Comparative assessment of periapical radiography and CBCT imaging for radiodiagnostics in the posterior maxilla

Abstract

Close proximity of the maxillary roots and the sinus floor makes a dental disease a probable cause of maxillary sinusitis. The aim of this study was to evaluate the ability of periapical radiography and cone beam computed tomography in defining the topographic relationship of maxillary teeth to the sinus floor and detecting apical periodontitis and other odontogenic causes of the maxillary sinusitis. Out of 145 dental records from subjects (mean age 52 years, range 20-75 years; 89 females) referred to the Oral Imaging Centre, KU Leuven, periapical and CBCT images of the posterior maxilla were selected for further analysis. Anatomical relationship of maxillary teeth to the sinus floor, apical periodontitis and other etiological causes of soft tissue thickening were assessed with both imaging modalities. The results of this study demonstrated that periapical radiographs are not adequate in observing the anatomical relationship between maxillary molars and the sinus floor. CBCT showed an intimate relationship of 1st and 2nd molar with the maxillary sinus in 50 and 45% of the cases, respectively. Periapical radiography could only spot approximately 40% of apical periodontitis on posterior maxillary teeth and 3% of all apical infections extending to the sinus, seen on CBCT.

Comparison of panoramic radiography and CBCT to identify maxillary posterior roots invading the maxillary sinus

“…3,11 Actually, it was the most frequent relationship between upper roots and the maxillary sinus, as reported by others. 15 A high correlation between panoramic radiograph and CBCT was found for roots classified with the Score 0, suggesting that panoramic radiography provides enough information for the surgical management of roots that are distant from the 0 1 2 3 Total CBCT 0 85 17 2 5 109 1 10 38 1 40 89 2 0 2 2 2 6 3 1 11 3 111 126 Total 96 68 8 158 330 p , 0.05, according to McNemar-Bowker test.…”

“…This accident, which has always been a concern for dental practitioners, 1 consists in the violation of the maxillary sinus floor and may or may not involve tearing of the Schneiderian membrane. 2,3 The topography of the maxillary sinus floor is extremely variable, with age, maxillary sinus size and maxillary sinus pneumatization being among the factors that can determine it. 3,4 Upper posterior roots and the maxillary sinus floor are separated by bone and, not rarely, solely by the sinus mucosa.…”

“…2,3 The topography of the maxillary sinus floor is extremely variable, with age, maxillary sinus size and maxillary sinus pneumatization being among the factors that can determine it. 3,4 Upper posterior roots and the maxillary sinus floor are separated by bone and, not rarely, solely by the sinus mucosa. 4 In some cases, the thinness of the bone that separates the root apices and the maxillary sinus cortical floor fails to prevent the spread of periapical or periodontal infections into the maxillary sinus.…”

“…4 In some cases, the thinness of the bone that separates the root apices and the maxillary sinus cortical floor fails to prevent the spread of periapical or periodontal infections into the maxillary sinus. 3,5 Not surprisingly, endodontic therapy, tooth extraction and orthodontic tooth movement are all potential causes of sinus complications. [6][7][8] Histological studies demonstrated that only a thin cortical bone layer envelops most roots that are radiographically protruding into the sinus, with actual mucosal perforations being found in 14-28% of the examined samples.…”

Relationship between root apices of maxillary posterior teeth and the maxillary sinus floor in patients from the Varna region

“…Anatomically, the maxillary sinus is universally classified into a sclerotic, pneumatic and mixed types (2). Dental clinicians are particularly interested in patients with a highly pneumatized maxillary sinus (3,4).…”