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Al-Worafi NA, Al-Aroomi MA, Al-Nasri A, Al-Balaa M, Al-Warafi LA, Al-Rokhami RK, Liu Y. Evaluation of maxillary sinus changes following molar distalization using clear aligners: A three-dimensional study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101815. [PMID: 38458547 DOI: 10.1016/j.jormas.2024.101815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To evaluate the impact of molar distalization with clear aligners (CAs) on maxillary sinus parameters and its proximity to the root apices of maxillary molars using Cone Beam Computed Tomography (CBCT). METHODS The study involved pre- and post-treatment CBCT images of 27 adult patients. MIMICS 21.0 software was used to measure maxillary sinus volume and surface area, while Invivo Dental 6.0 program was used to measure the sinus diameters and proximity of the maxillary molar root apices to the sinus floor. RESULTS Post-treatment, there was a marked increase in the average volume and surface area of the maxillary sinus on both sides; however, changes in dimensions were not statistically significant. Sinus proximity to the root apices of the maxillary molars showed statistically significant differences, particularly on the left side for all roots. Gender and age impacted the outcomes, with males and younger individuals showing more pronounced changes. No significant differences were observed between the left and right sinuses in all parameters. CONCLUSION Molar distalization with CAs increases maxillary sinus parameters, more notably in younger and male patients. All molar teeth roots moved toward the sinus, particularly the mesiobuccal root of the maxillary second molar protruded to the sinus.
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Affiliation(s)
- Naseem Ali Al-Worafi
- Department of Orthodontics, School and Hospital of Stomatology, China Medical University, Shenyang Clinical Medical Research Center of Orthodontic Disease, Shenyang 110002, PR China
| | - Maged Ali Al-Aroomi
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | | | - Maher Al-Balaa
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Leena Ali Al-Warafi
- Department of Orthodontics, Faculty of Dentistry, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Remsh Khaled Al-Rokhami
- Department of Orthodontics, Affiliated Stomatological Hospital of Nanchang University, Nanchang, China
| | - Yi Liu
- Department of Orthodontics, School and Hospital of Stomatology, China Medical University, Shenyang Clinical Medical Research Center of Orthodontic Disease, Shenyang 110002, PR China.
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Ding W, Jiang Y, Pang G, Liu Z, Wu Y, Li J, Wu F. AI model to detect contact relationship between maxillary sinus and posterior teeth. Heliyon 2024; 10:e31052. [PMID: 38799758 PMCID: PMC11126831 DOI: 10.1016/j.heliyon.2024.e31052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 04/10/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024] Open
Abstract
Objectives To establish a novel deep learning networks (MSF-MPTnet) based on panoramic radiographs (PRs) for automatic assessment of relationship between maxillary sinus floor (MSF) and maxillary posterior teeth (MPT), and to compare accuracy of MSF-MPTnet, dentists and radiologists identifying contact relationship. Study design A total of 1035 PRs and 1035 Cone-beam computed tomographys (CBCT)images were collected from January 2018 to April 2022. The relationships were classified into class I and II by CBCT. Class I represents non-contact group, and class II represents contact group. 350 PRs were randomly selected as test dataset and accuracy of MSF-MPTnet, dentists, and radiologists was compared. Results The intraclass correlation coefficient of dentists was 0.460-0.690 and it was 0.453-0.664 for radiologists. Sensitivity and accuracy of MSF-MPTnet were 0.682-0.852and 0.890-0.951, indicating that the output performance of MSF-MPTnet was reliable. Accuracy of maxillary premolars and molars were 79.7%-90.3 %, 76.2%-89.2 % and 72.9%-88.3 % in MSF-MPTnet model, dentists and radiologists. Accuracy of class I relationship in the MSF-MPTnet model (67.7%-94.6 %) was higher than that of dentists (56.5%-84.6 %) in maxillary first premolars and right second premolar, and accuracy of class I relationship in the MSF-MPTnet model is also higher than radiologists (40.0%-78.1 %) in all teeth positions (p < 0.05). Conclusions MSF-MPTnet model could increase detecting accuracy of the relationship between MSF and MPT, minimize pseudo contact relationship and reduce frequency of CBCT use.
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Affiliation(s)
- Wanghui Ding
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Yindi Jiang
- Hangzhou Linping Traditional Chinese Medicine Hospital, China
| | - Gaozhi Pang
- College of Computer Science and Technology, Zhejiang University of Technology, China
| | - Ziang Liu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Yuefan Wu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | | | - Fuli Wu
- College of Computer Science and Technology, Zhejiang University of Technology, China
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Yanık D, Nalbantoğlu AM. Anatomic relationship between the root apex of maxillary molars and maxillary sinus in the presence of antagonist teeth: A Kwak's method with divisions. Arch Oral Biol 2024; 165:105998. [PMID: 38805866 DOI: 10.1016/j.archoralbio.2024.105998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/21/2024] [Accepted: 05/07/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE The purpose of the study was to evaluate the proximity between the root apices of maxillary molars and maxillary sinus floor using cone-beam computed tomography (CBCT) in the southern Turkish subpopulation. DESIGN For the study, 246 CBCT images were analyzed. The absence of antagonist teeth was excluded. Kwak's types III and V were detailed with three divisions. Division M; the penetration of the mesial root only, Division D; the penetration of the distal root only, and Division MD; the penetration of both buccal roots. The distance between the maxillary sinus and the root apices was measured. Student's t-test, one-way ANOVA, and chi-square were used for statistical analysis. RESULTS The penetration of maxillary molars was 24.40%. The highest prevalence belonging to Type I. Division MD was 44.35% for Type III and 40.42% for Type V. Division M was higher than Division D. The distances between the sinus and root apices were 1.35-2.41 mm in Type I. The distance decreased with age (p < 0.05). CONCLUSION Both buccal root penetration into the sinus was higher than the single root penetration. The distance of the second molar root apices to the sinus was closer than the first molar. One-quarter of the first and second molars were inside the sinus. A greater likelihood of penetration of the root apices into the sinus with increased age.
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Affiliation(s)
- Deniz Yanık
- Süleyman Demirel University, Faculty of Dentistry, Department of Endodontics, Isparta, Turkiye.
| | - Ahmet Mert Nalbantoğlu
- Süleyman Demirel University, Faculty of Dentistry, Department of Periodontology, Isparta, Turkiye
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Mureşan AN, Dandoczi CA, Tudose RC, Hostiuc S, Rusu MC. Anatomical Possibilities of the Alveolar Bone at the Upper Second Premolar Level. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:726. [PMID: 38792909 PMCID: PMC11123058 DOI: 10.3390/medicina60050726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: The upper posterior teeth are typically regarded as being exclusively inferior to the maxillary sinus (MS). The expansion of the nasal fossa above the maxillary alveolar base (MAB) needs better investigation. The hypothesis was raised that the MAB in the upper premolar region, which is usually addressed by surgeons for the elevation of the antral floor, is not exclusively beneath the MS. Therefore, we aimed to document the possible upper relations of the MAB as antral, nasal, or both. Materials and Methods: A total of 145 CBCT scans were used to study four types of MAB: type 1-antral; type 2-antral with a palatal recess; type 3-antral and nasal; type 4-nasal. In type 2, the orthoradial width of the alveolar bone, the rectilinear width of the antral floor, and the maximum depth of the palatal recess were measured. For type 3, the MAB width and the straight widths of the antral and nasal segments of the MAB were measured. Results: Type 1 was found in 67.24%, type 2 in 13.45%, type 3 in 16.21%, and type 4 in 3.1% of the 290 MSs investigated. Palatal recesses were found in 11.72% of the MSs on the right side and 15.17% of the MSs on the left side. Types 1 and 2 exhibited strongly statistically significant bilateral symmetry (Pearson's Chi2 = 86.42, p < 0.001). Type 3 correlated equally with contralateral types 1 and 3. The bilateral symmetry for types 1-3 was stronger in the males (Pearson's Chi2 = 47.83, p < 0.001) than in the females (Pearson's Chi2 = 56.96, p < 0.001). There were no statistically significant associations between sex and the unilateral anatomical type. Conclusions: The MAB in the upper second premolar area should not be considered to be exclusively antral during surgeries or in anatomical teaching.
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Affiliation(s)
- Alexandru Nicolae Mureşan
- Division of Anatomy, Department 1, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, RO-020021 Bucharest, Romania (R.C.T.)
- Research Department, “Dr. Carol Davila” Central Military Emergency Hospital, RO-010825 Bucharest, Romania
| | - Carol Antonio Dandoczi
- Division of Anatomy, Department 1, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, RO-020021 Bucharest, Romania (R.C.T.)
| | - Răzvan Costin Tudose
- Division of Anatomy, Department 1, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, RO-020021 Bucharest, Romania (R.C.T.)
| | - Sorin Hostiuc
- Division of Legal Medicine and Bioethics, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, RO-020021 Bucharest, Romania
| | - Mugurel Constantin Rusu
- Division of Anatomy, Department 1, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, RO-020021 Bucharest, Romania (R.C.T.)
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Charoenwathana S, Vorakulpipat C, Kaewpradub P, Waikakul A, Kitisubkanchana J. Characteristics of CBCT versus panoramic signs of the surrounding bone of molar root protrusions into the maxillary sinus. Odontology 2024; 112:287-298. [PMID: 37405628 DOI: 10.1007/s10266-023-00833-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/25/2023] [Indexed: 07/06/2023]
Abstract
The study aimed to (a) investigate the amount and characteristics of the surrounding bone of protruded molar roots into the maxillary sinus using cone-beam computed tomography (CBCT) and (b) assess the correlation between the amount of bone with panoramic high-risk signs. Radiographs of 408 roots protruding beyond the sinus floor were evaluated. Axial CBCT images were used to investigate then classify eight characteristics of surrounding bone: no bone; bone < half the root girth in the proximal or buccal-palatal aspect; bone covering half the root girth in the proximal or buccal-palatal aspect; bone > half the root girth in the proximal or buccal-palatal aspect; and, complete bone. These were then grouped into four degrees of bone support: no bone; bone ≤ half the root girth; bone > half the root girth; and, complete bone. Panoramic signs were subclassified as: projection of root; interruption of the sinus floor; darkening of the root; upward curving of the sinus floor; absence of periodontal ligament space; and, absence of the lamina dura. Correlation between the degree of bone and the panoramic signs was evaluated using the Chi-square or Fisher's exact tests. Positive and negative predictive values, sensitivity, specificity, accuracy, and receiver operating characteristic analysis were calculated. Complete bone support was the most common. 'Projection of root' had a high negative predictive value and sensitivity. 'Absence of the periodontal ligament space and lamina dura' had a high positive predictive value, specificity, accuracy, and area under the curve. These two signs were significantly correlated with the degree of bone support.
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Affiliation(s)
- Sukanya Charoenwathana
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Ratchathewi District, 6, Yothi Road, Bangkok, Thailand
| | - Chakorn Vorakulpipat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Ratchathewi District, 6, Yothi Road, Bangkok, Thailand
| | - Pariya Kaewpradub
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Ratchathewi District, 6, Yothi Road, Bangkok, Thailand
| | - Aurasa Waikakul
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Ratchathewi District, 6, Yothi Road, Bangkok, Thailand
| | - Jira Kitisubkanchana
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Mahidol University, Ratchathewi District, No. 6, Yothi Road, Bangkok, 10400, Thailand.
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Zhang J, Liu L, Yang L, Wang J, Tan X, Huang D. Diagnosis of Odontogenic Maxillary Sinusitis by Cone-beam Computed Tomography: A Critical Review. J Endod 2023; 49:1445-1456. [PMID: 37659441 DOI: 10.1016/j.joen.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/04/2023]
Abstract
INTRODUCTION This review aims to provide an up-to-date overview of the current applications of cone-beam computed tomography (CBCT) and other imaging modalities in diagnosing odontogenic maxillary sinusitis (OMS). Furthermore, the clinical operation procedures of radiography modalities in OMS diagnosis were summarized, with the goal of assisting clinicians in improving OMS diagnostic accuracy in clinical practice. METHOD A comprehensive review of researches that discussed the applications of radiography modalities in the diagnosis of OMS was conducted. Pertinent information was evaluated and organized for this review. RESULTS Cone-beam computed tomography (CBCT) offers a superior, high-resolution, and three-dimensional view of the maxillary tooth-bone-sinus complex compared to conventional radiography modalities. It enables a better understanding and classification of the spatial relationships between root apices/periapical lesions and maxillary sinus. The use of CBCT, combined with the advantages of other radiography modalities and proper image interpretation, is indispensable to enhance OMS diagnostic accuracy and mitigate the risk of missed or misdiagnosis. CONCLUSION The significance of CBCT in the diagnosis of oral and maxillofacial conditions has garnered widespread recognition. It provides highly precise diagnostic information and classification basis for OMS. The clinical operation procedures for imaging examination are essential in ensuring the consistency and reliability of the diagnosis.
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Affiliation(s)
- Jinglan Zhang
- State Key Laboratory of Oral Diseases & National Center of Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Liu Liu
- State Key Laboratory of Oral Diseases & National Center of Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lei Yang
- State Key Laboratory of Oral Diseases & National Center of Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jing Wang
- State Key Laboratory of Oral Diseases & National Center of Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xuelian Tan
- State Key Laboratory of Oral Diseases & National Center of Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Dingming Huang
- State Key Laboratory of Oral Diseases & National Center of Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Sun R, Zheng LW, Sun YQ, Li TT, Ren JG, Zhao JH. Is it safe and effective to extract impacted maxillary tooth adjacent to maxillary sinus via submaxillary sinus membrane space approach?-a randomized controlled trial. Clin Oral Investig 2023; 27:6081-6087. [PMID: 37624523 DOI: 10.1007/s00784-023-05223-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To evaluate the clinical outcomes following extraction of impacted maxillary tooth adjacent to maxillary via submaxillary sinus membrane space approach. MATERIALS AND METHODS Seventy-two patients were enrolled in our study. The positions of the maxillary impacted tooth were confirmed by cone-beam computed tomography (CBCT). Cases were randomly divided into two groups: the "submaxillary sinus membrane space approach" was applied in the new method (NM) group, and the conventional "avoid maxillary sinus membrane exposure" strategy was executed in the traditional method (TM) group. The clinical and follow-up data were recorded. RESULTS The duration of the procedure in the TM group was significantly longer than those in the NM group (P < 0.05). Four teeth were accidentally displaced into the maxillary sinus with MSM perforation. The MSM perforation rate was slightly higher in the TM group than in the NM group, however, without significant difference between the two groups (8/36 vs. 3/36, P = 0.19). The maxillary sinus membrane perforation was associated with the displacement of tooth into the maxillary sinus (OR = 16.2, P = 0.026). The root tip exposure of the adjacent tooth was significantly higher in the TM group than in the NM group (10/36 vs. 1/36, P = 0.006). The incidence of reduced pulp vitality of the adjacent tooth was significantly higher in the TM group (10/36 vs. 1/36, P = 0.006), and it was associated with the exposure of the root tip intraoperatively (OR = 456.5, P < 0.001). The incidence of external root resorption was significantly lower in the NM group, and there was no significant association with the root exposure intraoperatively (OR = 3.7, P = 0.47). CONCLUSIONS Submaxillary sinus membrane space approach is a safe and efficient approach in extraction of impacted maxillary tooth. It is an alternative way for cases which are in close proximity to the maxillary sinus. CLINICAL RELEVANCE A novel method to extract impacted maxillary tooth adjacent to maxillary sinus.
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Affiliation(s)
- Rui Sun
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, No. 237 Luoyu Road, Wuhan, 430079, China
- Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, No. 237 Luoyu Road, Wuhan, 430079, China
| | - Lin-Wei Zheng
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, No. 237 Luoyu Road, Wuhan, 430079, China
| | - Yu-Qi Sun
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, No. 237 Luoyu Road, Wuhan, 430079, China
| | - Ting-Ting Li
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, No. 237 Luoyu Road, Wuhan, 430079, China
| | - Jian-Gang Ren
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, No. 237 Luoyu Road, Wuhan, 430079, China.
- Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, No. 237 Luoyu Road, Wuhan, 430079, China.
| | - Ji-Hong Zhao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, No. 237 Luoyu Road, Wuhan, 430079, China.
- Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, No. 237 Luoyu Road, Wuhan, 430079, China.
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Atallah HN, Ali MS, Abd Noor HJ, Sami SM, Haider J. Evaluation of the relation between the maxillary sinus and the posterior teeth using digital panoramic radiography. J Med Life 2023; 16:1240-1244. [PMID: 38024831 PMCID: PMC10652689 DOI: 10.25122/jml-2023-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/17/2023] [Indexed: 12/01/2023] Open
Abstract
This research aimed to determine the relationship between the maxillary posterior teeth and maxillary sinus floor (MSF), as well as the impact of nearby tooth loss on the space between MSF and posterior maxillary roots. A number of 120 digital panoramic radiographs were obtained from the archives of several clinics in Al-Najaf, Iraq, with the overall teeth examined in these radiographs including 236 of the 1st premolars, 227 of the 2nd premolars, 227 of the 1st molars, and 231 of the 2nd molars, from the right and left sides. The distances between the apices of the teeth and the maxillary sinus were determined. There are three categories of relationships between upper posterior teeth roots and MSF. These include type Os (root apex exists below or outside MSF), Type Co (root apex in contact with the MSF), and Type Is (root apex above or inside MSF). Type Os is the most encountered among premolars, Type Co is mostly encountered among the 2nd molars, and Type Is, in the 1st and 2nd molars. The study finds no correlation between age, gender, and the distribution of maxillary posterior tooth roots attached to the MSF. The first premolars were the furthest from MS, while the first molars were the closest. The most frequent link between maxillary molar roots and the MS was the Co-relation for the 2nd maxillary molar and the Is relation for the 1st maxillary molar. There is a non-significant decrease in the distance between the apices of the 1st maxillary premolar, 2nd maxillary premolar, and 1st maxillary molar and the MS before and after extraction.
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Affiliation(s)
| | - Marwah Safaa Ali
- Department of Oral and Maxillofacial Surgery, University of Kufa, Najaf, Iraq
| | | | - Suha Mohammad Sami
- Department of Oral and Maxillofacial Surgery, University of Kufa, Najaf, Iraq
| | - Julfikar Haider
- Department of Engineering, Manchester Metropolitan University, Manchester, United Kingdom
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Mekhtiev RS, Melnichenko YM, Kabak SL, Savrasova NA, Zatochnaya VV. [Relationships between the inferior wall of maxillary sinus and the roots of the maxillary molars]. STOMATOLOGIIA 2023; 102:52-59. [PMID: 36800786 DOI: 10.17116/stomat202310201152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate the position of the roots of the first and second upper molars relative to the bottom of the maxillary sinus (maxillary sinus) according to cone-beam computed tomography (CBCT). MATERIAL AND METODS The CBCT scans of 150 patients (69 men and 81 women) from the database of the X-ray department of the 11th City Clinical Hospital of Minsk who applied for dental care were studied. There are 4 variants of vertical relationships between the roots of the teeth and the lower wall of the maxillary sinus. At the contact of the molar roots and the bottom of the HPV, 3 variants of the horizontal relationship between the roots of the teeth and the bottom of the maxillary sinus in the frontal plane were identified. RESULTS The root apices of the maxillary molars can be located below the level of the MSF (type 0; 16.69%), contact with MSF (types 1-2; 72%) or protrude into the sinus cavity (type 3; 11.31%) at a distance of up to 6.49 mm. The roots of the second maxillary molar showed greater proximity to the MSF than the first molar roots and more often protruded into the maxillary sinus. The most common type of horizontal relationship between the molar roots and the MSF, in which the lowest point of the MSF was located centrally between buccal and palatal roots. It was found that the proximity between the roots and the MSF correlates with maxillary sinus vertical dimension. This parameter was significantly greater in type 3 when the roots protruded into the maxillary sinus than in type 0, when there was no contact between the MSF and the root apices of the molar teeth. CONCLUSION Significant individual variability in the anatomical relationships between the roots of the maxillary molars and the MSF indicates the need for the mandatory appointment of cone-beam computed tomography in preoperative planning for the extraction of these teeth and/or their endodontic treatment.
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Affiliation(s)
- R S Mekhtiev
- Educational Establishment ««Belarusian State Medical University», Minsk, Republic of Belarus
| | - Y M Melnichenko
- Educational Establishment ««Belarusian State Medical University», Minsk, Republic of Belarus
| | - S L Kabak
- Educational Establishment ««Belarusian State Medical University», Minsk, Republic of Belarus
| | | | - V V Zatochnaya
- Educational Establishment ««Belarusian State Medical University», Minsk, Republic of Belarus
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Anatomical Evaluation of Posterior Maxillary Roots in Relation to the Maxillary Sinus Floor in a Saudi Sub-Population: A Cross-Sectional Cone-Beam Computed Tomography Study. Healthcare (Basel) 2023; 11:healthcare11010150. [PMID: 36611610 PMCID: PMC9819467 DOI: 10.3390/healthcare11010150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023] Open
Abstract
To evaluate the mean distance and differences between posterior maxillary teeth and maxillary sinus floor (MSF) concerning the age and gender of the patients, a total of 124 maxillary sinuses and 496 posterior maxillary teeth were randomly selected in 62 cone-beam computed tomography (CBCT) images. Mean distances between posterior maxillary roots (PMRs) from different teeth and the MSF were measured using a calibrated tool in the software. Other relations regarding the gender and age of the patients were determined. The mean root-MSF distances in the right and left first premolars were more significant compared to the second premolars. No significant relation was found between the apices of the right and left first and second molar roots and the floor of the maxillary sinus concerning gender. A statistically significant relation was found between the apices of the buccal root of the right first premolar, right and left first and second molars and floor of the maxillary sinus concerning the age group 21-40 years (p-value = 0.009). This study showed that the second molar mesiobuccal root apex is frequently related to the sinus floor. Differences were reported concerning age, concerning the distance between posterior maxillary teeth and the maxillary sinus floor. CBCT technology helped provide the clinical proximity between the MSF and the posterior teeth root apices during the treatment planning.
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Talib Jiboon A, Alhamdani FY, Hussein Ali N. Radiographic Examination before Dental Extraction from Dentists' Perspective. Int J Dent 2023; 2023:4970981. [PMID: 37006963 PMCID: PMC10060071 DOI: 10.1155/2023/4970981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/03/2022] [Accepted: 01/23/2023] [Indexed: 04/04/2023] Open
Abstract
Background It is generally agreed that radiographic examination is important before dental extraction. It provides information about the roots and the surrounding tissues. In terms of practice, it does not seem to be a universally implemented protocol regarding the use of dental radiology before dental extraction. Besides, the type of radiographic technique is not specified. Some references prefer periapical dental radiographs. Others prefer orthopantomography), or even cone beam computed tomography Delpachitra et al. (2021) [1]. In terms of the dental practice, it is not clear whether there is a universally adopted protocol regarding the use of dental radiographs before dental extraction. Aim of the study. To assess dental professionals' perspective toward radiographic examination before conventional dental extraction. Materials and Methods A Google form questionnaire was circulated to different dental professionals using mainly ResearchGate, in addition to different social media platforms. Results One hundred and forty-five dentists participated in the questionnaire. The respondents were divided according to the country of current practice: national (Iraqi), regional (Middle Eastern), and international participants. Out of 144 respondents, 51.4% percent of the participants were international, while 40.3% were Iraqis, and 8.3% were from the Middle East. The need for dental radiography in all dental extraction procedures was reported in the majority of responses (n = 86). Only 11 dentists think there is no necessity for radiographic examination before conventional extraction. The chi-square test showed a highly significant relationship between the country of current practice and the need for X-ray examination for conventional dental extraction (P < 0.01). Seventy-six dentists prefer periapical radiographs. Thirty-five preferred orthopantomography. A highly significant relationship was found between the country of practice and the X-ray technique (P < 0.01). Conclusion The study showed that there is no universally adopted protocol regarding the use of dental radiography before dental extraction. The country of practice appears to govern the dentists' decisions regarding the need for an X-ray and the type of radiography prior to dental extraction. Periapical radiographs for posterior teeth seem to be the preferable choice before dental extraction.
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Affiliation(s)
- Atheer Talib Jiboon
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Mustansiriyah University, Baghdad, Iraq
| | - Faaiz Y. Alhamdani
- Clinical Sciences Department, College of Dentistry, Ibn Sina University of Medical and Pharmaceutical Sciences, Baghdad, Iraq
| | - Nagham Hussein Ali
- Clinical Sciences Department, College of Dentistry, Ibn Sina University of Medical and Pharmaceutical Sciences, Baghdad, Iraq
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Jung YH, Cho BH, Hwang JJ. Analysis of the root position and angulation of maxillary premolars in alveolar bone using cone-beam computed tomography. Imaging Sci Dent 2022; 52:365-373. [PMID: 36605857 PMCID: PMC9807791 DOI: 10.5624/isd.20220710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose This study investigated whether the relationship between the maxillary sinus and the root of the maxillary premolar is correlated with the root position and whether there is a difference in the long axis angle of premolars and the buccal bone thickness according to the sinus-root relationship and root position. Materials and Methods Cone-beam computed tomographic images of 587 maxillary first premolars and 580 second premolars from 303 patients were retrospectively reviewed. The maxillary sinus floor-root relationship was classified into 4 types, and the root position in the alveolar bone was evaluated as buccal, middle, or palatal. The long axis angle of the maxillary premolars in the alveolar bone and the buccal bone thickness were measured. The correlation between these parameters was analyzed. Results The maxillary sinus floor-root relationship showed a statistically significant correlation with the root position in the alveolar bone. Most maxillary first premolars were buccally located, and more than half of the second premolars had their roots in the middle. The long axis angle of the premolars was significantly larger in buccal-positioned teeth than in middle-positioned teeth, and the buccal bone was thinner. Conclusion When the root of the maxillary premolar was separated from the sinus floor, the premolar was often located on the buccal side. Most of the maxillary first premolars had a thinner buccal bone and larger inclination than the second premolars. It is recommended to evaluate the root position, sagittal angle and buccal bone thickness using CBCT for implant treatment planning.
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Affiliation(s)
- Yun-Hoa Jung
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Bong-Hae Cho
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Jae-Joon Hwang
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University, Yangsan, Korea
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Djorić I, Trivić A, Barna M, Milić I, Marković B, Valjarević S, Marinković S. Multidetector CT of the Nasal Cavity and Paranasal Sinuses Variations in 73 Patients. Indian J Otolaryngol Head Neck Surg 2022; 74:4653-4665. [PMID: 36742686 PMCID: PMC9895468 DOI: 10.1007/s12070-021-02940-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
Detailed knowledge of the anatomy of the nasal cavity and paranasal sinuses is very important in the diagnosis of pathological processes, planning of endoscopic surgery, and radiologic guiding techniques during certain operations. Observational study. Clinic of Neurosurgery, Institute and Department of Anatomy and Pathology, Clinic and Department for Otorhinolaryngology and Maxillofacial Surgery, Faculty of Medicine. Two heads with brains were serially cut in the axial and coronal planes. 73 individuals, who were enrolled among 1848 patients, underwent examination by multidetector computerized tomography. A nasal septal deviation was seen in 65.8%, and septal pneumatization in 11%. Superior concha pneumatization was observed in 1.4% of patients, middle concha bullosa in 30.2%, and its hypoplasia in 1.4%. The lamina papyracea dehiscence was also present in 1.4%. The uncinate process was absent in 1.4%, and it was pneumatized in 4.2%. Agger nasi cells were noticed in 34.3%, and Haller and Onodi cells in 20.7% each. The olfactory fossa was shallow in 9.7%, deep in 31.6%, and very deep in 58.9%. Absence of the frontal sinus was seen in 9.7%. The presellar type of the sphenoidal sinus was present in 11%, the sellar in 35.7%, and the postsellar in 53.5%. Hypoplasia of the maxillary sinus was revealed in 1.4%, and hyperpneumatization in 4.2%. The sinus floor was usually below the level (60.3%), at the same level (20.7%), or above the level of the nasal floor (19.2%). The bony septum within the sinus was seen in 52.1%. The presented data are of a great significance in order to avoid a misdiagnosis of the anatomic variations, to make a proper diagnosis of certain diseases, and for safe endonasal operations.
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Affiliation(s)
- Igor Djorić
- Faculty of Medicine, Clinic of Neurosurgery, Clinical Center of Serbia, Institute of Radiology, University of Belgrade, Dr. Kosta Todorović 4, 11000 Belgrade, Serbia
| | - Aleksandar Trivić
- Faculty of Medicine, Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, University of Belgrade, Pasterova 2, 11000 Belgrade, Serbia
| | - Mina Barna
- Faculty of Medicine, Institute of Pathology, University of Belgrade, Dr. Subotić 1, 11000 Belgrade, Serbia
| | - Ivan Milić
- Faculty of Medicine, Clinic of Neurosurgery, Clinical Center of Serbia, University of Belgrade, Dr. Kosta Todorović 4, 11000 Belgrade, Serbia
| | - Branka Marković
- Department of Anatomy, Faculty of Sports and Physical Education, University of Belgrade, Blagoja Parovica 156, 11000 Belgrade, Serbia
| | - Svetlana Valjarević
- Department of Otorhinolaryngology With Maxillofacial Pathology, Faculty of Medicine, Clinical Hospital Center Zemun, University of Belgrade, Vukova 9, 200140 Zemun, Serbia
| | - Slobodan Marinković
- Faculty of Medicine, Institute of Anatomy, University of Belgrade, Dr. Subotić 4/2, 11000 Belgrade, Serbia
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Treatment effects after maxillary total arch distalization using a modified C-palatal plate in patients with Class II malocclusion with sinus pneumatization. Am J Orthod Dentofacial Orthop 2022; 162:469-476. [PMID: 35773112 DOI: 10.1016/j.ajodo.2021.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the treatment effects after molar distalization using modified C-palatal plates in patients with Class II malocclusion with maxillary sinus pneumatization. METHODS This study consisted of 70 lateral cephalograms derived from cone-beam computerized tomography images of 35 patients with Class II malocclusion (mean age 22.3 ± 7.4 years) who had undergone bilateral total arch distalization of the maxillary dentition using modified C-palatal plates. The samples were divided into 2 groups according to sinus pneumatization; group 1 (n = 40), cephalograms with sinus pneumatization and group 2 (n = 30) cephalograms without sinus pneumatization. Paired t tests and independent-sample t tests were used to compare the changes in each group and between groups. RESULTS The distal movement of the maxillary first molars was 4.3 mm for group 1 and 3.5 mm for group 2, with the intrusion of 1.4 mm and 2.5 mm, respectively. There was no statistically significant difference between the 2 groups. Group 1 showed 3.5° of distal tipping of the maxillary second molars, which was significantly greater than the 0.2° in group 2 (P <0.05). The total treatment period, including distalization, was 2.2 years for group 1 and 1.9 years for group 2, but the difference was not significant. CONCLUSIONS There was no significant difference in the amount of distal movement and intrusion of the maxillary first molars between groups 1 and 2. Therefore, these results suggest that regardless of sinus pneumatization, molar distalization using temporary skeletal anchorage devices in Class II patients can be performed as a nonextraction treatment.
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KV S, G. Maragathavalli. Assessment of the vertical relationship between the maxillary posterior teeth and the maxillary antral floor in a South Indian population using Cone Beam Computed Tomography- A radiographic observational study. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i3.1411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction and Aim: Maxillary sinus, also known as the Antrum of Highmore, is said to be one of the largest pyramidal shaped paranasal sinuses that begins at the 10th week of intrauterine development and undergoes pneumatisation. The root apices of the maxillary posterior teeth have a proximity to the antral floor, so a thorough understanding of this anatomical relationship is very essential as it can have an important influence during dental procedures such as implant planning, extractions, and certain other oral and maxillofacial surgeries. The aim of this study was to assess the vertical relationship between the posterior teeth in the maxillary arch with the floor of the maxillary antrum, using Cone Beam Computed Tomography (CBCT) in a South Indian population.
Materials and Methods: This was a retrospective analysis of 50 right or left maxillary sinuses in panorama and tangential sections by tracing the outline forms of the maxillary antral floor and also measuring its vertical distance from maxillary posterior root apices.
Results: Four types of relationship patterns were observed between the maxillary antral floor and root apices of the maxillary posteriors. The root apices of the maxillary second molar were found to be in close proximity with the maxillary sinus (2.27mm) and similar observation was found in the left side with the left second molar to be in close proximity to the sinus (2.04 mm).
Conclusion: The assessment of this vertical relationship is very important during extractions, implant planning or during any other surgeries in the maxillofacial region.
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Effect of the Maxillary Sinus on Tooth Movement during Orthodontics Based on Biomechanical Responses of Periodontal Ligaments. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12104990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The maxillary sinus is a common anatomic limitation for orthodontic tooth movement. The effect of orthodontic forces on a particular anatomy can be studied using finite element analysis (FEA). Our study aimed to determine the effect of different tooth penetration depths into the maxillary sinus floor (MSF) on the orthodontic force system for bodily tooth movement. Using the cone-beam computed tomography of a patient with low MSF, we modeled the geometry of canine, premolar, and molar teeth with their periodontal ligaments and the alveolar bone surrounding them. The models were manually modified to simulate different root penetration depths. Thereafter, the center of resistance and stress distributions for teeth penetrating into the MS were determined using FEA. Moreover, the force systems for teeth with a low MSF to varying degree were evaluated based on the FEA results. During orthodontic tooth movement, the individual differences in the periodontal anatomy should be considered. The CR position decreases with the penetration depth, while the average hydrostatic stress in the PDL increases rapidly. In this paper, we present the correction coefficients of the orthodontic force and moment for a tooth penetrating into the MSF, which is necessary for personalized treatment planning.
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17
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Abdulghani EA, Al-Sosowa AA, Alhammadi MS, Al-Fakeh H, Al-Gumaei WS, Almashraqi AA, Sharhan HM, Cao B. Three-dimensional assessment of the favorability of maxillary posterior teeth intrusion in different skeletal classes limited by the vertical relationship with the maxillary sinus floor. Head Face Med 2022; 18:13. [PMID: 35413855 PMCID: PMC9003971 DOI: 10.1186/s13005-022-00316-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/02/2022] [Indexed: 12/25/2022] Open
Abstract
Background Understanding the anatomical relationship between the maxillary sinus floor (MSF) and the posterior maxillary teeth (PMT) is important when planning the orthodontic intrusion of the posterior teeth. This study aimed to determine the vertical relationship between posterior maxillary teeth and maxillary sinus floor in different skeletal classes in the Chinese adult population. Methods This is a retrospective cross-sectional study involved cone beam computed tomography images of 298 adult patients (145 males and 153 females) between 20 and 45 years old. The sample was categorized according to A point, Nasion, B point (ANB) angle into 102 Class I, 102 Class II, and 94 Class III malocclusion. Non-parametric Wilcoxon Mann–Whitney U and Kruskal–Wallis tests were used to compare the studied groups. The Intra-class Correlation Coefficient (ICC) was used to assess the intra- and inter-observer reliability analysis. Results Overall, there was a statistically significant difference in the mean distance between both genders (P < 0.001). The measured distance increased with age in all posterior tooth roots (P < 0.001). The root apex in the sagittal view appeared to be closer to the maxillary sinus than in the coronal view; 2.2 ± 4.3 and 3.1 ± 5.5 mm, respectively. The most frequent root scores were Type 1 and Type 2P. In both sagittal and coronal views, Class I demonstrated a higher Type 2P prevalence, whereas Class III showed a lower prevalence. The second molars’ mesiobuccal root had the largest number of penetration in the three examined skeletal classes. Conclusions Maxillary molars of Class I malocclusion with the majority of Type 2P root-sinus relationship have the highest possible risk of root resorption during molar intrusion due to cortical bone encroachment, while Class III malocclusion showed the least possible risk. Supplementary information The online version contains supplementary material available at 10.1186/s13005-022-00316-3.
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Affiliation(s)
- Ehab A Abdulghani
- Department of Orthodontics and Dentofacial Orthopedics, College of Dentistry, Lanzhou University, Lanzhou, China
| | - Abeer A Al-Sosowa
- Department of Periodontics, Faculty of Dentistry, Thamar University, Dhamar, Republic of Yemen.,Department of Periodontics, College of Dentistry, Lanzhou University, Lanzhou, China
| | - Maged Sultan Alhammadi
- Division of Orthodontics and Dentofacial Orthopedics, Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia.,Postgraduate Orthodontic Program, Department of Orthodontics, Pedodontics and Preventive Dentistry, Faculty of Dentistry, Sana'a University, Sana'a, Republic of Yemen
| | - Hanan Al-Fakeh
- Department of Prosthodontics, School of Stomatology, Lanzhou University, Lanzhou, China
| | - Waseem Saleh Al-Gumaei
- Department of Orthodontics and Dentofacial Orthopedics, College of Dentistry, Lanzhou University, Lanzhou, China.,School of Dentistry, Faculty of Dentistry, Ibb University, Ibb, Republic of Yemen
| | - Abeer A Almashraqi
- Department of Pre-clinical Oral Health Sciences, College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| | - Hasan M Sharhan
- Department of Orthodontics and Dentofacial Orthopedics, College of Dentistry, Lanzhou University, Lanzhou, China
| | - BaoCheng Cao
- Department of Orthodontics and Dentofacial Orthopedics, College of Dentistry, Lanzhou University, Lanzhou, China.
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Eid EA, El-Badawy FM, Hamed WM. “Accuracy of Intraoral Digital Radiography in Assessing Maxillary Sinus-Root Relationship Compared to CBCT”. Saudi Dent J 2022; 34:397-403. [PMID: 35814843 PMCID: PMC9263749 DOI: 10.1016/j.sdentj.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Esraa Ahmed Eid
- Oral and Maxillofacial Radiology, Ain Shams University 2021, Cairo, Egypt
- Assistant Lecturer of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
- Corresponding author.
| | - Fatma Mostafa El-Badawy
- Lecturer of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Walaa Mohamed Hamed
- Professor of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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Three-dimensional assessment of the favorability of maxillary posterior teeth intrusion in different facial patterns limited by the vertical relationship with the maxillary sinus floor. Clin Oral Investig 2022; 26:4905-4915. [DOI: 10.1007/s00784-022-04458-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/14/2022] [Indexed: 12/15/2022]
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Morsy E, El Dessouky S, Abdel Ghafar E. Assessment of proximity of the maxillary premolars roots to the maxillary sinus floor in a sample of Egyptian population using CBCT: An observational cross-sectional study. J Int Oral Health 2022. [DOI: 10.4103/jioh.jioh_355_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Ragab MH, Abdalla AY, Sharaan MES. Location of the Maxillary Posterior Tooth Apices to the Sinus Floor in an Egyptian Subpopulation Using Cone-beam Computed Tomography. IRANIAN ENDODONTIC JOURNAL 2022; 17:7-12. [PMID: 36703873 PMCID: PMC9868983 DOI: 10.22037/iej.v17i1.34696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 11/24/2021] [Accepted: 12/10/2021] [Indexed: 01/28/2023]
Abstract
Introduction The aim of this study was to evaluate the location of the apices of the maxillary posterior teeth to the maxillary sinus floor (MSF), the symmetry between both sides and the possible variations between males and females using cone-beam computed tomography (CBCT) in an Egyptian subpopulation. Materials and Methods CBCT images were collected from 120 patients (240 second premolars, 480 1st and 2nd molars, 1680 roots). The proximity of roots of maxillary second premolar and 1st and 2nd molars to the floor of the sinus was categorized into three categories: inside the sinus floor (IS), touching the sinus floor (TS) or outside the sinus floor (OS). The correlation of the distance with gender was analyzed as well as for symmetry. Friedman's test was used to compare between different roots and the Dunn's test was used for pair-wise comparisons when Friedman's test was significant. The Mann-Whitney U test was used to compare males and females. The significance level was set at P≤0.05. Results The highest prevalence of roots outside the sinus was found with second premolar (right and left) followed by palatal roots of right and left second molar. In addition, the highest prevalence of roots inside the sinus was found with mesiobuccal roots of maxillary second molar followed by the palatal root of maxillary first molar. There was no statistically significant difference between males and females or between both sides. Conclusion Neither gender nor side variations regarding the proximity to the maxillary sinus floor were observed.
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Affiliation(s)
- Mai Hamdy Ragab
- Department of Endodontics, College of Dentistry, Suez Canal University, Ismailia, Egypt;
| | - Asmaa Yousry Abdalla
- Department of Oral Radiology, College of Dentistry, Suez Canal University, Ismailia, Egypt
| | - Marwa El-Sayed Sharaan
- Department of Endodontics, College of Dentistry, Suez Canal University, Ismailia, Egypt;
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22
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Wang S, Wang X, Jiang J, Tiwari SK, Xiao Y, Ye L, Peng L. Relationship between the surgical access line of maxillary posterior teeth and the maxillary sinus floor. J Endod 2022; 48:509-515. [DOI: 10.1016/j.joen.2022.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 12/27/2022]
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Riccomi G, Casaccia J, Minozzi S, Felici C, Campana S, Giuffra V. Maxillary sinusitis as a respiratory health indicator: a bioarchaeological investigation into medieval central Italy. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2021; 35:40-48. [PMID: 34555588 DOI: 10.1016/j.ijpp.2021.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/31/2021] [Accepted: 09/11/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study aims to assess chronic maxillary sinusitis in an osteoarchaeological sample from the medieval rural site of Pieve di Pava (central Italy), to investigate triggers responsible for sinus inflammation, and to compare prevalence rates with coeval European rural sites. MATERIALS The analysis focused on 145 10th-12th-century adults with at least one preserved maxillary sinus. METHODS Sinusitis-related lesions were observed macroscopically and microscopically. Alveolar pathologies of the maxillary posterior dentition were recorded to investigate the impact of odontogenic sinusitis. RESULTS Maxillary sinusitis was observed in 23.4% of the individuals (n = 34), with similar frequencies in both sexes and bilateral sinusitis appearing more frequently than unilateral sinusitis. An association of alveolar lesions with sinusitis was found in 38.2% of cases. CONCLUSIONS Compared to coeval rural sites in Northern Europe, Pieve di Pava shows the lowest prevalence of maxillary sinusitis, likely reflecting a greater amount of time spent outdoors. Despite the small size of the sample, odontogenic sinusitis cannot be ruled out. SIGNIFICANCE This is the first Italian study to investigate maxillary sinusitis and to focus on the Mediterranean area, contributing to the understanding of this condition as a health indicator in ancient populations. LIMITATIONS Research limitations include preservation issues affecting the number of observable sinuses, the non-homogenous age distribution of the sample, and the impact of inclusion and methodological criteria on the comparability of results. SUGGESTIONS FOR FURTHER RESEARCH Further investigations into odontogenic sinusitis and the microscopic examination of dental calculus may provide new data on the pathogenesis of sinusitis.
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Affiliation(s)
- Giulia Riccomi
- Division of Paleopathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 57, 56126, Pisa, Italy.
| | - Jessica Casaccia
- School of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128, Roma, Italy.
| | - Simona Minozzi
- Division of Paleopathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 57, 56126, Pisa, Italy.
| | - Cristina Felici
- Department of History and Cultural Heritage, Via Roma 56, 53100, Siena, Italy.
| | - Stefano Campana
- Department of History and Cultural Heritage, Via Roma 56, 53100, Siena, Italy.
| | - Valentina Giuffra
- Division of Paleopathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 57, 56126, Pisa, Italy.
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Clarot S, Christensen BJ, Chapple AG, Block MS. Prediction of Residual Alveolar Bone Height in the Posterior Maxilla After Dental Extractions. J Oral Maxillofac Surg 2021; 80:517-524. [PMID: 34871583 DOI: 10.1016/j.joms.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/16/2021] [Accepted: 11/04/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE After tooth extraction in the posterior maxilla, bone resorption often limits implant placement unless additional grafting procedures are performed. However, it is difficult to predict the amount of bone that will remain after extraction based on current evidence. The purpose of this study was to develop a method for predicting the postextraction alveolar bone height in the posterior maxilla. PATIENTS AND METHODS The authors conducted a retrospective cohort study that included all patients who were treated for the extraction and replacement of a maxillary first molar with a dental implant from 2008 to 2019. Potential predictor variables included thirteen pre-extraction radiographic measurements obtained via cone-beam computed tomography. The outcome variable was having more than 6 mm of bone height from the alveolar crest to the sinus floor after extraction. Decision tree analyses were used to search for the best predictors of this outcome using random forest analysis with a maximum of 3 randomly chosen covariates in each candidate tree. RESULTS A total of 63 patients were included in the study; 55.6% were women, and the mean age was 57.6 ± 14.5 years. In this study population, having a bone height from the furcation to the maxillary sinus floor of <6.7 mm had a 7.1% chance of having >6 mm of bone height postoperatively, whereas those patients with ≥6.7 mm at the same position preoperatively had a 61.9% chance of having >6 mm of bone height postoperatively (P < .001). CONCLUSIONS This study suggests that patients with <6.7 mm of bone from the furcation to the sinus are at increased risk of having insufficient bone to support a dental implant without additional grafting at the maxillary first molar position. When treating these patients, the surgeon should consider performing a procedure at the time of extraction to increase bone height or explain additional bone grafting is expected for ideal implant placement.
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Affiliation(s)
- Samuel Clarot
- Resident, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Sciences Center, Metairie, LA
| | - Brian J Christensen
- Assistant Professor, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Sciences Center, Metairie, LA.
| | - Andrew G Chapple
- Assistant Professor, Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center, Metairie, LA
| | - Michael S Block
- Clinical Professor, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Sciences Center; Private Practice, Metairie, LA
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Sanglard LF, Oliveira LB, Massignan C, Polmann H, De Luca Canto G. Evaluating pain, fear, anxiety or stress/distress using children's drawings in paediatric dentistry: a scoping review. Eur Arch Paediatr Dent 2021; 23:199-222. [PMID: 34699048 DOI: 10.1007/s40368-021-00674-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/08/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE The aim of this study was to systematically review the literature to answer the question: Can children's drawings represent a helping tool so the dentist can better understand the children's pain, fear, anxiety or stress/distress and their perception concerning the dentist and/or dental treatment? METHODS A scoping review was done. Cochrane Library, EMBASE, LILACS, LIVIVO, PsycINFO, PubMed, Scopus, Web of Science, and Grey literature was searched. Cross-sectional, quasi-experimental and qualitative studies in which patients were children and adolescents were included. Two authors independently selected studies to extract data and evaluate methodological quality by using Joanna Briggs Institute tools. Data collected included: characteristics of the studies, drawing evaluation/scales, main results and conclusion. RESULTS Out of 1037 papers were identified in search, 25 studies verified the emotional state and the children's perceptions regarding dental environment and the dentist and were included in the narrative synthesis. The spontaneous drawings were useful to identify the children's emotions. Drawings might be considered a helping tool to identify children and adolescents' perception in relation to dental treatment. Few studies used validated instruments. There were methodological disparities among studies. CONCLUSIONS The drawings can be considered a useful tool in identifying children's pain, fear, anxiety or stress/distress and perceptions about the dentist and/or dental treatment. Future studies with standardized analysis of the drawings are recommended. Code https://doi.org/10.17605/OSF.IO/U5BJH . "Retrospectively registered".
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Affiliation(s)
- L F Sanglard
- Department of Dentistry, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil.
| | - L B Oliveira
- Department of Dentistry, Faculdade São Leopoldo Mandic, Campinas, São Paulo, Brazil
| | - C Massignan
- Department of Pediatric Dentistry, University of Brasília, Brasília, Brazil
| | - H Polmann
- Department of Pediatric Dentistry, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - G De Luca Canto
- Department of Pediatric Dentistry, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Yan Y, Li J, Zhu H, Liu J, Ren J, Zou L. CBCT evaluation of root canal morphology and anatomical relationship of root of maxillary second premolar to maxillary sinus in a western Chinese population. BMC Oral Health 2021; 21:358. [PMID: 34284763 PMCID: PMC8290624 DOI: 10.1186/s12903-021-01714-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/07/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To evaluate the root anatomy, root canal morphology and the anatomical relationship between the roots and maxillary sinus of maxillary second premolars by CBCT in a western Chinese population. METHODS A total of 1118 CBCT scans of the maxillary second premolars were collected from West China Hospital of Stomatology, Sichuan University. Information below were measured on axial, coronal and sagittal sections, recorded and evaluated properly: the number of roots and canals, the morphology of canal system classified by Vertucci standard, the inter-orifice distance of canal orifices, the curvature of each canal and the distance from root tip to maxillary sinus floor. RESULTS Among the 1118 teeth, 94.2% (1053) are single-rooted and 55.1% (616) have one canal. Type I (55.1%) is the commonest root canal morphology followed by Type II (31.9%). The mean inter-orifice distance (IOD) for multi-canal teeth ranging from 2.72 ± 0.32 to 3.41 ± 0.11 mm. Of 1622 canals, 38.8% (630) curvature are mesiodistal and 30.9% (501) are straight canals. The distance from root tip to maxillary sinus floor increased with age and the mean distance of single-rooted ones is 2.47 ± 3.45 mm. CONCLUSIONS All kinds of canal morphology category can be detected in maxillary second premolars. The IOD might be a predictable factor for root canal morphology. Roots of maxillary second premolars are related to maxillary sinus which should be treated carefully.
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Affiliation(s)
- Yujia Yan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - JingLin Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Hualing Zhu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Jun Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041 , China
| | - Jiayin Ren
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Radiology, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.
| | - Ling Zou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.
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Shetty S, Al Bayatti SW, Al-Rawi NH, Samsudin R, Marei H, Shetty R, Abdelmagyd HA, Reddy S. A study on the association between accessory maxillary ostium and maxillary sinus mucosal thickening using cone beam computed tomography. Head Face Med 2021; 17:28. [PMID: 34261509 PMCID: PMC8278720 DOI: 10.1186/s13005-021-00284-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 07/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accessory maxillary ostium (AMO) has a major role to play in the aetiology of maxillary sinusitis. Mucosal thickening is one of the key radiographic features of chronic maxillary sinusitis. The aim of this study was to identify the location of the AMOs and investigate the association between Mucosal Thickening [MT] and AMO using Cone Beam Computed Tomography [CBCT]. METHODS CBCT scans of 400 maxillary sinuses from the records of 200 patients who seeked various dental treatments at the Thumbay Dental Hospital, Gulf Medical University, Ajman, United Arab Emirates were evaluated. The incidence, anatomical position and maximal length of accessory maxillary ostia (AMO) in the maxillary antrum were reviewed using CBCT by two examiners. The association between MTs and AMOs were also analysed. RESULTS Among the 200 CBCT scans, 131 belonged to male patients and 69 scans belonged to female subjects within the age group of 18-65 years (mean age 41.32 years). AMOs were found in 142 maxillary antra (35.5 %). The inter-observer reliability for using CBCT to detect AMO was (k = 0.83). There was no significant difference in the frequency of AMOs when the age (P = 0.19) and gender (P = 0.54) distribution were considered. Sinuses with AMOs, showed significantly greater frequency of MTs (p = 0.001). AMOs with maximal length of less than 1mm were most commonly observed (51.40 %). AMOs with larger greater maximal length were associated with higher degrees of MT. The location of the AMOs, were not affected by the degree of MT. CONCLUSIONS The study demonstrates a clear association between degree of MT and occurrence of AMO in the maxillary sinus. However, the location of the AMO is independent of the degree of the MT. There is a greater probability of finding an AMO in the maxillary sinus if the MT in the sinus is more than 3 mm.
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Affiliation(s)
- Shishir Shetty
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates.
| | - Saad Wahby Al Bayatti
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Natheer Hashim Al-Rawi
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Rani Samsudin
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Hesham Marei
- College of Dentistry, Gulf Medical University, Ajman, United Arab Emirates
| | | | | | - Sesha Reddy
- College of Dentistry, Gulf Medical University, Ajman, United Arab Emirates
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Khojastepour L, Movahhedian N, Zolghadrpour M, Mahjoori-Ghasrodashti M. Assessment of the relationship between the maxillary sinus and the canine root tip using cone beam computed tomography. BMC Oral Health 2021; 21:338. [PMID: 34246270 PMCID: PMC8272249 DOI: 10.1186/s12903-021-01700-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of the present study is to investigate the relationship between the maxillary sinus and the canine root apices in cone beam computed tomographic images (CBCT) and to assess the amount of extension of the maxillary sinus to the anterior region of the jaw in different sexes and age groups. METHODS CBCT of 300 individuals (154 males and 146 females) over 20 years (with a mean age of 35.12 ± 8.40 years) were evaluated. The subjects were categorized into three age groups (20-30, 30-40, and 40-50 years). When the maxillary sinus extended to the canine area, the vertical distance between them was measured, and their relationship was classified into three types: I (more than 2 mm distance), II (less than 2 mm distance or in-contact), and III (interlock). RESULTS 413 out of 600 maxillary sinuses (68.8%) were extended into the canine area or beyond. Among them, 15 maxillary sinuses pneumatized into the incisor area (2.5%). The prevalence of the maxillary sinuses extended to the anterior region of the jaw was not significantly different between genders. However, it was significantly less frequent in the older age group and more frequent on the left side. In addition, the mean amount of anterior extension of the maxillary sinus (mm) was significantly lower in the older age group. Type I was the most frequent vertical relationship between the maxillary sinuses and canine apices with no significant difference in gender, side, and age groups. CONCLUSIONS In most cases, the maxillary sinus extended to the canine area and sometimes reached the incisor region. This necessitates paying more attention to the maxillary anterior sextant during surgical procedures.
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Affiliation(s)
- Leila Khojastepour
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Sciences, Qom Abad, Ghasrodasht St., Shiraz, Iran
| | - Najmeh Movahhedian
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Sciences, Qom Abad, Ghasrodasht St., Shiraz, Iran.
| | - Mohadeseh Zolghadrpour
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Eid EA, El-Badawy FM, Hamed WM. Intrusion of maxillary molar roots into the maxillary sinus in a sample of the Egyptian population using cone beam computed tomography. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00540-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The proximity of the maxillary sinus floor to the maxillary molar roots increases the probability of oroantral communication on conducting any surgical or endodontic procedure in the involved area. The aim of this study is to evaluate the relationship between each maxillary molar root and maxillary sinus floor using cone beam computed tomography. Predicting the probability of protrusion of each root into the sinus will consequently predict the probability of occurrence of the oroantral fistula in a sample of the Egyptian population.
Results
The total number of roots located outside the sinus was 121 (35.3%), while those contacting the sinus floor were 80 (23.3%) and those intruded the sinus were 141 (41.2%). The percentage of root intrusion into the sinus in males (56.9%) was significantly (p = 0.01) higher than females (42.9%). The probability of root intrusion in the left molars (54.2%) was non-significantly (p = 0.067) higher than that of the right side (44.3%). As for the type of tooth, the second molar showed the highest probability of root intrusion into the sinus (55.3%) followed by the third molars (52.6%) then the first molars (40.9). According to the type of root, the mesiobuccal root showed the highest probability of intrusion into the sinus (50.9%) followed by the palatal root (49.1%) then the distobuccal root (47.4%). However, the difference in both type of tooth and type of root was statistically non-significant (p = 0.051 and 0.869 respectively). As for the individual root with the highest probability of intrusion, the mesio-buccal root of the right third molar is the most frequent root to intrude the sinus (71.4%) and the mesio-buccal root of the right first molar is the least frequent (22.7%).
Conclusions
In a sample of the Egyptian population, males exhibit higher probability of root protrusion into the sinus than females. The side and type of tooth are of higher impact on the probability of its intrusion into the sinus compared to the type of root. Left second molars are at a higher risk of oroantral communications on surgical or endodontic procedures compared to other molars due to its highest probability of intrusion into the sinus.
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Regnstrand T, Torres A, Petitjean E, Lambrechts P, Benchimol D, Jacobs R. CBCT-based assessment of the anatomic relationship between maxillary sinus and upper teeth. Clin Exp Dent Res 2021; 7:1197-1204. [PMID: 34021741 PMCID: PMC8638317 DOI: 10.1002/cre2.451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives To describe the relationship between maxillary sinus (MS) and upper teeth based on cone beam computed tomographic scans (CBCT). Materials and methods Based on CBCT maxillary imaging data of 147 patients, distance between MS and apices of canines and posterior maxillary teeth were assessed. Distances between tooth roots and sinus were classified into three groups: distant (>2 mm), close (<2 mm) or in contact with MS. Teeth with apical lesions and uncommon root configurations were excluded. Results In total, 1075 teeth of maxillary canines, upper premolars and upper molars were included in this study. Teeth most often in contact with MS were the second (89%) and first (81%) maxillary molar without any significant difference (p = 0.19). Roots most often in contact with MS were the mesiobuccal and distobuccal root of the second molar (85% and 76%; p = <0.01) followed by the palatal root of the first molar (73%). A fifth of the upper canines are situated less than 2 mm from MS. Conclusions More than four out of five upper molars (first and second) are in a close relationship to the MS. Knowledge of the anatomical relationship between posterior maxillary teeth and the MS is important for diagnosis and treatment in this area.
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Affiliation(s)
- Tobias Regnstrand
- Section of Oral Diagnostics and Surgery, Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Andres Torres
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - Eline Petitjean
- Department of Oral Health Sciences, Endodontology, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Paul Lambrechts
- Department of Oral Health Sciences, Endodontology, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Daniel Benchimol
- Section of Oral Diagnostics and Surgery, Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Reinhilde Jacobs
- Section of Oral Diagnostics and Surgery, Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
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Pei J, Liu J, Chen Y, Liu Y, Liao X, Pan J. Relationship between maxillary posterior molar roots and the maxillary sinus floor: Cone-beam computed tomography analysis of a western Chinese population. J Int Med Res 2021; 48:300060520926896. [PMID: 32489120 PMCID: PMC7278324 DOI: 10.1177/0300060520926896] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE This study aimed to assess the positional relationships between the maxillary sinus and the first and second molars in a western Chinese population by using cone-beam computed tomography. METHODS This study included 212 patients (652 maxillary molars and 1956 roots). Patient demographics (sex and age) and cone-beam computed tomography data regarding the relationship between molar roots and the maxillary sinus were obtained. This relationship was stratified into four types for statistical analysis. RESULTS Sex and side did not significantly influence the distance between maxillary molar roots and the maxillary sinus. However, the distance between maxillary molar roots and the maxillary sinus increased with age. The mesiobuccal root of the second molar was nearest to the maxillary sinus. The most common relationship type involved absence of root contact with the sinus border and presence of a maxillary sinus cross-section above the root apex. CONCLUSIONS Compared with other teeth, the maxillary posterior teeth have a complex anatomical structure and are closely related to the sinus. These findings may serve as reference information for root canal treatment, tooth extraction, dental implant, and other dental clinical procedures among patients in western China.
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Affiliation(s)
- Jun Pei
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Clinical Research, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jiyuan Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Clinical Research, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yafei Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Clinical Research, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yuanyuan Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Clinical Research, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xuejuan Liao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Clinical Research, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jian Pan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Clinical Research, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Munakata M, Yamaguchi K, Sato D, Yajima N, Tachikawa N. Factors influencing the sinus membrane thickness in edentulous regions: a cone-beam computed tomography study. Int J Implant Dent 2021; 7:16. [PMID: 33649993 PMCID: PMC7921232 DOI: 10.1186/s40729-021-00298-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 02/02/2021] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Motohiro Munakata
- Department of Implant Dentistry, Showa University School of Dentistry, 2-1-1, Kita-Senzoku, Ota-ku, 145-8515, Tokyo, Japan.
| | - Kikue Yamaguchi
- Department of Implant Dentistry, Showa University School of Dentistry, 2-1-1, Kita-Senzoku, Ota-ku, 145-8515, Tokyo, Japan
| | - Daisuke Sato
- Department of Implant Dentistry, Showa University School of Dentistry, 2-1-1, Kita-Senzoku, Ota-ku, 145-8515, Tokyo, Japan
| | - Naoko Yajima
- Department of Implant Dentistry, Showa University School of Dentistry, 2-1-1, Kita-Senzoku, Ota-ku, 145-8515, Tokyo, Japan
| | - Noriko Tachikawa
- Tokyo Medical and Dental University Dental Hospital, Tokyo Medical and Dental University, Tokyo, Japan
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Jung YH, Cho BH, Hwang JJ. Comparison of panoramic radiography and cone-beam computed tomography for assessing radiographic signs indicating root protrusion into the maxillary sinus. Imaging Sci Dent 2021; 50:309-318. [PMID: 33409139 PMCID: PMC7758264 DOI: 10.5624/isd.2020.50.4.309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/17/2020] [Accepted: 09/01/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose This study investigated correlations between findings on panoramic radiographs and cone-beam computed tomography (CBCT) to assess the relationship between the maxillary sinus floor and the roots of maxillary posterior teeth. In addition, radiographic signs indicating actual root protrusion into the maxillary sinus were evaluated on panoramic radiographs. Materials and Methods Paired panoramic radiographs and CBCT images from 305 subjects were analyzed. This analysis classified 2,440 maxillary premolars and molars according to their relationship with the maxillary sinus floor on panoramic radiographs and CBCT images. In addition, interruption of the sinus floor was examined on panoramic radiographs. Results Root protrusion into the maxillary sinus occurred most frequently in the mesiobuccal roots of the second molars. The classification according to panoramic radiographs and CBCT images was the same in more than 90% of cases when there was no contact between the root apex and the sinus floor. When the panoramic radiograph showed root protrusion into the sinus, the CBCT images showed the same classification in 67.5% of second molars, 48.8% of first molars, and 53.3% of second premolars. There was a statistically significant relationship between interruption of the sinus floor on panoramic radiographs and root protrusion into the sinus on CBCT images. Conclusion The presence of root protrusion into the sinus on panoramic radiographs demonstrated a moderate ability to predict root protrusion into the maxillary sinus. Interruption of the maxillary sinus floor could be considered an indicator of actual root protrusion into the maxillary sinus.
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Affiliation(s)
- Yun-Hoa Jung
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Bong-Hae Cho
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Jae Joon Hwang
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University, Yangsan, Korea
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Qin Y, Shu G, Xu T. Evaluation of the Relationship Between Maxillary Sinus Wall and Maxillary Canines and Posterior Teeth Using Cone-Beam Computed Tomography. Med Sci Monit 2020; 26:e925384. [PMID: 32970652 PMCID: PMC7523419 DOI: 10.12659/msm.925384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The proximity between the maxillary sinus and dental roots may impede orthodontic tooth movement. This study aimed to explore the relationship between the maxillary sinus wall (MSW) and maxillary canines and posterior teeth using cone-beam computed tomography (CBCT). Material/Methods CBCT images (317) were examined for whether the mesial, distal, buccal, and palatal surfaces of the examined root contacted the MSW, and the contact distance of each root surface with the MSW was measured. The effects of age and sex were analyzed using logistic regression and linear regression analyses. Results The highest contact ratios with the MSW (ranging from 62.0% to 73.2%) were observed at the palatal root surfaces of the first molar mesiobuccal and distobuccal roots (1M MB and DB), the buccal root surface of the first molar palatal roots (1M P), and the mesial and buccal root surfaces of the second molars (2M), followed by the distal root surface of the second premolars (2PM) and the mesial root surfaces of the 1M MB and P (ranging from 49.2% to 59.3%). At these root surfaces, the contact ratios decreased with age (P<0.05), but the lowest still reached a range of 29.4% to 57.9% in the 30- to 47-year-old group. Conclusions The 2PM distal root surface, the 1M MB mesial and palatal root surfaces, the 1M DB palatal root surface, and the 1M P and 2M mesial and buccal root surfaces most frequently contacted the MSW. Clinicians should observe the contact of root surfaces with the MSW, even in aged patients.
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Affiliation(s)
- Yifei Qin
- Second Dental Center, Peking University School and Hospital of Stomatology, Beijing, China (mainland)
| | - Guang Shu
- Second Dental Center, Peking University School and Hospital of Stomatology, Beijing, China (mainland)
| | - Tianmin Xu
- Department of Orthodontics, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China (mainland)
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Zhou G, Leng D, Li M, Zhou Y, Zhang C, Sun C, Wu D. Root dentine thickness of danger zone in mesial roots of mandibular first molars. BMC Oral Health 2020; 20:43. [PMID: 32028960 PMCID: PMC7006201 DOI: 10.1186/s12903-020-1026-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 01/29/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Better understanding of the danger zone anatomy in mesial roots (MRs) of mandibular first molars (MFMs) may serve to decrease the risk of mishaps. This study aimed to measure the minimal distal dentine thicknesses of danger zone in MRs of MFMs in a native Chinese population using cone-beam computed tomography (CBCT). METHODS CBCT images of 1792 MFMs from 898 Chinese patients were analyzed. The minimal distal dentine thicknesses of the mesiobuccal (MB) and mesiolingual (ML) canals below the furcation 1, 2, 3, 4, 5 mm were measured. The association between the minimal distal dentine thicknesses and the root lengths, patient's age and gender, side were assessed. RESULTS The minimal distal dentine thicknesses of MB and ML canals are located 3 ∼ 4 mm below the furcation for both men and women. There are no differences between MB and ML canals, while the minimal distal dentine thicknesses of MB and ML canals were higher in men than women (P < 0.05), except at 1 and 3 mm of ML canals (P > 0.05). The minimal distal dentine thicknesses of MB and ML canals increased with age in both men and women at each location (P < 0.05). The minimum distal dentine thickness at every location were significantly different between long teeth and short teeth both in men and women (P < 0.05), with short teeth having the smallest mean values. There are no significant differences between two sides (P > 0.05). CONCLUSIONS The minimal distal dentine thicknesses of MRs in MSMs have close correlation with root length, patient's age and gender.
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Affiliation(s)
- Guangchao Zhou
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China.,Department of Radiology, the Affiliated Stomatological Hospital of Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China
| | - Diya Leng
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China.,Department of Radiology, the Affiliated Stomatological Hospital of Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China.,Department of Endodontics, the Affiliated Stomatological Hospital of Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China
| | - Mingming Li
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China.,Department of Radiology, the Affiliated Stomatological Hospital of Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China.,Department of Endodontics, the Affiliated Stomatological Hospital of Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China
| | - Yang Zhou
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China.,Department of Radiology, the Affiliated Stomatological Hospital of Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China.,Department of Endodontics, the Affiliated Stomatological Hospital of Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China
| | - Cuifeng Zhang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China.,Department of Radiology, the Affiliated Stomatological Hospital of Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China.,Department of Endodontics, the Affiliated Stomatological Hospital of Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China
| | - Chao Sun
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China.,Department of Radiology, the Affiliated Stomatological Hospital of Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China
| | - Daming Wu
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China. .,Department of Radiology, the Affiliated Stomatological Hospital of Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China. .,Department of Endodontics, the Affiliated Stomatological Hospital of Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China.
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Zhang X, Li Y, Zhang Y, Hu F, Xu B, Shi X, Song L. Investigating the anatomical relationship between the maxillary molars and the sinus floor in a Chinese population using cone-beam computed tomography. BMC Oral Health 2019; 19:282. [PMID: 31842859 PMCID: PMC6915992 DOI: 10.1186/s12903-019-0969-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 11/22/2019] [Indexed: 02/06/2023] Open
Abstract
Background The anatomical relationship between the root apices of maxillary molars and the maxillary sinus floor (MSF) is important for the treatment of dental implantations and endodontic procedures. In this study, the detailed anatomical relationships between the root apices of maxillary molars and the MSF were studied in a Chinese population using CBCT. Methods We collected the CBCT data files of patients who visited the stomatology outpatient clinic in Shanghai Fifth People’s Hospital, Fudan University from January 1, 2017 to January 1, 2019 and measured the following items: the distance between the molar root apices and the MSF, the thickness of the mucosa and cortical bone of the MSF closest to the root apices, and the angle between the buccal and palatal roots. Results The shortest distances between the root apices and the MSF were 1.57 ± 3.33 mm (the mesiobuccal root of the left second molar) and 1.61 ± 3.37 mm (the mesiobuccal root of the right second molar). Apical protrusion over the inferior wall of the sinus most often occurred in the mesiobuccal root of left second molar (frequency, 20.5%). The mucosa of the MSF was thinnest at the distobuccal root of the right second molar (1.52 ± 0.85 mm), the cortical bone of the MSF was thinnest at the mesiobuccal root of the right second molar (0.46 ± 0.28 mm), and the angle between the buccal and palatal roots ranged from 12.01° to 124.2° (42.36 ± 24.33 °). Conclusions Among the root apices of the maxillary molars, the mesiobuccal root apex of the left second molar was closest to the MSF, and it had the highest incidence of protrusion into the sinus. The unique anatomical relationship between the maxillary molars and the MSF in this Chinese population is critical for treatment planning for dental implantation or endodontic procedures.
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Affiliation(s)
- Xi Zhang
- Department of Stomatology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, 200240, China
| | - Yan Li
- Department of Health Management, The Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Yi Zhang
- Radiology Department, Shanghai Prison General Hospital, Shanghai, 201318, China
| | - Fengling Hu
- Department of Stomatology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, 200240, China
| | - Bin Xu
- Department of Stomatology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, 200240, China
| | - Xiaojun Shi
- Department of Stomatology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, 200240, China.
| | - Liang Song
- Department of Stomatology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, 200240, China.
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El Hachem R, Wassef E, Mokbel N, Abboud R, Zogheib C, El Osta N, Naaman A. Influence of the Maxillary Sinus on the Accuracy of the Root ZX Apex Locator: An Ex Vivo Study. Dent J (Basel) 2019; 7:dj7010003. [PMID: 30609762 PMCID: PMC6473460 DOI: 10.3390/dj7010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/15/2018] [Accepted: 12/11/2018] [Indexed: 11/30/2022] Open
Abstract
This study evaluated the accuracy of the Root ZX (J. Morita, Tokyo, Japan) electronic apex locator in determining the working length when palatal maxillary molar roots are in a relationship with the sinus. Seventeen human maxillary molars with vital pulp were scheduled for an extraction and implant placement as part of a periodontal treatment plan. The access cavity was prepared, and a #10 K file (Dentsply Maillefer, Ballaigues, Switzerland) was inserted into the palatal root using the Root ZX apex locator in order to determine the electronic working length (EWL); then, the teeth were extracted. To determine the real working length (RWL), a #10 K file was introduced into the root canal until its tip touched a glass plate. EWL and RWL were compared. Images reconstructed with CBCT (cone beam computerized tomography) revealed that eight palatal roots were related to the maxillary sinus, whereas nine were not. The results showed a significant difference between the EWL and the RWL of the palatal roots related to the sinus (p < 0.001). No significant difference was observed in measurements of roots not in contact with the sinus (p > 0.05). Within the study limitations, the reliability of Root ZX was influenced by the relationship of the roots with the maxillary sinus.
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Affiliation(s)
- Roula El Hachem
- Department of Endodontics, Faculty of Dentistry, Saint Joseph University, P.O. Box 11-5076 Riad el-Solh, Beirut 1107 2180, Lebanon.
| | - Elie Wassef
- Department of Periodontics, Faculty of Dentistry, Saint Joseph University, P.O. Box 11-5076 Riad el-Solh, Beirut 1107 2180, Lebanon.
| | - Nadim Mokbel
- Department of Periodontics, Faculty of Dentistry, Saint Joseph University, P.O. Box 11-5076 Riad el-Solh, Beirut 1107 2180, Lebanon.
| | - Richard Abboud
- Department of Maxillo-Facial Radiology, Saint Joseph University, B.P. 11-514 Riad el-Solh, Beirut 1107 2050, Lebanon.
| | - Carla Zogheib
- Department of Endodontics, Faculty of Dentistry, Saint Joseph University, P.O. Box 11-5076 Riad el-Solh, Beirut 1107 2180, Lebanon.
| | - Nada El Osta
- Department of Prosthodontics, Saint Joseph University, B.P. 11-514 Riad el-Solh, Beirut 1107 2050, Lebanon.
| | - Alfred Naaman
- Department of Endodontics, Faculty of Dentistry, Saint Joseph University, P.O. Box 11-5076 Riad el-Solh, Beirut 1107 2180, Lebanon.
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