinus floor. After the measurement, the positions of the maxillary molar teeth relative to the maxillary sinus were classified into four categories as type 1, 2, 3, and 4.

RESULTS

ABH measurements in males were significantly higher than females (p < 0.05), but there were no differences between sides (p > 0.05). There were significant differences between types of both M1 and M2 for ABH, and the longest ABH was measured in type 1 (p < 0.05). Type 3 was the most common among 1308 maxillary molars teeth followed by type 1, type 2, and type 4.

CONCLUSION

Determination of the relationship between maxillary molar teeth and the maxillary sinus and analysis of ABH according to this relationship may help plan endodontic treatment, apical surgery, and immediate implant therapy and prevent their complications.

Impact of maxillary teeth morphology on the failure rate of local anesthesia

Objective:

To investigate the effect of maxillary single and multiple rooted teeth on the success rate of buccal infiltration anesthesia.

Subjects and Methods:

This clinical study was performed by dividing the participants into three groups. Group one included 30 patients with upper anterior teeth, group two 23 patients with upper premolars teeth and group three 39 patients with upper molars for extraction. Onset time of anesthtic action was evaluted by using electronic pulp tester. Pulp testing assessments were carried out immediately before the injection and at the intervals of 2 mins following the injection until the anesthetic success obtains.

Results:

Seventy-nine patients in this study secured anesthetic success within study duration time (10 min). However, there were 13 patients with dental anesthesia failures (3 patients with single rooted teeth and 10 patients with multiple rooted teeth). There were no significant differences in the mean onset time of pulpal anesthesia between the anterior, middle and posterior teeth (P value = 0.449). Clinically, patients with single rooted teeth reported faster dental anesthesia and earlier teeth extraction than patients with multiple rooted teeth.

Conclusion:

This study showed that the single rooted teeth have faster pulpal anesthesia and early extraction than teeth with multiple roots but not statistically significant. Administration of extra local anesthetic cartridge or using intraseptal injection technique can be a solution to overcome the failure of anesthesia in the maxillary posterior teeth.

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

Background:

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

Aims and Objectives:

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

Materials and Methods:

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

Results:

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

Conclusion:

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