Does the quality of residual alveolar bone apical to a periodontal lesion beneath the maxillary sinus play a vital role in preventing the extension of periodontal disease to maxillary sinus? A CBCT-assisted retrospective study

Abstract

BACKGROUND: The mucous membrane of the maxillary sinus is sensitivis susceptible to infection or inflammation adjacent to it, which may contribute to mucous membrane thickening (MMT). Residual alveolar bone quality (RABQ) is considered a quality of the remaining bone apical to periodontal defect adjoining to the floor of the maxillary sinus. OBJECTIVE: The current study aimed to analyze the minimum RABQ to prevent the extension of periodontal pathology from reaching maxillary sinus using cone-beam computed tomography (CBCT). METHODS: In this retrospective observational study, 240 sinus exposure CBCT records of 146 patients were evaluated. Patients with at least one sinus exposure were included. RABQ and MMT were calculated using CBCT inbuilt tools. RABQ was divided into four groups based on gray scale values (GSV). Statistical analysis was performed using one way ANOVA and independent sample t-tests. Correlation was completed applying Pearson’s correlation coefficient. RESULTS: A significant difference (p< 0.05) was observed between the MMT values of the four RABQ groups. Inverse correlation was observed between mean MMT and GSV values. Mean MMT was higher than pathological MMT range (> 2 mm), with significant differences in groups A and B, where mean GSV values are less than 500. Mean GSV greater than 500 in groups C and D show non-pathological MMT. Prevalence of MMT is 91.4% if GSV is < 500 and 7.5% if GSV is > 500. CONCLUSIONS: Our study suggests that MMT is present if RABQ has GSV values < 500. Maxillary sinusitis and its etiology from periodontal pathology can be excluded based on RABQ adjoining periodontal lesion. Early detection and prompt treatment along with appropriate regenerative protocols can be performed to increase the RABQ. Further microbiological investigation is required to support the present results.

Assess the Association Between Periodontitis and Maxillary Sinusitis: A Cross-Sectional Cone-Beam Computerized Tomography (CBCT) Study

“…The average MT in our study was 5.5 mm, which corresponded with the previous study by Phothikhun et al, where they found the average MT to be 5.0 mm [ 25 ], while in contrast, the study by Apparaju et al found an average of 3.43 mm of MT. Additionally, a study by Zhang et al found the average MT to be 8.25 mm [ 13 , 28 ]. These results found in the literature can be explained by the sample size because the study, which was consistent with our results, had a sample size of 500 CBCT images, which approximates our sample size.…”

“…Teeth with roots within the maxillary sinus were about twice as likely to be related to maxillary sinus pathologies [10]. Anatomically, maxillary posterior teeth are close to the maxillary sinus, which also shares a blood supply, which may explain why inflammation is transmitted to the sinus from periodontal pockets [11][12][13]. According to Roque-Torresa et al, 83% of OS is caused by apical periodontitis and other periodontal disorders [10].…”