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

An analysis of the relevance and proximity between maxillary posterior root apices to the maxillary sinus and the buccal cortical bone plate

Background/purpose

Understanding the relationship between maxillary sinus and posterior root apices is critical in preventing dental treatment complications. This study aimed to analyze and showcase the relationship between the posterior root apices and the maxillary sinus floor, the distance to the buccal cortical bone, and their correlation with age, gender, and sides.

Materials and methods

Cone-beam computed tomography images were collected from 94 patients with a total of 478 maxillary posterior teeth and 997 roots. The shortest distance from root apices to the closest border of maxillary sinus and the outer buccal cortical bone margin were measured and grouped for statistical analysis for the differences (P < 0.05).

Results

The root apices of maxillary molars and single-rooted second premolars were located closer to the maxillary sinus compared to first premolars (P < 0.01). The buccal root of two-rooted first premolar had the shortest horizontal distance to the buccal cortical bone among all roots (P < 0.01). The lowest position of the maxillary sinus floor was mostly located at the palatal side (P < 0.01) and between the buccal and palatal root apices (P < 0.01) in the maxillary premolars and molars, respectively. Increasing age would lead to longer distances between the root apices and the maxillary sinus (P < 0.01). Additionally, male patients had thicker buccal cortical bone than female patients (P < 0.01).

Conclusion

Different tooth positions, age, and gender significantly impact the relationships between root apices and the maxillary sinus and buccal cortical plates, informing patient-centered and individually tailored approaches for more effective and safer surgical endodontic treatment.

Anatomic relationship between the root apex of maxillary molars and maxillary sinus in the presence of antagonist teeth: A Kwak's method with divisions

OBJECTIVE

The purpose of the study was to evaluate the proximity between the root apices of maxillary molars and maxillary sinus floor using cone-beam computed tomography (CBCT) in the southern Turkish subpopulation.

DESIGN

For the study, 246 CBCT images were analyzed. The absence of antagonist teeth was excluded. Kwak's types III and V were detailed with three divisions. Division M; the penetration of the mesial root only, Division D; the penetration of the distal root only, and Division MD; the penetration of both buccal roots. The distance between the maxillary sinus and the root apices was measured. Student's t-test, one-way ANOVA, and chi-square were used for statistical analysis.

RESULTS

The penetration of maxillary molars was 24.40%. The highest prevalence belonging to Type I. Division MD was 44.35% for Type III and 40.42% for Type V. Division M was higher than Division D. The distances between the sinus and root apices were 1.35-2.41 mm in Type I. The distance decreased with age (p < 0.05).

CONCLUSION

Both buccal root penetration into the sinus was higher than the single root penetration. The distance of the second molar root apices to the sinus was closer than the first molar. One-quarter of the first and second molars were inside the sinus. A greater likelihood of penetration of the root apices into the sinus with increased age.

Multifactorial analysis of the maxillary premolar area for immediate implant placement using cone beam computed tomography: A study of 333 maxillary images

STATEMENT OF PROBLEM

Immediate implant placement in the maxillary premolar area is challenged by anatomic variations imposing risks such as perforation of the buccal bone and the maxillary sinus. Previous studies have addressed the potentially relevant factors individually; a study assessing all relevant variables comprehensively and with a large sample size is lacking.

PURPOSE

The purpose of this observational study was to analyze multiple anatomic considerations, including sagittal root position, alveolar bone concavity angle, buccal bone perforation, maxillary sinus floor root proximity, and maxillary sinus perforation in the maxillary premolar area, using cone beam computed tomography (CBCT) to inform, perceive, and simplify the placement of immediate implants.

MATERIAL AND METHODS

The analysis involved 333 CBCT images (189 of men, 144 of women). A total of 1332 first and second maxillary premolars were assessed for sagittal root position, alveolar bone concavity angle, buccal bone perforation, maxillary sinus floor root proximity, and maxillary sinus perforation. Chi-squared and kappa tests were used to analyze the distributions and agreement, respectively, while dependent and independent t tests were used to assess sex and tooth-specific differences. The Spearman correlation test was used to explore the potential correlations (α=.05) RESULTS: The majority of sagittal root position distribution was on the buccal side, ranging from 79.3% to 88.3%, while maxillary sinus floor root proximity showed a predominance of the T0 category (roots separated from the maxillary sinus floor), with noticeable sex disparities in the second right premolar (73% in men versus 50.7% in women; P<.001). The "perforation" category of buccal bone perforation was highest in the right first premolar (54.1%), being higher in women across all teeth. The "perforation" category of maxillary sinus perforation was highest in the left second premolar (21.9%). Associations were found between buccal bone perforation and sagittal root position in the second premolars. The Spearman correlation between root proximity and sinus perforation was high, ranging from 0.68 to 0.78.

CONCLUSIONS

The alveolar bone concavity angle in first premolars, compared with second premolars, poses a higher risk of buccal bone perforation, especially in women. The buccal position is the most common sagittal root position. The risk of sinus perforation is higher in maxillary second premolars, with proximity to or protrusion into the maxillary sinus floor categories strongly correlating with this complication. These findings highlight the importance of thorough assessment and strategic planning to ensure successful immediate implant placement and minimize potential complications.

Evaluation of Dimensional Changes in Maxillary and Frontal Sinus in Adult Patients With Anterior Open Bite and Normal Overbite: A Retrospective Cone Beam Computed Tomography (CBCT) Study

INTRODUCTION

An anterior open bite is a form of vertical discrepancy that presents as a lack of contact between maxillary and mandibular segments. The treatment modalities usually involve either intrusion of posterior teeth or extrusion of anterior or a combination of both. The anatomical relationship between the apex of the maxillary molar roots to the inferior wall of the maxillary sinus floor is crucial in planning posterior intrusion. The paranasal sinuses influence the growth of the facial structures that eventually get altered in various malocclusions. Studies have proven that the height of the sinus gets modified in anterior open bite owing to pneumatization. This study aims to evaluate the distance from the root apex of maxillary first molars (mesiobuccal, distobuccal, and palatal roots) to the maxillary sinus floor to evaluate the significance of the vertical pneumatization of the sinus on planning for true intrusion in anterior open bite and to assess the correlation between frontal and maxillary sinuses in an anterior open bite.

METHODS

This retrospective study evaluated 30 pre-treatment cone beam computed tomographies (CBCTs) of patients out of which 15 were with anterior open bite and 15 with ideal overbite. Linear measurements were carried out using care stream software in CBCTs.

RESULTS

There was a significant correlation between the distance of the palatal root and the distobuccal root of the maxillary first molar to the maxillary sinus floor bilaterally in the anterior open bite (p<0.04). A significant moderate positive correlation of the maxillary and frontal sinus height in anterior open bite (p<0.006). A significant moderate negative correlation between the distance from the palatal root to the maxillary sinus floor and maxillary sinus height in anterior open bite (p<0.001).

CONCLUSION

Vertical pneumatisation of the maxillary sinus has caused a significant negative correlation between the apex of the palatal root of the maxillary first molar tooth and the maxillary sinus floor in the anterior open bite. The palatal root being the closest to the sinus floor, and the distobuccal root being second nearest. There is a significant correlation between the height of the sinuses in the anterior open bite.

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.

Bibliometric analysis and diagnostic efficacy of cone-beam computed tomography studies published in Imaging Science in Dentistry from 2011 to 2022

Purpose

This bibliometric analysis aimed to provide a comprehensive overview of the characteristics, trends, and level of diagnostic efficacy of studies on cone-beam computed tomography (CBCT) published in Imaging Science in Dentistry (ISD) from 2011 to 2022.

Materials and Methods

Publications related to CBCT identified in the electronic collection of ISD were selected according to eligibility criteria by 2 independent reviewers who collected data on the characteristics of the articles (year, authors, and country). The type and topic of studies were analyzed using VOSviewer v.1.6.18 (Centre for Science and Technology Studies, Leiden University, Leiden, Netherlands). The research articles were classified according to the hierarchical scale of diagnostic efficacy.

Results

Of the 236 articles included, most were from South Korea and Brazil. Bong-Hae Cho and Yun-Hoa Jung were the most prolific authors on the topic of CBCT. The most frequently published types of studies were cross-sectional and laboratory-based. The most popular topics WERE related to the diagnosis of pathologies and/or alterations, as well as anatomical variations. On the diagnostic efficacy scale, most studies were rated level 1 (technical efficacy) or 2 (diagnostic accuracy efficacy).

Conclusion

A steady increase was observed in publications related to CBCT, which are of both clinical and academic interest. The trends in these publications were analyzed, revealing that most are cross-sectional studies primarily exploring the capabilities of CBCT in diagnosing pathologies and/or changes in the oral and maxillofacial complex. These studies were typically classified as level 1 or 2 on the diagnostic efficacy scale.

Does maxillary sinus proximity affect molar root resorption during distalization using Invisalign? a CBCT study

BACKGROUND

This study aimed to assess the correlation between maxillary sinus proximity to root apices of maxillary molars and root resorption during molar distalization using clear aligner therapy (CAT).

MATERIALS AND METHODS

Thirty-eight cone beam computed tomography scans (CBCTs) obtained pre- (T0) and post-treatment (T1) from 19 adult patients (36.68 ± 13.50 years), who underwent maxillary molar distalization using Invisalign® aligners (Align Technology, Inc., San José, CA, USA) with a minimum of 2 mm distalization, were evaluated in this study At least 22 h of aligner wear per day was a main inclusion criterion. Sinus proximity and changes in root lengths were measured for 61 molars (183 roots). Spearman coefficient analysis was used for assessing correlation between sinus proximity and root resorption. The level of significance was set at p ≤ 0.05. The reproducibility of measurements was assessed by intraclass correlation coefficient (ICC).

RESULTS

Spearman coefficient revealed no significant correlation between sinus proximity and molar root resorption for mesiobuccal, distobuccal or palatal roots (p = 0.558, p = 0.334, p = 0.931, respectively).

CONCLUSION

There was no correlation between maxillary sinus proximity to root apices of maxillary molars and root resorption.

Role of CBCT in Prediction of Oro-antral Communication Post Third Molar Extraction: A Retrospective Study

OBJECTIVE

 Oro-antral communication (OAC) is one of the most frequently encountered complications during third molar extraction. Various radiographic factors, like excessive maxillary sinus pneumatization, long periods of edentulism, periapical lesions, etc., have been considered high-risk factors for OAC. However, a panoramic radiograph has not proven to be accurate in predicting the chances of OAC. Through this retrospective study, we evaluated the efficacy of a CBCT in predicting the incidence of OAC after maxillary third molar extraction.

MATERIALS AND METHODS

 We conducted a retrospective study in our department, which included the patients who had undergone extraction of a maxillary third molar over five years with the presence of panoramic X-rays and/or CBCT scans prior to extraction. Primary outcomes assessed from the case files were intra-operative complications like OAC, root fracture, tuberosity fracture, pterygoid plate fracture, etc. The incidence of these complications was correlated with the presence or absence of CBCT before extraction.

RESULTS

 Out of 920 extracted maxillary third molar, only 148 teeth (16.1%) had a CBCT record before extraction. The most commonly encountered complication was broken inaccessible root piece/s (4.9%), followed by OAC (3.5%). An inter-group comparison showed that a significantly higher percentage of patients (p < 0.001) with CBCT records had an incidence of OAC (11.5%) as against the group of patients with no CBCT record (1.9%).

CONCLUSION

 A CBCT scan prior to cases with high-risk factors for OAC can be a valuable tool in accurately predicting the chances of OAC after maxillary third molar extraction.

Prevalence and pattern of proximity of maxillary posterior teeth to maxillary sinus with mucosal thickening: A cone beam computed tomography based retrospective study

Context

Odontogenic sinusitis is a prevalent but frequently unrecognized condition, and periapical pathologies of maxillary posterior teeth are accused as one of the main causative factors.

Aim

This study aimed to evaluate the relationship between the periapical status of maxillary posterior teeth and its proximity to the maxillary sinus floor in the occurrence of incidental sinus pathologies using cone-beam computed tomography (CBCT).

Methodology

CBCT scans of 118 patients of age range 18-77 years were evaluated retrospectively to determine the relationship of maxillary posterior teeth to sinus floor in which vertical relationship was assessed using modified Kwak's classification and periapical status using CBCT periapical index. Statistical analysis was performed using SPSS statistics software.

Results

Of all 227 sinuses examined, 56.8% showed pathological changes, with mucosal thickening being the most common. More than 50% (50.2%) of sinuses were associated with periapical lesions of at least one maxillary posterior tooth based on evidence of pathological mucosal thickening. The presence of pathologic mucosal thickening was also significantly related (P < 0.05) to the presence of periapical pathologies. There was a significant association between tooth position and pathological sinus mucosal thickening, especially with second molars, first molars, and second premolars, respectively (P < 0.05). Second molar involvement was the most significant (P < 0.05).

Conclusion

The present study established a positive association between periapical disease status of maxillary posteriors and maxillary sinus mucosal thickening. Maxillary second premolar and first and second molars pathologies can significantly affect the maxillary sinus compared to other maxillary posterior tooth. CBCT proved to be an efficient imaging modality in detecting these changes.

[Relationships between the inferior wall of maxillary sinus and the roots of the maxillary molars]

OBJECTIVE

The aim of the study is to evaluate the position of the roots of the first and second upper molars relative to the bottom of the maxillary sinus (maxillary sinus) according to cone-beam computed tomography (CBCT).

MATERIAL AND METODS

The CBCT scans of 150 patients (69 men and 81 women) from the database of the X-ray department of the 11th City Clinical Hospital of Minsk who applied for dental care were studied. There are 4 variants of vertical relationships between the roots of the teeth and the lower wall of the maxillary sinus. At the contact of the molar roots and the bottom of the HPV, 3 variants of the horizontal relationship between the roots of the teeth and the bottom of the maxillary sinus in the frontal plane were identified.

RESULTS

The root apices of the maxillary molars can be located below the level of the MSF (type 0; 16.69%), contact with MSF (types 1-2; 72%) or protrude into the sinus cavity (type 3; 11.31%) at a distance of up to 6.49 mm. The roots of the second maxillary molar showed greater proximity to the MSF than the first molar roots and more often protruded into the maxillary sinus. The most common type of horizontal relationship between the molar roots and the MSF, in which the lowest point of the MSF was located centrally between buccal and palatal roots. It was found that the proximity between the roots and the MSF correlates with maxillary sinus vertical dimension. This parameter was significantly greater in type 3 when the roots protruded into the maxillary sinus than in type 0, when there was no contact between the MSF and the root apices of the molar teeth.

CONCLUSION

Significant individual variability in the anatomical relationships between the roots of the maxillary molars and the MSF indicates the need for the mandatory appointment of cone-beam computed tomography in preoperative planning for the extraction of these teeth and/or their endodontic treatment.

Anatomical Evaluation of Posterior Maxillary Roots in Relation to the Maxillary Sinus Floor in a Saudi Sub-Population: A Cross-Sectional Cone-Beam Computed Tomography Study

To evaluate the mean distance and differences between posterior maxillary teeth and maxillary sinus floor (MSF) concerning the age and gender of the patients, a total of 124 maxillary sinuses and 496 posterior maxillary teeth were randomly selected in 62 cone-beam computed tomography (CBCT) images. Mean distances between posterior maxillary roots (PMRs) from different teeth and the MSF were measured using a calibrated tool in the software. Other relations regarding the gender and age of the patients were determined. The mean root-MSF distances in the right and left first premolars were more significant compared to the second premolars. No significant relation was found between the apices of the right and left first and second molar roots and the floor of the maxillary sinus concerning gender. A statistically significant relation was found between the apices of the buccal root of the right first premolar, right and left first and second molars and floor of the maxillary sinus concerning the age group 21-40 years (p-value = 0.009). This study showed that the second molar mesiobuccal root apex is frequently related to the sinus floor. Differences were reported concerning age, concerning the distance between posterior maxillary teeth and the maxillary sinus floor. CBCT technology helped provide the clinical proximity between the MSF and the posterior teeth root apices during the treatment planning.

Analysis of the root position and angulation of maxillary premolars in alveolar bone using cone-beam computed tomography

Purpose

This study investigated whether the relationship between the maxillary sinus and the root of the maxillary premolar is correlated with the root position and whether there is a difference in the long axis angle of premolars and the buccal bone thickness according to the sinus-root relationship and root position.

Materials and Methods

Cone-beam computed tomographic images of 587 maxillary first premolars and 580 second premolars from 303 patients were retrospectively reviewed. The maxillary sinus floor-root relationship was classified into 4 types, and the root position in the alveolar bone was evaluated as buccal, middle, or palatal. The long axis angle of the maxillary premolars in the alveolar bone and the buccal bone thickness were measured. The correlation between these parameters was analyzed.

Results

The maxillary sinus floor-root relationship showed a statistically significant correlation with the root position in the alveolar bone. Most maxillary first premolars were buccally located, and more than half of the second premolars had their roots in the middle. The long axis angle of the premolars was significantly larger in buccal-positioned teeth than in middle-positioned teeth, and the buccal bone was thinner.

Conclusion

When the root of the maxillary premolar was separated from the sinus floor, the premolar was often located on the buccal side. Most of the maxillary first premolars had a thinner buccal bone and larger inclination than the second premolars. It is recommended to evaluate the root position, sagittal angle and buccal bone thickness using CBCT for implant treatment planning.

Treatment effects after maxillary total arch distalization using a modified C-palatal plate in patients with Class II malocclusion with sinus pneumatization

INTRODUCTION

The purpose of this study was to evaluate the treatment effects after molar distalization using modified C-palatal plates in patients with Class II malocclusion with maxillary sinus pneumatization.

METHODS

This study consisted of 70 lateral cephalograms derived from cone-beam computerized tomography images of 35 patients with Class II malocclusion (mean age 22.3 ± 7.4 years) who had undergone bilateral total arch distalization of the maxillary dentition using modified C-palatal plates. The samples were divided into 2 groups according to sinus pneumatization; group 1 (n = 40), cephalograms with sinus pneumatization and group 2 (n = 30) cephalograms without sinus pneumatization. Paired t tests and independent-sample t tests were used to compare the changes in each group and between groups.

RESULTS

The distal movement of the maxillary first molars was 4.3 mm for group 1 and 3.5 mm for group 2, with the intrusion of 1.4 mm and 2.5 mm, respectively. There was no statistically significant difference between the 2 groups. Group 1 showed 3.5° of distal tipping of the maxillary second molars, which was significantly greater than the 0.2° in group 2 (P <0.05). The total treatment period, including distalization, was 2.2 years for group 1 and 1.9 years for group 2, but the difference was not significant.

CONCLUSIONS

There was no significant difference in the amount of distal movement and intrusion of the maxillary first molars between groups 1 and 2. Therefore, these results suggest that regardless of sinus pneumatization, molar distalization using temporary skeletal anchorage devices in Class II patients can be performed as a nonextraction treatment.

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

Introduction

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

Material and methods

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

Results

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

Conclusions

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

Assessment of the Relationship between Maxillary Posterior Teeth and Maxillary Sinus Using Cone-Beam Computed Tomography

Introduction

Because of the close contact between maxillary sinus and maxillary posterior teeth, procedural errors such as perforation of the sinus may occur during surgical intervention resulting in oroantral communication, which if not corrected, would develop into a fistula. The aim of this study was to evaluate the relationship between maxillary posterior teeth and maxillary sinus floor in a population of the western area of Saudi Arabia, and if age, gender, and size may affect such distance.

Materials and Methods

This retrospective study evaluated 539 cone-beam computed tomography (CBCT) radiographs of patients over 20 years of age. Patients were divided into four groups according to age: group I (20–30 years), group II (31–40 years), group III (41–50 years), and group IV (more than 50 years). From coronal and sagittal images of CBCT, the vertical distance between the posterior maxillary root and the maxillary sinus was measured and classified according to its proximity to the maxillary sinus.

Results

Gender and size did not significantly affect the distance between maxillary posterior root and maxillary sinus. However, there was a significant increase in this distance with increased age. Mesiobuccal root of the second molar was the nearest root to the maxillary sinus (0.8 ± 1.62, p < 0.001), while the buccal root of the first premolar was the farthest root (5.39 ± 3.26, p < 0.001).

Conclusion

Regarding the population of this study, the buccal roots of the second molars are the closest to the sinus floor. Complications associated with maxillary molar extraction and implantation are greater at a younger age. Because the distance between posterior maxillary teeth and maxillary sinus was mostly type 1 (0–2 mm), clinicians are advised to perform CBCT to get a better understanding of the relationship between maxillary posterior roots and maxillary sinus before surgical intervention.

Three-dimensional assessment of the favorability of maxillary posterior teeth intrusion in different skeletal classes limited by the vertical relationship with the maxillary sinus floor

Background

Understanding the anatomical relationship between the maxillary sinus floor (MSF) and the posterior maxillary teeth (PMT) is important when planning the orthodontic intrusion of the posterior teeth. This study aimed to determine the vertical relationship between posterior maxillary teeth and maxillary sinus floor in different skeletal classes in the Chinese adult population.

Methods

This is a retrospective cross-sectional study involved cone beam computed tomography images of 298 adult patients (145 males and 153 females) between 20 and 45 years old. The sample was categorized according to A point, Nasion, B point (ANB) angle into 102 Class I, 102 Class II, and 94 Class III malocclusion. Non-parametric Wilcoxon Mann–Whitney U and Kruskal–Wallis tests were used to compare the studied groups. The Intra-class Correlation Coefficient (ICC) was used to assess the intra- and inter-observer reliability analysis.

Results

Overall, there was a statistically significant difference in the mean distance between both genders (P < 0.001). The measured distance increased with age in all posterior tooth roots (P < 0.001). The root apex in the sagittal view appeared to be closer to the maxillary sinus than in the coronal view; 2.2 ± 4.3 and 3.1 ± 5.5 mm, respectively. The most frequent root scores were Type 1 and Type 2P. In both sagittal and coronal views, Class I demonstrated a higher Type 2P prevalence, whereas Class III showed a lower prevalence. The second molars’ mesiobuccal root had the largest number of penetration in the three examined skeletal classes.

Conclusions

Maxillary molars of Class I malocclusion with the majority of Type 2P root-sinus relationship have the highest possible risk of root resorption during molar intrusion due to cortical bone encroachment, while Class III malocclusion showed the least possible risk.

Supplementary information

The online version contains supplementary material available at 10.1186/s13005-022-00316-3.

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.

Location of the Maxillary Posterior Tooth Apices to the Sinus Floor in an Egyptian Subpopulation Using Cone-beam Computed Tomography

Introduction

The aim of this study was to evaluate the location of the apices of the maxillary posterior teeth to the maxillary sinus floor (MSF), the symmetry between both sides and the possible variations between males and females using cone-beam computed tomography (CBCT) in an Egyptian subpopulation.

Materials and Methods

CBCT images were collected from 120 patients (240 second premolars, 480 1^st and 2^nd molars, 1680 roots). The proximity of roots of maxillary second premolar and 1^st and 2^nd molars to the floor of the sinus was categorized into three categories: inside the sinus floor (IS), touching the sinus floor (TS) or outside the sinus floor (OS). The correlation of the distance with gender was analyzed as well as for symmetry. Friedman's test was used to compare between different roots and the Dunn's test was used for pair-wise comparisons when Friedman's test was significant. The Mann-Whitney U test was used to compare males and females. The significance level was set at P≤0.05.

Results

The highest prevalence of roots outside the sinus was found with second premolar (right and left) followed by palatal roots of right and left second molar. In addition, the highest prevalence of roots inside the sinus was found with mesiobuccal roots of maxillary second molar followed by the palatal root of maxillary first molar. There was no statistically significant difference between males and females or between both sides.

Conclusion

Neither gender nor side variations regarding the proximity to the maxillary sinus floor were observed.

Comparison of maxillary molar roots with maxillary sinus in high-resolution CBCT: A retrospective study

Background:

The maxillary sinus is a pyramidal-shaped osseous cavity, and maxillary molars are found to be in close proximity to the sinus floor or even protruding into it. The present study was conducted to measure the relation between the roots and sinus floor and also the thickness of the bone using CBCT to determine age and gender differences.

Materials and Methods:

The individuals were separated into two groups based on age: Those under 40 and those over 40 years. There were 25 men and 25 females in the study. Axial, coronal, and sagittal slices of the CBCT images were obtained.

Results:

The first molar root distance and cortical bone thickness varied significantly between men and women, as well as across different ages. Mesiobuccal root with sinus floor was shown to have a substantial mean value for both sexes (P = 0.049 and P = 0.003). In females, the thickness of the buccal plate was 1.291 mm, whereas, in men, it was 2.447 mm (P = 0.000). There was a substantial difference in the thickness of the buccal plate between men and women who were at least 40 years old (P = 0.000).

Conclusion:

This study suggests how important it is to look at anatomical features and bone thickness when determining a person's age and gender.

Radiographic evaluation of the anatomical relationship of maxillary sinus floor with maxillary posterior teeth apices in the population of Al-Qassim, Saudi Arabia, using cone beam computed tomography

Background & objective

In current clinical dental practice radiographic imaging plays a major role in exploring the relationship between the maxillary sinus floor (MSF) and maxillary posterior teeth root apices, especially when there is an involvement of pathology in the periapical area that may lead to infectious, inflammatory or traumatic changes in the maxillary sinus (MS). It is also essential for exact implant placement, and therapeutic and surgical plans. The prevalence of different forms of anatomic relationship of the MSF to posterior root apices from one population to another is large. Hence the current research was conceived to evaluate the horizontal and vertical relationship forms of posterior root apices to the MSF in the Al-Qassim population of Saudi Arabia using Cone Beam Computed Tomography (CBCT).

Materials and methods

To conduct the study, a total of 200 patients' data (100 male and 100 female) were taken from the archives. The linear distances of the root apices to the MSF were measured for maxillary posterior teeth. On cross-sectional CBCT images, the Kwak et al. criteria were used to assess the horizontal and vertical relationships between the root apices of maxillary posterior teeth and the MSF.

Results

The mean distance between the apices of the maxillary second premolar ranged from 4.63 mm to 6.49 mm. The mean value of the distance between the apices of the posterior teeth and the MSF had a range of 0.68 ± 0.39 mm on the disto-buccal root (DBR) of the maxillary right second molar to 3.93 ± 1.26 mm on the palatal root (PR) of the maxillary left first molar. A similar result was observed in the maxillary second molar DBR in the male group (0.68 ± 1.17 mm) and the female group (0.69 ± 1.17 mm). The most frequently observed vertical relations were type 2 and type 2H horizontal relations.

Conclusion

This study concludes that maxillary molar roots show greater proximity with the MSF when compared with premolars, and that the type 2 vertical and type 2H horizontal distribution suggests that the anatomy of each tooth and the maxillary sinus floor should be evaluated by CBCT prior to treatment planning.

Atenafu E, Ketabi M. CBCT data relevant in treatment planning for immediate maxillary molar implant placement

Background

This study used CBCT images to evaluate the suitability of maxillary first and second molar sites to receive immediate implants. Buccopalatal and mesiodistal widths of maxillary molar inter-radicular septum were evaluated at three different levels (crestal, middle, and apical), in addition to assessments of the root apex and furcation proximities to the sinus floor and comparisons of these measurements between the first and second upper molar sites before extraction.

Methods

A total of 427 dental sites from 223 patients were used to measure the buccopalatal and mesiodistal widths of inter-septal/furcal (IRS) bone of maxillary first and second molars and vertical distances from the furcation and from all the root apices to the sinus floor (SF).

Results

Mean coronal-most buccopalatal/mesiodistal IRS widths were 7.33/6.52 mm for the first and 6.86/5.85 mm for the second molars (P=0.008). Corresponding mean FSD (furcation-sinus floor) values were 9.69 mm (range: 2.02-24.68 mm) and 8.84 mm (range: 1.48-25.09 mm). Mean distances from all the root apices to SF were <3 mm. The palatal roots of the first molars had higher sinus intrusion rates (28.85%) than their buccal counterparts, while for the second molars, the mesiobuccal roots showed the highest sinus intrusion (37.65%).

Conclusion

In the current patient sample, 61.7% of the first and 34% of the second molars had a sufficiently broad IRS to encase a 5-mm-diameter IMI (immediate molar implant) completely. The mean FSD of 9 mm for both molars indicated that some sinus floor elevation would likely be needed unless short implants were used.

Safe sites for orthodontic miniscrew insertion in the infrazygomatic crest area in different facial types: A tomographic study

INTRODUCTION

Temporary skeletal anchorage devices (TSADs) are used to obtain skeletal anchorage for orthodontic treatment. Their insertion in the infrazygomatic crest (IZC) allows efficient orthodontic mechanics. Different facial types have different bone configurations. We aimed to evaluate the differences in bone thicknesses in the IZC area among patients of each facial type to determine a safe zone for TSAD insertion.

METHODS

For this retrospective study, 86 cone-beam computed tomography (CBCT) scans were divided into 3 groups according to the facial type: group I, 24 CBCT scans of hyperdivergent patients; group II, 30 scans of neutral patients; and group III, 32 scans of hypodivergent patients. The buccal alveolar bone thickness was measured in 6 zones between the second premolar and distal root of the second molar, 5, 7, 9, and 11 mm apical to the alveolar crest.

RESULTS

The IZC areas with minimum thickness for TSAD insertion follows: group I, between first and second molars at 11 mm from the alveolar crest, mesial root of the second molar at 9 mm from the crest, and distal root of the second molar at 11 mm from the crest; groups II and III, between first and second molars at 11 mm from the crest and mesial root of the second molar at 11 mm from the crest.

CONCLUSIONS

The safe zones for IZC miniscrew insertion are located 11 mm from the alveolar crest between the maxillary first and second molars and on the mesial root of the second molar for all the 3 facial types.

Assessment of the relationship between the maxillary sinus and the canine root tip using cone beam computed tomography

BACKGROUND

The purpose of the present study is to investigate the relationship between the maxillary sinus and the canine root apices in cone beam computed tomographic images (CBCT) and to assess the amount of extension of the maxillary sinus to the anterior region of the jaw in different sexes and age groups.

METHODS

CBCT of 300 individuals (154 males and 146 females) over 20 years (with a mean age of 35.12 ± 8.40 years) were evaluated. The subjects were categorized into three age groups (20-30, 30-40, and 40-50 years). When the maxillary sinus extended to the canine area, the vertical distance between them was measured, and their relationship was classified into three types: I (more than 2 mm distance), II (less than 2 mm distance or in-contact), and III (interlock).

RESULTS

413 out of 600 maxillary sinuses (68.8%) were extended into the canine area or beyond. Among them, 15 maxillary sinuses pneumatized into the incisor area (2.5%). The prevalence of the maxillary sinuses extended to the anterior region of the jaw was not significantly different between genders. However, it was significantly less frequent in the older age group and more frequent on the left side. In addition, the mean amount of anterior extension of the maxillary sinus (mm) was significantly lower in the older age group. Type I was the most frequent vertical relationship between the maxillary sinuses and canine apices with no significant difference in gender, side, and age groups.

CONCLUSIONS

In most cases, the maxillary sinus extended to the canine area and sometimes reached the incisor region. This necessitates paying more attention to the maxillary anterior sextant during surgical procedures.

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.

Relationship between maxillary posterior molar roots and the maxillary sinus floor: Cone-beam computed tomography analysis of a western Chinese population

OBJECTIVE

This study aimed to assess the positional relationships between the maxillary sinus and the first and second molars in a western Chinese population by using cone-beam computed tomography.

METHODS

This study included 212 patients (652 maxillary molars and 1956 roots). Patient demographics (sex and age) and cone-beam computed tomography data regarding the relationship between molar roots and the maxillary sinus were obtained. This relationship was stratified into four types for statistical analysis.

RESULTS

Sex and side did not significantly influence the distance between maxillary molar roots and the maxillary sinus. However, the distance between maxillary molar roots and the maxillary sinus increased with age. The mesiobuccal root of the second molar was nearest to the maxillary sinus. The most common relationship type involved absence of root contact with the sinus border and presence of a maxillary sinus cross-section above the root apex.

CONCLUSIONS

Compared with other teeth, the maxillary posterior teeth have a complex anatomical structure and are closely related to the sinus. These findings may serve as reference information for root canal treatment, tooth extraction, dental implant, and other dental clinical procedures among patients in western China.

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.

Topographic relationship between maxillary sinus and roots of posterior teeth: a cone beam tomographic analysis

Purpose:

The objective of the research was to determine the relationship between root apices and maxillary sinus wall, and to analyze pulpoapical conditions of 2nd premolars, 1st molars, 2nd molars, 3rd molars using cone beam computerized tomography (CBCT).

Materials and methods:

This study was conducted on a retrospective manner of CBCT images of 1000 maxillary sinus with 500 subjects, who visited the Department of Dento-Maxillofacial Radiology. The association of each teeth with sinus floor and pulpoapical status were categorized. The association among gender, age, lateralization of sinus cavity were evaluated.

Results:

A total of 602 second premolars, 500 first molars, 623 second molars, 347 third molars were evaluated. There were no significant differences between pulpoapical condition of teeth and gender or left and right sides (p=0.065, p=0.072). There were significant associations between pulpoapical condition of all teeth and age (p=0.023), and the relationship of each root with maxillary sinus and age (p=0.037). There was significant association between vertical position and right/left sides in second and third molars (p=0.033).

Conclusion:

Age seems to have relationship with periapical condition of teeth, and the association of root with the sinus cavity.

Evaluation of the Relationship Between Maxillary Sinus Wall and Maxillary Canines and Posterior Teeth Using Cone-Beam Computed Tomography

Background

The proximity between the maxillary sinus and dental roots may impede orthodontic tooth movement. This study aimed to explore the relationship between the maxillary sinus wall (MSW) and maxillary canines and posterior teeth using cone-beam computed tomography (CBCT).

Material/Methods

CBCT images (317) were examined for whether the mesial, distal, buccal, and palatal surfaces of the examined root contacted the MSW, and the contact distance of each root surface with the MSW was measured. The effects of age and sex were analyzed using logistic regression and linear regression analyses.

Results

The highest contact ratios with the MSW (ranging from 62.0% to 73.2%) were observed at the palatal root surfaces of the first molar mesiobuccal and distobuccal roots (1M MB and DB), the buccal root surface of the first molar palatal roots (1M P), and the mesial and buccal root surfaces of the second molars (2M), followed by the distal root surface of the second premolars (2PM) and the mesial root surfaces of the 1M MB and P (ranging from 49.2% to 59.3%). At these root surfaces, the contact ratios decreased with age (P<0.05), but the lowest still reached a range of 29.4% to 57.9% in the 30- to 47-year-old group.

Conclusions

The 2PM distal root surface, the 1M MB mesial and palatal root surfaces, the 1M DB palatal root surface, and the 1M P and 2M mesial and buccal root surfaces most frequently contacted the MSW. Clinicians should observe the contact of root surfaces with the MSW, even in aged patients.

A cone-beam computed tomographic assessment of the proximity of the maxillary canine and posterior teeth to the maxillary sinus floor: Lessons from 4778 roots

INTRODUCTION

When tooth roots protrude into the maxillary sinus, apical root resorption and tipping may occur during horizontal tooth movement across the sinus floor. Three-dimensional cone-beam computed tomography (CBCT) images may provide detailed information without distortion and overlap. We evaluated the relationships between the maxillary tooth root apices and the maxillary sinus floor using CBCT.

METHODS

We evaluated 4778 roots from 76 men (aged 27.6 ± 10.4 [mean ± standard deviation] years; range, 18-69 years), and 225 women (aged 30.4 ± 12.0 years; range, 18-68 years). The positional relationships between the maxillary tooth root apices, including the canine, premolar (first and/or second), and molar (first and/or second), and the inferior wall of the maxillary sinus were comprehensively evaluated on 2 cross-sectional CBCT images (ie, the sagittal and coronal planes). These distances were measured in both images simultaneously.

RESULTS

The sagittal plane distances were significantly larger than coronal plane distances, except for the distobuccal root of the first molar. Pearson correlation test revealed a significant negative correlation between the distance and the patient's age.

CONCLUSIONS

Our study provides valuable information for planning orthodontic tooth movement through the maxillary sinus, which may help to predict the occurrence and severity of root resorption.

Can CT predict the development of oroantral fistula in patients undergoing maxillary third molar removal?

PURPOSE

In maxillary wisdom tooth extraction, the necessity of CT is unknown. The purpose of this study was to investigate whether CT adding to orthopantomography is useful for predicting oroantral perforation during maxillary third molar extraction.

METHODS

Various risk factors for oroantral perforation during maxillary third molar extraction were investigated by univariate and multivariate analyses. We analyzed those of all patients and the patients who underwent CT, respectively. The proximity of the roots to the maxillary sinus floor (root-sinus [RS] classification) and Archer classification were assessed using panoramic radiography. The number of roots and vertical relationship were assessed using CT.

RESULTS

A total of 604 out of 3299 patients underwent CT adding to orthopantomography. In all cases, multivariate analyses except for CT findings showed that the RS classification type III/IV and the Archer classification Type B/C/D in panoramic findings were significantly correlated with oroantral perforation as radiological findings. In cases for which CT was performed, multivariate analyses showed that one root (OR 12.87) and the vertical relationship Type D (OR 5.63) in CT findings, besides the RS classification type III/IV (OR 4.47) in panoramic findings, were significantly related to oroantral perforation.

CONCLUSION

The RS classification and the Archer classification in panoramic findings can predict the risk of oroantral perforation. The usefulness of CT adding to orthopantomography is limited. However, when the relationship between the upper wisdom tooth and maxillary sinus floor (RS classification) is unclear, to check whether the number of roots is one and the apex of one root is projecting into the maxillary sinus in CT findings, is useful for the prediction.

Alveolar bone height according to the anatomical relationship between the maxillary molar and sinus

Purpose

The aim of this study was to investigate the available alveolar bone height between the maxillary molars and the sinus floor according to their anatomical relationship using cone-beam computed tomographic (CBCT) images.

Methods

A total of 752 maxillary first (M1) and second molars (M2) on CBCT scans of 188 patients were selected. First, each maxillary molar was categorized as type 1, 2, 3, or 4 according to the relationship of the molar root with the maxillary sinus floor. The frequency distribution of each type was analyzed. Second, the shortest vertical distance (VD) of each molar was measured from the furcation midpoints of the roots to the lowest point of the sinus floor by 2 observers. Intraclass correlation coefficients and the t-test were calculated for the VD measurements.

Results

For M1, type 3 was the most frequent, followed by type 2. For M2, type 3 was the most common, followed by type 1. The VD measurements of type 1 were 9.51±3.68 mm and 8.07±2.73 mm for M1 and M2, and those of type 3 were 3.70±1.52 mm and 4.03±1.53 mm for M1 and M2, respectively. The VD measurements of M2 were significantly higher in female patients than in male patients.

Conclusions

Type 3 was the most frequent anatomical relationship in the maxillary molars, and showed the lowest alveolar bone height. This information will help clinicians to prevent complications related to the maxillary sinus during maxillary molar treatment and to predict the available bone height for immediate implant planning.

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.

Anatomical relationship between the maxillary posterior teeth and the sinus floor according to an anterior overbite

OBJECTIVE

To evaluate the vertical relationship between the maxillary sinus floor (MSF) and the maxillary posterior teeth (MPT) according to an anterior overbite.

SETTINGS AND SAMPLE POPULATION

The patients were divided into three groups according to an anterior overbite. The open bite group (OBG) included patients with an anterior overbite of ≤0 mm, the normal overbite group (NBG) included patients with an overbite of 0-3 mm, and the deep bite group (DBG) included patients with an overbite ≥3 mm. Thirty patients were randomly matched into each group based on age and sex.

MATERIALS AND METHODS

The distances and vertical relationship between the MSF and the MPT was analysed using cone-beam computer tomography. The vertical relationship between the two was classified as either favourable or unfavourable for the intrusion of the posterior teeth.

RESULTS

A higher ratio of patients in the OBG had MPT positioned close to the MSF than the DBG. Intrusion of the posterior teeth was unfavourable for an average of 87.2%, 77.2% and 70.2% molars in the OBG, NBG and DBG, respectively.

CONCLUSIONS

The vertical distance between the MSF and the MPT is associated with an anterior overbite. The posterior teeth were in an unfavourable position for the orthodontic intrusion in the OBG as compared to the other groups. Additional caution is needed when planning orthodontic intrusion treatment for patients with an anterior open bite. But, there were some individual variations within each group.

Anatomical analysis of periapical bone of maxillary posterior teeth: a cone beam computed tomography study

Objectives

To investigate the periapical bone thicknesses of maxillary posterior teeth at the preferred level for root resection (3 mm apical to the root end) and to determine vertical distances from apex to maxillary sinus floor (MSF) using cone beam computed tomography (CBCT) scans.

Methods

CBCT scans were collected from 341 subjects (2389 teeth). Associations of bone thicknesses and vertical distances with age and sex were determined by one-way analysis of variance.

Results

At the level of root-end resection, buccal bone was the thickest over the mesiobuccal roots of second molars (mean, 2.99 mm) and thinnest over the double-root first premolars (mean, 0.29 mm). In maxillary posterior teeth, thicker buccal bone was found in men than in women. The mesiobuccal roots of second molars were nearest to the MSF (mean, 1.33 mm), and were also most frequently extended into the sinus cavity (15.81%). Subjects more than 40 years of age had larger vertical distances from root apices to MSF in the molar region, compared with younger subjects.

Conclusions

Generally, periapical bone was thicker in men, and root apices were located nearer to the MSF in younger subjects. Age and sex should be considered before endodontic microsurgery.

Maxillary molar root protrusion into the maxillary sinus: a comparison of cone beam computed tomography and panoramic findings

This study aimed to examine the prevalence of molar roots protruding into the maxillary sinus and to determine the panoramic radiographic signs as correlated with cone beam computed tomography (CBCT). CBCT images of 354 roots were assessed and classified into three types, according to the relationship between the root and maxillary sinus. The prevalence of root protrusion into the maxillary sinus was calculated then the panoramic images assessed. After excluding some unidentified roots on the panoramic images, 200 were investigated for panoramic signs, including (i) projection of the root apex into the sinus cavity, (ii) interruption of the maxillary sinus floor's cortex, (iii) absence of periodontal ligament space, (iv) darkening of the involved root region, and (v) upward curving of the sinus floor. The respective correlation between the panoramic signs and CBCT types was assessed. Forty-six percent of roots showed protrusion into the sinus with the palatal root of the first molar having the greatest prevalence (33/200 roots). The panoramic signs 'projection of the root apex in the sinus cavity' and 'darkening of the involved root apical region' both strongly indicated root protrusion into the maxillary sinus (P<0.05).

Cone Beam Computed Tomography in Oral and Maxillofacial Surgery: An Evidence-Based Review

Cone Beam Computed Tomography (CBCT) is a valuable imaging technique in oral and maxillofacial surgery (OMS) that can help direct a surgeon’s approach to a variety of conditions. A 3-dimensional analysis of head and neck anatomy allows practitioners to plan appropriately, operate with confidence, and assess results post-operatively. CBCT imaging has clear indications and limitations. CBCT offers the clinician 3-dimensional and multi-planar views for a more accurate diagnosis and treatment without the financial burden and radiation exposure of conventional computed tomography (CT) scans. Furthermore, CBCT overcomes certain limitations of 2-dimensional imaging, such as distortion, magnification, and superimposition. However, CBCT lacks the detailed depiction of soft tissue conditions for evaluation of pathologic conditions, head and neck infections, and temporomandibular joint (TMJ) disc evaluation. This review evaluates the evidence-based research supporting the application of CBCT in the various fields of oral and maxillofacial surgery, including dentoalveolar surgery, dental implants, TMJ, orthognathic surgery, trauma, and pathology, and will assess the value of CBCT in pre-operative assessment, surgical planning, and post-operative analysis when applicable. Additionally, the significant limitations of CBCT and potential areas for future research will be discussed.

Marginal bone loss and resorption of second molars related to maxillary third molars in panoramic images compared with CBCT

OBJECTIVES

Compare findings among observers in panoramic images (PAN) and cone beam CT (CBCT); and assess findings in PAN as indicators for marginal bone loss and resorption observed in CBCT.

METHODS

120 impacted maxillary third molars with PAN and CBCT were included. Four observers assessed morphological features: (1) tooth angulation; (2) number of roots; (3) bony impaction (yes/no) and pathology; (4) marginal bone level at the second molar (normal/>3 mm = bone loss); (5) resorption in the second molar (no/superficial/< half way through the dentin/≥ half way through the dentin/involving the pulp); (6) size of follicular space (normal/> 4 mm(cyst)). Percentage accordance and κ statistics described observer variation in PAN and CBCT. Logistic regression analyses tested findings in PAN as indicators for marginal bone loss or resorption observed in CBCT.

RESULTS

κ values were fair and interobserver accordance was marginally higher in CBCT than PAN. Agreement between PAN and CBCT was 81-88% for marginal bone loss and 68-81% for resorption. Severe resorption was more often observed in CBCT. Mesio-angulated third molars and marginal bone loss interpreted in PAN significantly indicated marginal bone loss observed in CBCT (odds ration 17-34; p < 0.012; 8.8-52.8; p < 0.02). In contrast, findings in PAN were not significant indicators for resorption observed in CBCT (p > 0.05).

CONCLUSION

In general, there was a fair agreement for marginal bone loss between PAN and CBCT, and PAN could significantly predict bone loss observed in CBCT. However, presence of resorption observed in CBCT could not be determined from PAN, and more severe resorption was observed in CBCT. CBCT is indicated if resorption in the second molar needs to be assessed.

Evaluation of the relationship between the maxillary sinus floor and the root apices of the maxillary posterior teeth using cone-beam computed tomographic scanning

Background

The relationship between the maxillary sinus (MS) and the root apices of the posterior teeth is of clinical relevance in diagnosing and treatment planning in the posterior area of the maxilla. This study aimed to assess the relationship between the MS floor and the root apices of the posterior teeth using cone-beam computed tomography (CBCT) scanning.

Materials and Methods

325 CBCT scans of patients aged 20-70 years were analyzed. Patients were divided into three age groups: young group (20-44 years), middle age group (45-59 years), and elderly group (60-70). The distance from the MS floor and the root apices of posterior teeth was measured in each group. The relationship between the MS and the posterior roots was also recorded according to Kwak classification. The results were analyzed by IBM statistic SPSS.

Results

Type II was most commonly seen in the first and second molars. For premolars, Type I was often observed. The shortest distance to the floor of MS was recorded for the mesiobuccal root of the second molar and the longest distance for the palatal root of the first and second molars. No statistical differences were found between age groups (P > 0.01).

Conclusion

The anatomical relationship between the MS and the root apices of the posterior teeth is of clinical importance and should be taken into consideration during surgical or endodontic treatment.

Accuracy of panoramic radiography in diagnosing maxillary sinus-root relationship: A systematic review and meta-analysis

OBJECTIVE:

To investigate the accuracy of panoramic radiography (PR) in diagnosing maxillary sinus-root relationships (SRRs).

MATERIALS AND METHODS:

PubMed, EMBASE, CENTRAL, Web of Science, ScienceDirect, CBM, Baidu Scholar, and SIGLE were searched. The studies comparing the diagnostic accuracy of PR and computed tomography/cone-beam computed tomography (CT/CBCT) for SRR were included.

RESULTS:

Eleven studies were included. Meta-analyses showed that, for type I SRR, PR had the highest specificity, positive likelihood ratio (+LR), diagnostic odds ratio (DOR), and area under the curve (AUC), with a high sensitivity and a low negative LR (-LR). For type IV, PR had a high DOR and AUC, with the highest sensitivity but a low +LR, the lowest -LR, and the lowest specificity. For type II, PR had the lowest AUC, with a low sensitivity, +LR, and DOR and a high -LR. For type III, PR had the lowest sensitivity, +LR, and DOR and the highest -LR. The distance from root tips to the maxillary sinus floor on PR was significantly longer (mean difference: -1.88 mm; 95% confidence interval: -2.19 to -1.57; P < .0001) than that on CT/CBCT.

CONCLUSIONS:

Currently available evidence suggests PR could be reliable for detecting type I SRR. PR has a good ability to confirm true type IV SRR but a poor ability to rule out false type IV SRR. For type II and III SRR, PR shows poor accuracy and tends to overestimate the extent of protrusion of the roots into the maxillary sinus. When PRs display type II, III, or IV SRR and related treatment is needed, CBCT should be used for further examinations.

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

BACKGROUND

Maxillary posterior teeth have close anatomical proximity to the maxillary sinus floor (MSF), and the race, gender, age, side and presence/absence of adjacent teeth may influence the mean distances between the root apices and the MSF. This study aimed to evaluate both the relationship between the maxillary posterior teeth and MSF, and the influence of adjacent teeth loss on the distance between the maxillary posterior roots and MSF.

METHODS

Cone-beam computed tomography images were collected from 1011 Chinese patients. The relationship between the maxillary posterior teeth and the MSF was divided into three types: Type OS (the root apex extending below/outside the MSF), Type CO (the root apex contacting with the MSF), Type IS (the root apex extending above/inside the MSF). The minimum vertical distances between the maxillary posterior roots apices and the MSF were recorded. The correlations of the distances with gender and age were analyzed. The distances between the maxillary posterior root apices and the MSF with different types of adjacent teeth loss was evaluated.

RESULTS

Type OS was the most common relationship of all posterior root apices (P<0.05). Type IS was highest in the palatal roots (PRs) of the maxillary first molars (MFMs) and the mesiobuccal roots (MBRs) of the maxillary second molars (MSMs) (24.8% and 21.6%) (P<0.05). The frequency of Type IS decreased with age except the premolar roots and PRs of the MSMs (P<0.05). The MBRs of the MSMs had the lowest distances to the MSF (0.8 ± 2.5 mm), followed by the distobuccal roots of the MSMs (1.3 ± 2.7 mm) and the PRs of the MFMs (1.4 ± 3.4 mm) (P<0.05). Age was an important influencing factor to the mean distances while gender had little effects. The distance between the maxillary second premolar root apices and the MSF decreased with the absence of adjacent teeth (P<0.05).

CONCLUSIONS

The maxillary molars showed greater proximity to the MSF than premolars. Age had significant impacts on the relationship between maxillary posterior roots and MSF. The absence of maxillary first molars will influence the proximity of maxillary second premolar root apices to MSF.

Proximity of the roots of posterior teeth to the maxillary sinus in different facial biotypes

INTRODUCTION

Orthodontists consider facial growth pattern and oral function when developing a treatment plan. Less attention is given to the relationship between the maxillary posterior teeth and the maxillary sinus. We aimed to evaluate the relationship between the roots of the maxillary posterior teeth and the floor of the maxillary sinus.

METHODS

Proximity of the roots to the maxillary sinus was scored for the left and right first and second premolars and molars (scores, 0-3). Mean scores per patient and per tooth type were calculated. The influences of age, sex, and facial biotype on mean scores per patient and tooth were analyzed.

RESULTS

The mean scores per patient and the second molar scores were significantly lower in the normodivergent subjects compared with the hypodivergent subjects, and in the hypodivergent vs the hyperdivergent groups, indicating that the hypodivergent biotype had significantly fewer second molar roots into the sinus than the normodivergent and hyperdivergent biotypes. Age had no effect on mean score per patient, but in the hyperdivergent group, the second molar score increased with age, meaning that second molar roots tend to be closer to the sinus floor.

CONCLUSIONS

In a young population (7-24 years), the positions of the apices of the maxillary second molar roots in relation to the maxillary sinus floor are associated with the facial biotype. In a hypodivergent biotype, the roots of the second molars are located farther from the sinus floor compared with the normodivergent and hyperdivergent facial patterns.

Dento-alveolar measurements and histomorphometric parameters of maxillary and mandibular first molars, using micro-CT

BACKGROUND

Micro-CT is a high-resolution, non-invasive, and non-destructive imaging technique, currently acknowledged as a gold standard modality for assessing quantitatively and objectively dental morphology and bone microarchitecture parameters.

PURPOSE

The aim of this study was to analyze critical dental and periodontal measurements characterizing the mandibular (MandFM) and maxillary (MaxFM) first molar architecture, as well as the corresponding bony socket, using micro-CT.

MATERIALS AND METHODS

Thirty-eight human dried skulls (22-76 years) were scanned to enable the virtual analysis of 61 first molars. Depending on the type of measurement, the parameters were recorded on two-dimensional sections or directly on three-dimensional models. Tooth morphology was described by four aspects (e.g., tooth width, trunk length, root length, and root span), while the socket architecture was assessed by buccal plate thicknesses and bone density measurements.

RESULTS

Minimum, maximum, and mean distances as well as cortical and trabecular bone densities were recorded in MandFM and MaxFM. It is noteworthy that the buccal plate thickness was found to be less than 1 mm in more than 55% of cases in MaxFM, whereas only in 20.8% of cases in MandFM (and even 0% at two sites). A wide range of bone densities was observed and the comparison between MandFM and MaxFM did not show a significant difference. Furthermore, cortical densities were negatively correlated with aging, while trabecular densities were not influenced.

CONCLUSIONS

Using micro-CT, three-dimensional aspects of the human first molar morphology and microstructural parameters of the surrounding bone were evaluated in the mandible and in the maxilla. These comprehensive measurements and their correlation with aging may be of great importance for the use of immediate implant placement in molar extraction sockets and thus the potential long-term success of this treatment modality.

Differences in distances between maxillary posterior root apices and the sinus floor according to skeletal pattern

INTRODUCTION

The aim of this study was to evaluate the distances from the maxillary posterior root apices to the inferior wall of the maxillary sinus using cone-beam computed tomography images and the relationships between roots and maxillary sinus according to age, sex, and skeletal pattern.

METHODS

Three-dimensional images of each root were checked, and the distances were measured along the true vertical axis from the apex of the root to the sinus floor in 118 patients (63 male, 55 female) aged 10 to 28 years. Compare-means statistic tests were done to assess the differences between groups classified according to age, sex, and skeletal pattern.

RESULTS

The frequency of root contact with the sinus floor increased from 70% at the second premolar to more than 80% at the buccal roots of the first and second molars. Male and older age (20-28 years) groups had significantly smaller distances or more protrusion of the root into the sinus than female and younger age (10-20 years) groups. The distances were shorter, or there was more protrusion of the root into the sinus in the hyperdivergent, down-canted palatal plane, and large gonial angle groups.

CONCLUSIONS

Male, older age, hyperdivergent skeletal pattern, and large gonial angle groups had significantly closer distances between maxillary root tips and the sinus floor or more protrusion of the roots into the sinus. The intrusion of the maxillary molars in those situations may be difficult and slow because of the pneumatized maxillary sinus.

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

AIM

The purpose of the present study was to evaluate the relationship between the maxillary sinus floor and the upper posterior root tips in the Colombian population using cone-beam computed tomography.

METHODS

A total of 1656 roots were analyzed (1104 molars and 552 premolars), classified as types I (outside the maxillary sinus) and II (inside the maxillary sinus).

RESULTS

The results showed that the palatal root of the maxillary first molar was most frequently found inside the antrum.

CONCLUSIONS

Understanding the relationship between the maxillary sinus floor and the upper posterior root tips is important to the clinician when performing conventional or surgical endodontic treatment and conventional surgery procedures in order to minimize or avoid the risk of damaging the maxillary sinus.

Distances from the root apices of posterior teeth to the maxillary sinus and mandibular canal in patients with skeletal open bite: A cone-beam computed tomography study

Purpose

This study determined and compared the distances from the maxillary root apices of posterior teeth to the floor of the maxillary sinus, or maxillary sinus distances (MSDs), and the distances from the mandibular root apices of the posterior teeth to the mandibular canal, or mandibular canal distances (MCDs), in Thai subjects with skeletal open bite and skeletal normal bite.

Materials and Methods

Pretreatment cone-beam computed tomography (CBCT) images were obtained from 30 Thai orthodontic patients (15 patients with skeletal normal bite and 15 with skeletal open bite) whose ages ranged from 14 to 28 years. The CBCT images of the patients were processed and measured using the Romexis Viewer program. The MSDs and MCDs from the root apices of the maxillary and mandibular second premolar, first molar, and second molar to the maxillary sinus floor or the mandibular canal were measured perpendicularly to the occlusal plane. The Student t test was used for comparisons between the 2 groups.

Results

The greatest mean MSDs were from the root apex of the second premolars in both groups, whereas the least mean MSDs were from the mesiobuccal root apex of the second molars. The greatest mean MCDs were from the mesial root apex of the first molars, whereas the least mean MCDs were from the distal root apex of the second molars.

Conclusion

There were no differences in the mean MSDs or the mean MCDs between the skeletal normal bite group and the skeletal open bite group.

Study of Anatomical Relationship between Posterior Teeth and Maxillary Sinus Floor in a Subpopulation of the Brazilian Central Region Using Cone-Beam Computed Tomography - Part 2

This study evaluated the anatomical relationship between posterior teeth root apices and maxillary sinus floor (MSF) on 202 cone beam computed tomography (CBCT) exams. The distance between the root apices and the MSF, as well as the MSF thickness of the cortical bone closest to root apices and furcation regions were measured. The vertical and horizontal relationships of the MSF with the molar roots were classified into categories adapted from the criteria proposed by Kwak et al. (14). The shortest distances between MSF and the root apices were observed in the mesiobuccal root of the second molar (0.36±1.17 mm) and the palatal root of the first molar (0.45±1.10 mm) and the widest in buccal roots of the first premolars (5.47±4.43 mm). Significant differences were observed between the distance of MSF to the root apices of single-rooted first and second premolars. The cortical thickness ranged from 0.65±0.41 mm over the mesiobuccal root of the second molar to 1.28±0.42 mm over the buccal root of the first premolar. The most observed vertical and horizontal relationships were type II and 2H, respectively. The maxillary molar roots showed greater proximity to the MSF. The thickness of the MSF cortical bone closest to the apices and furcation regions was found to be similar only for premolars.

The use of digital periapical radiographs to study the prevalence of alveolar domes

PURPOSE

In the present study, we coined the term 'alveolar dome' and aimed to demonstrate the prevalence of alveolar domes through digital periapical radiographs.

MATERIALS AND METHODS

This study examined 800 digital periapical radiographs in regard to the presence of alveolar domes. The periapical radiographs were acquired by a digital system using a photostimulable phosphor (PSP) plate. The χ(2) test, with a significance level of 5%, was used to compare the prevalence of alveolar domes in the maxillary posterior teeth and, considering the same teeth, to verify the difference in the prevalence of dome-shaped phenomena between the roots.

RESULTS

The prevalence of alveolar domes present in the first pre-molars was statistically lower as compared to the other maxillary posterior teeth (p<0.05). No statistically significant difference was observed in the prevalence of alveolar domes between the maxillary first and second molars. Considering the maxillary first and second molars, it was observed that the palatal root presented a lower prevalence of alveolar domes when compared to the distobuccal and mesiobuccal roots (p<0.05).

CONCLUSION

The present study coined the term 'alveolar dome', referring to the anatomical projection of the root into the floor of the maxillary sinus. The maxillary first and second molars presented a greater prevalence of alveolar domes, especially in the buccal roots, followed by the third molars and second pre-molars. Although the periapical radiograph is a two-dimensional method, it can provide dentists with the auxiliary information necessary to identify alveolar domes, thus improving diagnosis, planning, and treatment.