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

Abstract

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.

Comparison of panoramic radiography and cone-beam computed tomography for assessing radiographic signs indicating root protrusion into the maxillary sinus

“…Previous studies have reported good agreement for roots that were not in contact with the maxillary sinus floor on panoramic radiographs and CT or CBCT images. 17,18,20,21,22 In our results, type 0 showed high agreement between panoramic radiographs and CBCT images, while the other types showed low agreement. In this study, the high negative predictive values indicated that CBCT is not necessary when panoramic radiographs show that the root is not in contact with the maxillary sinus.…”

“…Many studies have reported that the type 0 relationship was most commonly observed. 20,22,23,25,28,32 Other studies showed that type 0 was most frequently observed in premolars and type 3 in molars. 16,18,19,26,34 Differences in reported sinus-root relationships might be due to ethnicity or methodology.…”

“…[15][16][17][18][19] When panoramic radiographs showed a distinct distance between the roots and the sinus, it was found to be unnecessary to order CBCT. 20 However, there was significant disagreement between panoramic radiographs and CT or CBCT images when the panoramic radiograph showed root protrusion into the sinus. 18,21,22 Panoramic radiography was unreliable for evaluating the relationship between the roots and the maxillary sinus.…”

“…18,21,22 Panoramic radiography was unreliable for evaluating the relationship between the roots and the maxillary sinus. 16,20 The clinician must determine when it is necessary to order CBCT to assess the relationship between the maxillary sinus and the maxillary posterior teeth. 22 In previous studies, some instances of root protrusion into the sinus shown on panoramic radiographs were actually shown to be located laterally or medially to the sinus on CBCT images.…”

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

“…Numerous articles have sought to answer a critical question when evaluating mandibular third molars: Is panoramic imaging alone sufficient to stratify the risk of inferior alveolar nerve injury? A large meta-analysis conducted by Sun et al concluded that while panoramic radiography has high specificity, its sensitivity is inadequate for ruling out the risks of nerve damage [10,11,12]. While more recent articles illustrate the inadequacies of panoramic imaging in predicting IAN injury, they did not compare its sensitivity to CBCT or any other alternative method of imaging.…”