Elsevier

Journal of Endodontics

Volume 37, Issue 11, November 2011, Pages 1504-1511
Journal of Endodontics

Clinical Research
Resolution of Maxillary Sinus Mucositis after Endodontic Treatment of Maxillary Teeth with Apical Periodontitis: A Cone-Beam Computed Tomography Pilot Study

https://doi.org/10.1016/j.joen.2011.07.007Get rights and content

Abstract

Introduction

Apical periodontitis (AP) is an inflammatory response that can affect the maxillary sinus. This study characterized maxillary sinus mucositis adjacent to teeth with AP and assessed its resolution after endodontic treatment.

Methods

Thirty maxillary sinuses in subjects (n = 29) who had AP associated with maxillary posterior teeth were imaged with cone-beam computed tomography (CBCT). When mucositis was detected, its resolution was assessed with CBCT scanning 3 months after treatment, and periapical healing was assessed using the periapical index (PAI) after 6 months.

Results

Excluding 5 sinuses obscured by sinusitis, mucositis was detected in 14 of 25 sinuses (56%). Nonsignificant inverse association was observed between the mucosal lining thickness and the distance from the sinus to root apices with AP. Four noncompliant subjects were discontinued. Three months after treatment, mucositis was fully resolved in 3 of 10 subjects (30%), partially resolved in 3 of 10 subjects (30%), unchanged in 3 of 10 subjects (30%), and worsened in 1 subject (10%). Six months after treatment, 6 of 10 subjects (60%) had reduced PAI scores classified as healed or healing. The subject with expanded mucositis at 3 months was not healing at 6 months.

Conclusions

Within the limited sample of this pilot study, CBCT imaging revealed a lower-than-expected prevalence of mucositis adjacent to teeth with AP. Fully resolved mucositis was not common 3 months after endodontic treatment, suggesting that in specific cases it might linger beyond 3 months after the elimination of the endodontic infection. Because of the low statistical power, the association between the resolution of mucositis and periapical healing could not be explored.

Section snippets

Subjects

Data from a preliminary study on 3 subjects who had AP associated with maxillary teeth—second premolar, first molar, and second molar—was used for sample size calculation. CBCT imaging revealed the presence of mucositis in 2 of 3 subjects (66%), which is slightly lower than the previously reported range of 77% to 83% in CBCT studies 13, 14. It was estimated that full or partial resolution of mucositis after endodontic treatment would be discernible in 90% of subjects, suggested by the

Results

A high degree of repeatability in the linear CBCT measurements was achieved. The intraobserver agreement for PAI calibration was k = 0.86, indicating very good agreement (29). A total of 30 maxillary teeth (4 first premolars, 6 second premolars, 15 first molars, and 5 second molars) and sinuses were assessed. Preoperative changes were recorded within 24 of 30 sinuses (80%), with 10 sinuses displaying >1 change. Mucositis was recorded in 14 of 30 sinuses (47%), periostitis in 16 of 30 sinuses

Discussion

Although AP is regarded primarily as a localized infection, different changes have been described in the maxillary sinus adjacent to the affected teeth with a prevalence exceeding 70% 11, 12. Among these changes, mucositis was detected by CBCT scanning in 77% to 83% of patients 13, 14. Our preliminary data supported the relatively high prevalence of mucositis in subjects with AP affecting maxillary teeth. At the time this study was undertaken, no CBCT-based evidence was available on the

Acknowledgments

The authors thank Dr Jerry Chapnik who served as an otolaryngology consultant.

The authors deny any conflicts of interest related to this study.

References (32)

  • D. Ørstavik et al.

    Apical periodontitis: microbial infection and host responses

  • S. Ericson et al.

    Sinographic examination of the maxillary sinus in cases of chronic periapical osteitis

    Odontol Tidskr

    (1964)
  • K. Mattila

    Roentgenological investigations into the relation between periapical lesions and conditions of the mucous membrane of maxillary sinuses

    Acta Odontol Scand

    (1965)
  • S. Ericson et al.

    Local hyperplasia of the maxillary sinus mucosa after elimination of adjacent periapical osteitis. A follow-up study

    Odontol Revy

    (1966)
  • B. Nenzen et al.

    The effect of conservative root canal therapy on local mucosal hyperplasia in the maxillary sinus

    Odontol Revy

    (1967)
  • I. Melen et al.

    Chronic maxillary sinusitis. Definition, diagnosis and relation to dental infections and nasal polyposis

    Acta Otolaryngol

    (1986)
  • Cited by (49)

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

      2020, Journal of Endodontics
      Citation Excerpt :

      Nenzén and Welander33 reported that focal MT adjacent to the molars with AP decreased after successful root canal treatment. Nurbakhsh et al34 reported 30% complete improvement and 30% partial improvement in a study comparing 30 patients with AP before and after endodontic treatment. One limitation of the study was the retrospective design.

    • Association between Odontogenic Conditions and Maxillary Sinus Disease: A Study Using Cone-beam Computed Tomography

      2016, Journal of Endodontics
      Citation Excerpt :

      Localized MT is the most characteristic imaging aspect of an odontogenic sinus disease (4). The findings of this research showed that the presence of a periapical lesion and the close relationship with the sinus floor significantly increased the chance of having localized MT. This is expected because periapical lesions derive from a source of intense odontogenic infections in the root canal (achieving periapical tissues), surrounding structures, and sinus cavity (1, 2, 6, 15). Moreover, a trend of increased MT has also been reported with a decreased distance between the sinus floor and infected sites (6).

    View all citing articles on Scopus

    Supported by grants from the American Association of Endodontists Foundation, the International Federation of Endodontic Associations, the Canadian Academy of Endodontics Endowment, and the Alpha Omega Fraternity.

    View full text