What are the risk factors for maxillary sinus pathologies? A CBCT study

Development of a machine learning-based predictive model for maxillary sinus cysts and exploration of clustering patterns

BACKGROUND AND OBJECTIVE

There are still many controversies about the factors influencing maxillary sinus cysts and their clinical management. This study aims to construct a prediction model of maxillary sinus cyst and explore its clustering pattern by cone beam computerized tomography (CBCT) technique and machine learning (ML) method to provide a theoretical basis for the prevention and clinical management of maxillary sinus cyst.

METHODS

In this study, 6000 CBCT images of maxillary sinus from 3093 patients were evaluated to document the possible influencing factors of maxillary sinus cysts, including gender, age, odontogenic factors, and anatomical factors. First, the characteristic variables were screened by multiple statistical methods, and ML methods were applied to construct a prediction model for maxillary sinus cysts. Second, the model was interpreted based on the SHapley Additive exPlanations (SHAP) values, and the risk of maxillary sinus cysts was predicted by generating a web page calculator. Finally, the K-mean clustering algorithm further identified risk factors for maxillary sinus cysts.

RESULTS

By comparing the various metrics in the training and test sets of multiple ML models, eXtreme Gradient Boosting (XGBoost) is the best model. The average area under curve (AUC) values of the XGBoost model in the training, validation, and test sets, respectively, are 0.939, 0.923, and 0.921, which indicates its excellent classification and discrimination ability. The cluster analysis model further categorized maxillary sinus cysts into high-risk and low-risk groups, with apical lesions, severe periodontitis, and age ≥ 53 as high-risk factors for maxillary sinus cysts.

CONCLUSION

These findings provide valuable insights into the etiology and risk stratification of maxillary sinus cysts, offering a theoretical basis for their prevention and clinical management. The integration of CBCT imaging and ML techniques holds the potential for prevention and personalized treatment strategies of maxillary sinus cysts.

Changes in Maxillary Sinus Structure Due to Tooth Loss and the Effects of Sex and Aging on CBCT Before Maxillary Sinus Augmentation: A Cross-Sectional Study of 120 Patients

Prosthesis for missing maxillary molars with dental implants often requires maxillary sinus augmentation owing to insufficient alveolar bone height. However, the anatomical structure of the maxillary sinus is a significant risk factor. This study used preoperative cone-beam computed tomography (CBCT) to investigate changes in the anatomical structure of the maxillary sinus due to tooth loss and conducted an epidemiological survey of Japanese people to determine the effects of gender and age on these changes. Preoperative CBCT scans were analyzed in patients aged ≥ 50 years with free-end maxillary molar edentulism involving ≥ 2 missing teeth seeking implant treatment. Statistical analyses were performed. One hundred and twenty participants (46 males, 74 females; mean age, 62.1 ± 7.4 years) with 3.0 ± 0.9 missing teeth and an existing bone volume of 6.2 ± 3.1 mm were included. Lateral wall thickness, sinus angle, sinus membrane thickness, maxillary sinus length and width, and the presence of the sinus septa significantly differed between missing and non-missing sides. Maxillary sinus height and sinus membrane thickness on missing side and maxillary sinus height and width on non-missing side varied significantly. Aging was associated with maxillary sinus length and width changes on the non-missing side in males, whereas no age-associated effects were identified in females. To ensure the safe execution of maxillary sinus augmentation, a thorough understanding of maxillary sinus anatomy is crucial prior to surgery.

Dental maxillary sinus pathology: a CBCT-based case-control study

This study evaluated the association between dental infection and maxillary sinus pathology, and the influence of age, sex, type of tooth, root proximity to the sinus floor, the condition of the primary maxillary ostium, and the presence of an accessory maxillary ostium in this process. Computed Tomography scans were selected, and upper posterior teeth were evaluated for the presence of apical periodontitis (AP), bone loss with furcation involvement, and endoperiodontal lesion (EPL), subsequently, sinuses were evaluated for mucosal thickening (MT) and opacification of the maxillary sinus (OMS). Logistic regression models were constructed, and Chi-squared and Fisher's tests were applied. Patients with AP were 15.63 times (7.576;32.268) and, 25.97 times (16.22,41.56) more likely to have MT and OMS, respectively. No teeth were associated with EPL in the group without sinus pathology, indicating a strong association with OMS. Male patients were 1.30 times more likely to have MT, and 5.86 times more likely to have OMS than female patients. The condition of the ostium, presence of an accessory ostium, type of tooth, and proximity of the root to the sinus floor were not associated with MT or OMS. In conclusion, male sex and the presence of AP and EPL are associated with maxillary sinus pathology.

The relation between Schneiderian membrane thickening and radiodiagnostic features of periapical pathology

This study aimed to assess the relationship between Schneiderian membrane thickening and periapical pathology in a retrospective analysis of Cone Beam Computed Tomography (CBCT) images. For this, 147 CBCT scans containing 258 sinuses and 1,181 teeth were assessed. Discontinuation of the lamina dura, widening of the periodontal ligament space, apical periodontitis (AP), and partly demineralized maxillary sinus floor associated with AP were considered periapical pathology. Maxillary sinus mucosal thickening (MSMT) was classified as odontogenic or non-odontogenic. An irregular band with a focal tooth associated thickening and local thickening related to a root were considered odontogenic types of MSMT. The relation between the imaging features of periapical pathology and the type and thickness of MSMT was determined by logistic regression and linear mixed model, respectively. In addition, linear regression and Mann Whitney test evaluated the relation and demineralization of the AP lesion towards the sinus floor (p≤0.05). The odds of having an odontogenic type of MSMT were significantly higher when a periapical pathology was present in the maxillary sinus. Eighty-two percent of AP partly demineralized towards the sinus floor were associated with an odontogenic MSMT. Both AP lesions partly demineralized towards the sinus floor and, with increased diameter, led to increased MSMT. In conclusion, there is an 82% risk of having an odontogenic type of MSMT with the presence of AP partly demineralized towards the sinus floor. More thickening of the maxillary sinus mucosa is seen with larger AP lesions and partial demineralization of the sinus floor.

Retrospective analysis of pathological changes in the maxillary sinus with CBCT

The aim of this study is to examine the frequency of maxillary sinus pathologies and their relationship with each other using cone beam computed tomography (CBCT) and to make a new grade according to the number of affected walls. 1000 maxillary sinuses of 500 patients with CBCT images were included in the study. Anatomical variations and pathological formations of the maxillary sinuses were examined. Images were evaluated for the presence of flat, polypoidal, partial and generalized mucosal thickening, partial and total opacification, polyps and mucous retention cysts. Maxillary sinus pathologies were graded according to the number of walls affected. In the examined CBCT images, no pathology was found in 54.2% of the maxillary sinuses, while pathology was observed in 45.8%. The most common sinus pathologies were mucous retention cyst (12.3%) and polypoidal thickening (12.2%). While pneumatization, ostium obstruction, and the presence of sinus-related roots were associated with sinus pathology, no relationship was found with nasal septum deviation and the presence of septa. Before dental implant and sinus surgery applications, the presence of sinus pathologies and their relationship with anatomical variations can be evaluated with CBCT, a three-dimensional technique, and complications such as sinus membrane perforation, infection, failure to break the bone window due to the presence of antral septa, graft loss and oroantral fistula formation can be reduced.

Applications of artificial intelligence in the analysis of dental panoramic radiographs: an overview of systematic reviews

OBJECTIVES

This overview of systematic reviews aimed to establish the current state of knowledge on the suitability of artificial intelligence (AI) in dental panoramic radiograph analysis and illustrate its changes over time.

METHODS

Medical databases covered by the Association for Computing Machinery, Bielefeld Academic Search Engine, Google Scholar, and PubMed engines were searched. The risk of bias was assessed using ROBIS tool. Ultimately, 12 articles were qualified for the qualitative synthesis. The results were visualized with timelines, tables, and charts.

RESULTS

In the years 1988-2023, a significant development of information technologies for the analysis of DPRs was observed. The latest analyzed AI models achieve high accuracy in detecting caries (91.5%), osteoporosis (89.29%), maxillary sinusitis (87.5%), periodontal bone loss (93.09%), and teeth identification and numbering (93.67%). The detection of periapical lesions is also characterized by high sensitivity (99.95%) and specificity (92%). However, due to the small number of heterogeneous source studies synthesized in systematic reviews, the results of this overview should be interpreted with caution.

CONCLUSION

Currently, AI applications can significantly support dentists in dental panoramic radiograph analysis. As systematic reviews on AI become outdated quickly, their regular updating is recommended. PROSPERO registration number: CRD42023416048.

Increased risks of maxillary sinus mucosal thickening in Chinese patients with periapical lesions

Objectives

This study aimed to evaluate the effects of factors related to periapical lesions (PALs) on sinus membrane thickening (SMT) in the Chinese population using cone-beam computed tomography (CBCT).

Methods

In this retrospective study, CBCT images (n = 512) of maxillary sinuses of 446 patients were evaluated by two examiners for SMT and PALs, PAL size, and the distance between the maxillary sinus floor (MSF), and the PAL's edge/root apex. The data were analyzed using analysis of variance, the Kruskal-Wallis test, χ²-test, and logistic regression.

Results

A binary logistic regression model showed that the prevalence and severity of SMT > 2 mm were significantly associated with older age (>60 years) (odds ratio [OR]: 4.03, 95% confidence interval [CI]): 2.24-7.72, P < 0.001], male sex (OR: 2.08, 95% CI: 1.21-3.56, P < 0.006), and PALs (OR: 6.89, 95% CI: 3.93-12.08, P < 0.001). The type of contact and penetration between the MSF and PALs or root apex showed a more significant relation with SMT > 2 mm than did distance after adjusting for confounding factors, including age and sex (PALs: OR = 10.17 and 14.57, P < 0.001; root apex: OR = 3.49 and 5.86, P < 0.001).

Conclusions

The prevalence and severity of SMT were significantly associated with older age, male sex, PALs, PAL size, and the distance between the MSF and PALs/root apex. Therefore, communication between dental surgeons and an otolaryngology specialist is important for the timely diagnosis and treatment of SMT of dental origin.

Analysis of risk variables for association with maxillary sinus mucosal thickenings: a cone-beam computed tomography-based retrospective study

PURPOSE

This study aimed to determine which patient-related, anatomical, pathologic, or iatrogenic variables may be directly associated with and which may have a modifying effect on the generation of maxillary sinus (MS) mucosal thickenings.

METHODS

A total of 278 cone-beam computed tomography (CBCT) scans obtained from 114 males and 164 females were evaluated. The protocol included the assessment of 21 candidate variables, of which 18 were bilateral and 3 were unique. The relationship among the study variables and the mucosal thickenings were examined individually and adjusted for confounding using univariate and multivariate binary logistic regression models.

RESULTS

The prevalence of mucosal thickenings was 71.20% at patient level and 53.40% at sinus level. The ostium height > 28.15 mm, the infundibulum length ≤ 9.55 mm, the infundibulum width ≤ 0.50 mm, along the occurrence of periapical lesions and slight-to-severe periodontal bone loss acted as strong/independent risk variables for MS mucosal thickenings. Confounding and interaction relationships between MS height and depth, and between the alveolar process type and the presence of foreign materials with respect to age stratum > 47.50 years might be also associated with the mucosal thickenings.

CONCLUSIONS

While increased ostium height, decreased infundibulum length/width, the presence of periapical lesions and periodontal involvement might be the foremost indicator variables for MS mucosal thickenings, there are synergistic relationships among the increased sinus height and depth as well as aging regarding atrophic/partially atrophic alveolar process status and the presence of foreign materials that may be also associated with a greater proportion of these mucosal abnormalities.

CBCT Evaluation of Periapical Pathologies in Maxillary Posterior Teeth and Their Relationship with Maxillary Sinus Mucosal Thickening

In modern dentistry, radiographic imaging is crucial for examining the connection between the maxillary sinus floor and the root apices of the maxillary posterior teeth, particularly when the periapical region is affected by pathology that could result in infectious, inflammatory, or traumatic changes in the maxillary sinus. This study aimed to investigate the prevalence of periapical pathologies in the maxillary posterior teeth and their relationship with maxillary sinus mucosal thickening by using cone-beam computed tomography scans. This retrospective study was conducted on 420 digitized CBCT images which were scanned in sagittal, axial, and coronal views. Out of 420 total images, 223 (53.1%) were of males and 197 (44.9%) were of females. The data were analyzed using SPSS version 28. A total of 2936 posterior maxillary teeth were tested for periapical pathology (PP), 1477 on the right side and 1459 on the left side. In terms of gender, there was no significant relationship between PP in maxillary posterior teeth on both sides and mucosal thickness of the maxillary sinus (p > 0.05). A significant relationship was found between PP in maxillary posterior teeth on both sides and maxillary sinus mucosal thickening (p < 0.05). This study concluded that the prevalence of periapical pathology in the maxillary posterior teeth was significantly associated with a rise in the incidence of maxillary sinus mucosal thickening. Moreover, the primary causative factor for the pathophysiology of the odontogenic maxillary sinus was the periapical pathology in both maxillary first molars.

Maxillary Sinus Pathology and its Relationship with Pathology and Dental Treatments. Systematic Review

Introduction and objective: The aim of this review is to evaluate to what extent sinus pathology originates from dental pathology or treatment, and to assess the occurrence frequency of sinus pathology in its different forms using cone beam computed tomography (CBCT). Method: The literature review was conducted using PubMed, Scopus and the Cochrane Library. Forty-two articles were included (25 case series, ten cross- sectional studies, three case-control studies, two cohort studies, one prospective study, and one retrospective study). Results: Forty-two articles involving a total of 13,191 patients and 17,374 CBCTs were included in this review. The most frequent pathological findings were, by a considerable degree, inflammatory diseases, which represented 75.16% of the total findings, followed by infection (12.13%), tumours (6.88%), and high pneumatisation (2.07%). Within dental pathology, there is a direct Pearson correlation with polyps (1) and opacification (0.999), and an almost direct correlation with retention cysts (0.981) and sinus-associated dental elements (0.972). Conclusions: Our results further support the argument that dental modifications and treatments are an important cause of sinus pathology. For this reason, dental aetiologies must be taken into account by both dentists, maxillofacial surgeons and ENT when considering the most appropriate treatment for patients with maxillary sinusitis.

Evaluation of the effect of periapical lesions and other odontogenic conditions on maxillary sinus mucosal thickness characteristics and mucosal appearance: A CBCT study

Background. This retrospective study aimed to investigate the effect of various dental and maxillary sinus variables on maxillary sinus mucosal thickness (MT). The variables included periodontal bone loss (PBL), periapical status, dental restorations of posterior maxillary teeth, and the distance from the root apices to the sinus mucosa.

Methods. Cone-beam computed tomography (CBCT) images of the maxillary sinuses (n = 600) in 300 patients were examined. The sinus MT and the distance of the roots from maxillary sinuses were measured. Apical lesions of the roots, PBL, and situations of adjacent teeth were recorded. The relationships between these conditions and MT and characterization of MT were evaluated. The Kruskal–Wallis H test was used to compare groups due to the non-normal distribution of the data. The relationship between categorical variables was analyzed using chi-squared test.

Results. There was a significant correlation between maxillary sinus MT and periapical lesions, PBL, and restorations (P < 0.05). MT increased as the apical lesions of premolar teeth enlarged (P < 0.05, P = 0.022). MT increased in cases of mild PBL of molar teeth (P = 0.041).

Conclusion. In this retrospective study, the MT significantly increased in patients with periapical lesions, inadequate endodontic treatment, increased PBL, and inadequate dental restorations.

Height difference between the vestibular and palatal walls and palatal width: a cone beam computed tomography approach

Background

The objective of this study was to measure two parameters involved in tri-dimensional implant planning: the position of the buccal and palatal bone wall and the palatal thickness.

Methods

Cone beam computed tomography (CBCT) images (Planmeca ProMax 3D) of 403 teeth (208 upper teeth and 195 lower teeth) were obtained from 49 patients referred to the Dental School of Seville from January to December 2014. The height difference between the palatal and buccal walls was measured on the most coronal point of both walls. The thickness of the palatal wall was measured 2 mm from the most coronal point of the palatal wall.

Results

The mean values in the maxilla were 1.7 ± 0.9 mm for central and lateral incisors, 2.2 ± 1.7 mm for canines, 1.6 ± 0.9 mm for premolars and 1.9 ± 1.5 mm for molars. In the lower jaw, the mean values were 1.3 ± 0.8 mm for incisors, 1.7 ± 1.2 mm for canines, 2.3 ± 1.3 mm for premolars, and 2.6 ± 1.7 mm for molars. In the upper jaw, more than 55% of maxillary teeth (excluding second premolars and molars) presented mean height differences greater than 1 mm. In the mandible, more than 60% of incisors showed a buccal bone thickness of 1 mm from the apical to lingual aspect. All teeth except the second premolar presented a buccal wall located more than 1 mm more apically than the lingual bone wall.

Conclusions

The buccal bone wall is located more apically (greater than 1 mm) than the palatal or lingual table in most of the cases assessed. The thickness of the palatal or lingual table is also less than 2 mm in the maxilla and mandible, except in the upper canines and premolars and the lower molars.

Factors influencing the sinus membrane thickness in edentulous regions: a cone-beam computed tomography study

BACKGROUND

During implant treatment in the maxillary molar area, maxillary sinus floor augmentation is often performed to ameliorate the reduced alveolar bone height attributable to bone remodeling and pneumatization-induced expansion of the maxillary sinus. However, this augmentation may cause complications such as misplaced implants, artery damage, and maxillary sinus mucosal perforation; infections like maxillary sinusitis; and postsurgical complications such as bone graft leakage and postoperative nasal hemorrhaging. To reduce the complications during maxillary sinus floor augmentation and postoperative infections, we performed retrospective investigations of various systemic and local factors that influence pre-operative sinus mucosal thickness (SMT) by using cone-beam computed tomography (CBCT). Subjects included patients who underwent maxillary sinus floor augmentation in an edentulous maxillary molar area with a lateral approach. Pre-operative SMT, existing bone mass, and nasal septum deviation were measured using CBCT images. Relationships between SMT and the following influencing factors were investigated: (1) age, (2) sex, (3) systemic disease, (4) smoking, (5) period after tooth extraction, (6) reason for tooth extraction, (7) residual alveolar bone height (RBH), (8) sinus septa, and (9) nasal septum deviation. Correlations were also investigated for age and RBH (p < 0.05).

RESULTS

We assessed 35 patients (40 sinuses; 11 male, 24 female). The average patient age was 58.90 ± 9.0 years (males, 57.9 ± 7.7 years; females, 59.9 ± 9.4 years; age range, 41-79 years). The average SMT was 1.09 ± 1.30 mm, incidence of SMT > 2 mm was 25.0%, incidence of SMT < 0.8 mm was 50.0%, and the average RBH was 2.14 ± 1.02 mm. The factors that influenced SMT included sex (p = 0.0078), period after tooth extraction (p = 0.0075), reason for tooth extraction (p = 0.020), sinus septa (p = 0.0076), and nasal septum deviation (p = 0.038).

CONCLUSIONS

Factors associated with higher SMT included male sex, interval following tooth extraction < 6 months, periapical lesions, sinus septa, and nasal septum deviation. Factors associated with SMT > 2 mm were sex and reason for tooth extraction, while factors associated with SMT < 0.8 mm were time following tooth extraction and nasal septum deviation. Despite the limitations of this study, these preoperative evaluations may be of utmost importance for safely conducting maxillary sinus floor augmentation.