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

doi:10.1016/j.joen.2016.07.003

Journal of Endodontics

Volume 42, Issue 10, October 2016, Pages 1509-1515

https://doi.org/10.1016/j.joen.2016.07.003 Get rights and content

Highlights

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We use cone-beam computed tomographic images to evaluate the association between periapical and periodontal conditions and maxillary sinus diseases.
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It was found that generalized and localized mucosal thickening were associated, respectively, with periodontal bone loss and periapical lesions.
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Maxillary sinusitis and retention cysts were not related to odontogenic alterations.

Abstract

Introduction

The maxillary sinus can be affected by dental infections because of its close relationship with upper teeth. This study aimed to assess the most common types of maxillary sinus alterations and to associate them with odontogenic conditions using cone-beam computed tomographic (CBCT) images.

Methods

CBCT scans of 400 patients showing sinus disease in 1 or both maxillary sinuses were evaluated. Sinus alteration was considered as follows: generalized or localized mucosal thickening (MT), maxillary sinusitis (MS), and retention cysts (RCs). The odontogenic conditions evaluated were inadequate endodontic treatment, periapical lesions, and periodontal bone loss. Descriptive and multiple logistic regression analyses were performed.

Results

Sinus diseases were observed in 85.9% of the maxillary sinuses. The most prevalent condition was generalized MT (65.2%) followed by localized MT (24.8%), MS (6.4%), and RCs (3.6%). Generalized MT was more related to males (odds ratio = 1.45, P < .05) and periodontal bone loss (P < .05). Localized MT was associated with periapical lesions (odds ratio = 3.09, P < .05) and showed a close anatomic relationship between teeth and the sinus floor (odds ratio = 2.77, P < .05). There were no statistically significant associations between either MS or RCs and the odontogenic conditions studied.

Conclusions

The most prevalent sinus diseases were the generalized and localized MT, and they were the only ones related to odontogenic conditions (periodontal bone loss and periapical lesions, respectively). We emphasize that CBCT imaging is an appropriate method for evaluating the maxillary sinus findings and their associated odontogenic conditions.

Section snippets

Study Sample

This retrospective study was performed with approval by the local research ethics committee of the health sciences center (protocol number 273.599).

From a pool of 2000 CBCT scans of the maxilla and paranasal sinuses obtained between January 2010 and January 2011 in a radiology clinic in Pernambuco, Brazil, 400 images were randomly selected according to the following inclusion criteria: examinations of patients with sinus disease in at least 1 of the maxillary sinuses and good quality images for

Results

Of the 400 CBCT scans evaluated, 218 (54.5%) were females and 182 (45.5%) males; age ranged between 13 and 82 years old (mean = 47.09 ± 14.28). Sinus alterations were observed bilaterally in 258 (64.5%) patients and unilaterally in 142 (35.5%) (P < .001). Thus, of the 766 maxillary sinuses in the study, 658 (85.9%) showed abnormalities.

Table 1 shows the values regarding the distribution of maxillary sinus diseases. The generalized MT was the most prevalent condition (65.2%), occurring mostly

Discussion

CBCT imaging provides high-resolution images and allows simultaneous and accurate assessment of maxillary sinuses 21, 22, teeth, and adjacent tissues in all planes, including the relationships between these structures 5, 23. Therefore, we chose CBCT imaging to conduct this research because of its wide use in various fields of dentistry and its high accuracy and sensitivity compared with 2-dimensional radiographs for the diagnosis of sinus changes (24), assessment of the quality of endodontic

Conclusion

In conclusion, the most prevalent sinus diseases were generalized and localized MT, respectively, and both were found to be related to odontogenic alterations. Generalized MT was more frequently associated with periodontal bone loss and localized MT with periapical lesions. We emphasize that CBCT imaging is an appropriate method for evaluating maxillary sinus findings and their associated dental conditions.

Acknowledgments

The authors would like to thank the National Council for Scientific and Technological Development (CNPq). The authors would like also to thank Glaucia Maria Bovi Ambrosano, PhD, for assisting in this article by providing statistical analysis support and Dr Marco Antônio Gomes Frazão for making the images available to us.

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

References (33)

I. Brook
Sinusitis of odontogenic oringin
Otolaryngol Head Neck Surg
(2006)
N. Obayashi et al.
Spread of odontogenic infection originating in the maxillary teeth: computerized tomographic assessment
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(2004)
Y. Lu et al.
Associations between maxillary sinus mucosal thickening and apical periodontitis using cone-beam computed tomography scanning: a retrospective study
J Endod
(2012)
B. Nurbakhsh et al.
Resolution of maxillary sinus mucositis after endodontic treatment of maxillary teeth with apical periodontitis: a cone-beam computed tomography pilot study
J Endod
(2011)
S. Shanbhag et al.
Association between periapical lesions and maxillary sinus mucosal thickening: a retrospective cone-beam computed tomographic study
J Endod
(2013)
M.M. Bornstein et al.
Characteristics and dimensions of the Schneiderian membrane and apical bone in maxillary molars referred for apical surgery: a comparative radiographic analysis using limited cone beam computed tomography
J Endod
(2012)
J. Vallo et al.
Prevalence of mucosal abnormalities of the maxillary sinus and their relationship to dental disease in panoramic radiography: results from the Health 2000 Health Examination survey
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(2010)
N. Timmenga et al.
Maxillary sinus function after sinus lifts for the insertion of dental implants
J Oral Maxillofac Surg
(1997)
J.H. Jung et al.
A retrospective study of the effects on sinus complications of exposing dental implants to the maxillary sinus cavity
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(2007)
P. Mehra et al.
Maxillary sinus disease of odontogenic origin
Otolaryngol Clin North Am
(2004)

X. Liang et al.

A comparative evaluation of cone beam computed tomography (CBCT) and multi-slice CT (MSCT) Part I. On subjective image quality

Eur J Radiol

(2010)

J.J. Cymerman et al.

Evaluation of odontogenic maxillary sinusitis using cone-beam computed tomography: three case reports

J Endod

(2011)

A.C. Gomes et al.

Influence of endodontic treatment and coronal restoration on status of periapical tissues: a cone-beam computed tomographic study

J Endod

(2015)

Y.H. Liang et al.

Endodontic outcome predictors identified with periapical radiographs and cone-beam computed tomography scans

J Endod

(2011)

U.P. Nair et al.

Maxillary sinusitis of odontogenic origin: cone-beam volumetric computerized tomography-aided diagnosis

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

(2010)

L. Ritter et al.

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

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

(2011)

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Citation Excerpt :
Computed Tomography (CT) has been used as a gold standard diagnostic technique for sinus pathologies; but due to its low spatial resolution and high radiation dose to the patient it may not be an appropriate modality for diagnosis of odontogenic sinusitis. Cone Beam Computed Tomography (CBCT), provides an accurate evaluation of maxillary sinus changes and its association with the adjacent teeth, bone and pathology without distortion and superimposition caused by teeth and surrounding structures with an additional advantage of better resolution and lower radiation exposure.1,8,9 Therefore, CBCT is the preferred modality for assessing patients who have both dental and sinus complains.
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.
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.
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.
Most prevalent sinus change was mucosal thickening. Periodontal bone loss was significantly associated with mucosal thickening. CBCT is an appropriate method for sinus evaluation.
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Basic ResearchAssociation between Odontogenic Conditions and Maxillary Sinus Disease: A Study Using Cone-beam Computed Tomography

Highlights

Abstract

Introduction

Methods

Results

Conclusions

Section snippets

Study Sample

Results

Discussion

Conclusion

Acknowledgments

Otolaryngol Head Neck Surg

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Endod

J Endod

J Endod

J Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Otolaryngol Clin North Am

Eur J Radiol

J Endod

J Endod

J Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

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