A comparative study of diagnostic accuracy of panoramic radiographs with cone-beam computed tomographic images in the evaluation of the relationship of maxillary sinus and root tips.

The proximity of the maxillary sinus and root tips is a condition that can lead to various complications during dental procedures. The aim of this study is definition the types and frequency of relationship between maxillary sinus and root tips by Cone Beam Computed Tomograpic (CBCT) imaging and examination the accuracy of panoramic radiographs in terms of determination of relationship between maxillary sinus and root tips according to CBCT imaging which is accepted as reference standart. 3,621 intact teeth of 484 patients were evaluated. The relationship between root tips and sinus is classified as: class 0, more than 0.5 mm distance between the root apex and the sinus floor; class 1, less than 0.5 mm distance between root apex and sinus floor; class 2, root apex in contact with the sinus floor; class 3, root apex protrudes into the sinus cavity. In the CBCT data set, descriptive analysis including the frequency distribution of the relationship types according to the tooth types were performed. McNemar-Bowker test and R program were used to test the accuracy of panoramic radiographs by the comparative analysis with CBCT imaging. Class 3 relationship was the most frequently found at the second molars (53.6%) and the first molars (49.5%). The most frequent type of relationship for second premolars (43.6%), first premolars (85.1%) and canines (89.9%) was class 0. The accuracy of the panoramic radiographs was calculated as 82%. The close relationship between the first or the second molars and maxillary sinus should be considered before dental procedures. Evaluation of panoramic radiographs provides more accurate information about the root tips, which are below the sinus floor and protruded into the sinus cavity.