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

Effect of the anatomical patterns of maxillary sinus floor on the endodontic microsurgery plan of maxillary sinusitis of endodontic origin

BACKGROUND

Due to the close relationship between maxillary posterior teeth and maxillary sinus floor (MSF), infection from teeth with endodontic disease may spread into maxillary sinus and cause the occurrence of maxillary sinusitis of endodontic origin (MSEO). Endodontic microsurgical intervention in infected teeth causing MSEO requires careful assessment and planning. This study evaluated the anatomical patterns of MSF using cone-beam computed tomography (CBCT), and further explored their influence on the endodontic microsurgery of MSEO.

METHODS

A total of 333 CBCT scans were collected between August and December 2023. The classification of MSEO, the degree of mucosal thickening, and the shortest distance from the root apex to MSF were recorded. An improved classification of the anatomical relationships between the teeth and MSF was proposed based on CBCT images. Additionally, the angle at the nadir of MSF, and the divergence angle between the roots and maxillary sinus septa were recorded. Analysis of variance was used to analyze the differences among different groups. A significance level of P < 0.05 was employed.

RESULTS

The anatomical relationship between the root apex and MSF affected the endodontic microsurgery plan of MSEO. Maxillary sinus elevation is needed when MSF is below the line between the buccal and palatal roots, when the root apices contact or protrude into MSF, or when apical lesion is directly connected to the maxillary sinus mucosa. In addition, maxillary sinus mucosal thickening may be more severe when the root apex or apical lesion is close to the maxillary sinus.

CONCLUSION

The anatomical relationship between maxillary posterior teeth and MSF is an important factor in evaluating and designing endodontic microsurgery for MSEO.

Utilizing a Novel AI Tool to Detect the Posterior Superior Alveolar Artery's Location's Impact on Maxillary Sinus Mucosal Thickening in the Presence of Periapical Lesions

Periapical lesions have been implicated in sinus-related complications, but the precise influence of anatomical variations in the posterior superior alveolar artery (PSAA) on mucosal thickening remains an uncharted aspect. The new AI tool employed in this research utilizes advanced image processing algorithms to enhance image visualization. Background and Objectives: This study examines the accuracy of a new cone beam computed tomography (CBCT) software (eVol DXS, version 1.0.1.0) employing AI to detect the PSAA's location and the effect of that on maxillary sinus thickening in the presence of periapical lesions. Materials and Methods: This retrospective study included 120 CBCT cases with posterior maxillary periapical lesions and 120 without odontogenic infections. Teeth with proximity (<2 mm) to the sinus were excluded in both groups to eliminate the sinus floor's perforation effect. Both the PSAA locations and maxillary sinus thickening were classified and compared. Results: The mucosal thickening differs significantly (p < 0.001) between the study group and the control group. The study showed that an increased sinus thickness occurred when the PSAA was beneath the sinus membrane in the study group (62.5% compared to 8.6%; p < 0.001 *). The AI tool helped to achieve a 100% identification rate in determining the PSAA locations. Conclusions: AI algorithms for PSAA localization, which affects mucosal thickness in response to periapical lesions, yield excellent results.