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

Abstract

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.

Keywords: Cone-beam computed tomography; maxillary sinus mucosal thickening; odontogenic sinusitis; periapical pathology.

Figure 1

Vertical relationships between root and floor of maxillary sinus as seen in cone-beam computed tomography coronal section images. (a) Type I, (b) Type II, (c) Type III, (d) Type IV, (e) Type V

Figure 2

Mucosal thickening in maxillary sinus as seen in cone-beam computed tomography sagittal section images. (a) Normal (no mucosal thickening), (b) 0 to 2 mm, (c) 2 to 4 mm (mild maxillary sinus mucosal thickening), (d) 4 to 10 mm (moderate), and (e) >10 mm (severe)