Prevalence and anatomical variations of maxillary sinus septa: A cone-beam computed tomography analysis

Evaluation of anatomical variants and pathological findings of the maxillary sinus prior to sinus floor elevation: A Cone Beam CT retrospective study in 660 patients

Background

Maxillary sinuses may present a wide spectrum of anatomical variations and pathological lesions whose recognition is mandatory for the clinician, especially prior to any surgical intervention in the area, such as in cases of sinus floor elevation. The goal of this study was the evaluation, mapping and prevalence of sinus anatomical variants and pathoses in Cone Beam Computed Tomography (CBCT) scans of dental patients.

Material and Methods

660 CBCT examinations of adult patients involving both sinuses were obtained (between 2017 and 2023) and analyzed. The following anatomic variants and pathologic findings were evaluated: antral septa (AS), posterior superior alveolar artery (PSAA), sinus hypoplasia, sinusitis, odontogenic cysts, retention cysts, antroliths, and various less common lesions (e.g.: benign fibro-osseous dysplastic lesions, neoplasms etc.). Investigation of the association of the findings with patients' age and gender was performed using the Chi-square test (X2), Fisher's exact test, t-test, and ANOVA (P<0.05). Differences in prevalence between findings, based on their location (right and/or left sinus), were investigated using z-test and t-test.

Results

AS were found in 38.6%, and PSAA was identifiable in 90.2% (mean distance from the sinus floor=6.44 mm) of the patients respectively. 3% of patients had hypoplasia, 15.6% sinusitis, 2.7% odontogenic cysts, 16.1% retention cysts, 8.6% antroliths, and 1.7% uncommon lesions (e.g. malignant neoplasms and fibrous dysplasia). A statistically significant association was found between gender and PSAA diameter, PSAA distance from the sinus floor, hypoplasia, sinusitis, and retention cysts, as well as a statistically significant association between age and PSSA diameter and sinusitis.

Conclusions

The prevalence of various anatomical variants and pathologic findings of the maxillary sinus did not differ based on their location. However, some of these findings appear to be related to either gender or age. CBCT is a valuable diagnostic tool to identify various anatomical variants and pathological findings of the maxillary sinus. Key words:Sinus, anatomy, pathology, CBCT.

Association between gubernacular canals characteristics and teeth eruption status: a cone-beam computed tomography study

Background

There have been few studies that have evaluated the imaging characteristics of the gubernacular canal. Additionally, it is important to understand the role of this structure and its relationship with tooth erupt. Therefore, the objective of this study was to investigate the association between gubernacular canal features and teeth eruption status on cone-beam computed tomography (CBCT) images.

Material and Methods

In this cross-sectional study, 150 CBCT images were obtained from patients referred to a maxillofacial radiology clinic in Babol, northern Iran, in 2021. Eruption status (normal, delayed, and impacted) and the presence of the gubernacular canal were recorded. If the gubernacular canal was detected, its opening site in the alveolar crest (buccal, lingual, and central) and its attachment site to the dental follicle (usual, unusual) were further assessed.

Results

Gubernacular canal was observed in 133 (88.7%) of the total 150 CBCT images. Also, 41 cases (27.3%) had impacted teeth. The detection rate of the gubernacular canal in the normal, delayed, and impacted eruption of teeth was 92.1% (n=93), 75.0% (n=6), and 82.9% (n=34), respectively (p=0.135). Opening the gubernacular canal in the alveolar crest was not associated with teeth eruption status. Also, unusual attachment sites of the gubernacular canal to dental follicles were mostly seen in abnormal eruptions.

Conclusions

According to the findings, observing the presence of the gubernacular canal on CBCT may not help anticipate teeth eruption problems. Key words:Gubernacular canal, Cone-beam computed tomography, Tooth eruption.

Diagnostic performance of cone-beam computed tomography for apical periodontitis: a systematic review and meta-analysis

Purpose

We aimed to conduct a systematic review and meta-analysis of studies examining the performance of cone-beam computed tomography (CBCT) imaging in apical periodontitis (AP) prediction. This was done to address the contradictory results reported in the existing literature on this topic.

Material and methods

We searched the Embase, PubMed, Cochrane library, and Scopus databases for literature published from inception to 30 June 2023 without language restriction using appropriate keywords. We included studies that reported the diagnostic accuracy values of CBCT in AP detection among humans by comparing AP diagnosis with a control group without lesions. We pooled the diagnostic accuracy values using a random effects model and presented the estimates as percentage and 95% confidence interval (CI). The heterogeneity between the surveys was explored by I2 statistic.

Results

Out of 301 citations initially identified, a total of 8 eligible studies were finally included. According to the analyses, the overall pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) estimated for CBCT were 94.6% (95% CI: 90.2-97.1; I2 = 55.9%, p = 0.026), 91.2% (95% CI: 81.7-96.0; I2 = 81.6%, p < 0.001), 93.0% (95% CI: 87.4-96.2; I2 = 56.5%, p = 0.024), and 92.3% (95% CI: 82.3-96.8; I2 = 86.4%, p < 0.001), respectively. The overall pooled sensitivity, specificity, PPV, and NPV of digital radiography were 61.0% (95% CI: 38.3-79.8; I2 = 94.4%, p < 0.001), 97.3% (95% CI: 85.6-99.5; I2 = 86.7%, p < 0.001), 98.3% (95% CI: 92.0-99.6; I2 = 74.4%, p = 0.002), and 41.6% (95% CI: 28.0-56.6; I2 = 89.5%, p < 0.001), respectively.

Conclusions

CBCT imaging has excellent diagnostic accuracy in AP prediction. Also, CBCT has better discriminant test performance for AP than digital radiography.

Prevalence and Characteristics of the Maxillary Sinus Septa in a Saudi Arabian Sub-population: A Retrospective Cone Beam Computed Tomography (CBCT)-Based Study

OBJECTIVES

This study aims to investigate and determine the prevalence, location, and morphological differences of the maxillary sinus septa using cone beam computed tomography (CBCT) images in the Madina region and to discuss its clinical implications during sinus surgery.

METHODS

This study was a retrospective cross-sectional radiographic analysis of 808 CBCT scans from patients who attended Taibah University's College of Dentistry between December 2018 and June 2023. Age, gender, number of septa present per side, location (anterior, middle, posterior), morphology (complete or partial), and type (primary or secondary) were among the study variables. For data statistics, correlation analysis was utilized.  Results: Eight hundred eight CBCT scans were included with a mean age of 34.7±15.08. Septal bone was absent in 60.64% of the sinuses examined. Single septa were more common than multiple septa (p=0.009). Bilateral septal presence and the left septal bone were more common than the right, but none of these distributions were statistically significant. Males showed more sinus septa compared to females, but the difference was not statistically significant (p=0.420). Single septa were more prevalent in people under the age of 25.

CONCLUSION

More than 60% of the Madina population had patent sinus cavities with no septal processes, but males with single septal processes predominated.

Diagnostic performance of artificial intelligence using cone-beam computed tomography imaging of the oral and maxillofacial region: A scoping review and meta-analysis

Purpose

The aim of this study was to conduct a scoping review and meta-analysis to provide overall estimates of the recall and precision of artificial intelligence for detection and segmentation using oral and maxillofacial cone-beam computed tomography (CBCT) scans.

Materials and Methods

A literature search was done in Embase, PubMed, and Scopus through October 31, 2022 to identify studies that reported the recall and precision values of artificial intelligence systems using oral and maxillofacial CBCT images for the automatic detection or segmentation of anatomical landmarks or pathological lesions. Recall (sensitivity) indicates the percentage of certain structures that are correctly detected. Precision (positive predictive value) indicates the percentage of accurately identified structures out of all detected structures. The performance values were extracted and pooled, and the estimates were presented with 95% confidence intervals (CIs).

Results

In total, 12 eligible studies were finally included. The overall pooled recall for artificial intelligence was 0.91 (95% CI: 0.87-0.94). In a subgroup analysis, the pooled recall was 0.88 (95% CI: 0.77-0.94) for detection and 0.92 (95% CI: 0.87-0.96) for segmentation. The overall pooled precision for artificial intelligence was 0.93 (95% CI: 0.88-0.95). A subgroup analysis showed that the pooled precision value was 0.90 (95% CI: 0.77-0.96) for detection and 0.94 (95% CI: 0.89-0.97) for segmentation.

Conclusion

Excellent performance was found for artificial intelligence using oral and maxillofacial CBCT images.