Evaluation of association between maxillary sinusitis and odontogenic inflammation using volumetric cone-beam computed tomography

The aim of this study is to evaluate frequency of maxillary sinusitis cases and association between maxillary sinusitis and inflammation of the maxillary posterior teeth using cone beam computed tomography (CBCT). CBCT scans (Kodak 9000 3D, Carestream Health, Trophy, France) of 1000 patients were evaluated retrospectively for the presence of mucosal thickening. Odontogenic maxillary sinusitis were categorized by degree (<2 mm. 2–5 mm and >5 mm) and type (flat or polypoid). Thickening >2 mm was considered pathological and cases which had periapical inflammation in premolars/molars with pathological mucosal thickening were recorded as odontogenic maxillary sinusitis. The parameters which can influence amount and type of mucosal thickening such as demographic variables, tooth type and parameters related to apical lesion (lesion diameter, distance between apical lesion border and maxillary sinus floor, number of teeth and roots with apical lesion) were recorded. Besides, the vertical and horizontal relationship between the maxillary sinus and maxillary premolar/molars was evaluated by topographic measurements making from four different regions. The scans were evaluated by a single investigator. The variables were analysed using Descriptive, Linear and Logistic Regression Analysis. Kappa was used to measure intraobserver agreement. Mucosal thickening was observed in 202 CBCT scans and odontogenic origin was determined in 47.5 % of these images. The most frequently detected amount of mucosal thickening more than was Type III thickening ( > 10 mm) (41.7 %) , whereas flat type thickening (%59.4) was the most frequent type of mucosal thickening. The tooth most frequently associated with odontogenic sinusitis is the maxillary first molar ( 43.8 %). Regression analysis revealed association between mucosal thickening >2mm and gender (males), amount of mucosal thickening and number of roots-teeth with apical lesion and lesion diameter, while single parameter affecting on the type of mucosal thickening was detected as number of roots with apical lesion. Topographic measurement revealed that horizontal thickness of the buccal alveolar bone was thinner on the maxillary premolar/ molars as compared to the horizontal thickness of the palatal alveolar bone. The vertical relationship showed that the distance between the apices of the buccal and palatal roots and the inferior wall of the maxillary sinus at the maxillary molars was significantly shorter than those at the maxillary premolars. In conclusion; if there is large diameter apical lesion with molar tooth and multiple roots especially in male patient, risk of odontogenic maxillary sinusitis can increase as independently from correlation with distance between apical lesion border and maxillary sinus floor. Also, dental treatment option must be absolutely evaluated in addition to medical treatment in persistent and recurrent maxillary sinusitis cases. Keywords: periapical lesion, maxillary sinusitis, cone-beam computed tomography