Accuracy of panoramic radiography in diagnosing maxillary sinus-root relationship: A systematic review and meta-analysis

Characteristics of CBCT versus panoramic signs of the surrounding bone of molar root protrusions into the maxillary sinus

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.

Evaluation of the relation between the maxillary sinus and the posterior teeth using digital panoramic radiography

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.

Performance of panoramic radiography compared with computed tomography in the evaluation of pathological changes in the maxillary sinuses: a systematic review and meta-analysis

OBJECTIVE

A systematic review was performed to evaluate the performance of panoramic radiography (PR) vs CT or cone beam CT (CBCT) in the diagnosis of pathological maxillary sinuses.

METHODS

This review was registered in the PROSPERO database under the number CRD42020211766. Observational studies that compared PR with CT/CBCT were used to evaluate pathological changes in the maxillary sinuses. A complete search of seven primary databases and gray literature was carried out. The risk of bias was assessed according to the Newcastle-Ottawa tool, and the GRADE tool was used to assess the quality of evidence. A binary meta-analysis was performed to assess the effectiveness of evaluating pathological alterations in the maxillary sinuses in PR and CT/CBCT.

RESULTS

Seven studies were included in our study, out of which four were included in a quantitative analysis. All studies were classified as low risk of bias. Five studies compared PR with CBCT and two studies compared PR to CT. The most common pathological alteration in maxillary sinuses reported was mucosal thickening. CT/CBCT was seen to be the most effective method for assessing pathological changes in the maxillary sinus when compared to PR (RR = 0.19, 95% confidence interval [CI] = 0.05 to 0.70, p = 0.01).

CONCLUSION

CT/CBCT are the most appropriate imaging methods to evaluate pathological changes in the maxillary sinuses, while PR is still limited in the evaluation of these changes being considered only for initial diagnosis.

Does the floor of the maxillary sinus affect tooth movement for premolar extraction space closure?

OBJECTIVE

The study investigated orthodontic tooth movement by comparing various horizontal and angular measures of the teeth having different sinus-root relationship (SRR) of patients undergoing first premolar extraction treatment protocols.

MATERIALS AND METHODS

This retrospective cross-sectional study included 45 Taiwanese adult patients, classified as the control group (n = 15) and the sinus group (n = 30) according to SRR. The control group had type I SRR (sinus floor above the level connecting the buccal and palatal root apices), whereas the sinus group included patients with type V SRR (the buccal and palatal root displayed apical protrusion into the sinus floor). Morphology was identified using pretreatment orthopantomograms. Lateral cephalometric measurements were conducted before treatment (T1) and at debonding (T2).

RESULTS

Post debonding, there were no statistically significant difference in the two groups. However, the incisors in the control group became marginally more upright than those of the sinus group, and the molars demonstrated tipping movement with minimal anchorage loss in the sinus group than in the control group. The total treatment time was not significantly different between the 2 groups.

CONCLUSION

The study revealed that the sinus-root relationship does not affect the orthodontic tooth movement. However, a more extensive 3-D study with larger sample size is strongly recommended before coming to any conclusion.

CLINICAL RELEVANCE

The lining of the floor of the maxillary sinus does not affect the orthodontic tooth movement.

The Use of CBCT in Evaluating the Health and Pathology of the Maxillary Sinus

The use of cone-beam computed tomography (CBCT) has been increasing in dental practice. This narrative review summarized the relevance and utilizations of CBCT to visualize anatomical structures of the maxillary sinus and common pathologies found in the maxillary sinus. The detection/visualization rate, the location and the morphometric characteristics were described. For sinus anatomy, the reviewed features included the posterior superior alveolar artery, sinus pneumatization, sinus hypoplasia, sinus septa, and primary and accessory sinus ostia. For pathology, the following items were reviewed: membrane thickening associated with periapical lesions/periodontal lesions, mucous retention cyst, and antrolith. The visualization and assessment of the maxillary sinus is very important prior to procedures that take place in close proximity with the sinus floor, such as tooth extraction, implant insertion, and sinus floor elevation. Some sinus pathologies may be associated with odontogenic lesions, such as periapical diseases and periodontal bone loss.

Basic Knowledge and New Advances in Panoramic Radiography Imaging Techniques: A Narrative Review on What Dentists and Radiologists Should Know

Objectives: A panoramic radiograph (PAN) is the most frequently diagnostic imaging technique carried out in dentistry and oral surgery. The correct performance of image acquisition is crucial to obtain adequate image quality. The aim of the present study is to (i) review the principles of PAN image acquisition and (ii) describe positioning errors and artefacts that may affect PAN image quality. Methods: Articles regarding PAN acquisition principles, patient’s positioning errors, artefacts, and image quality were retrieved from the literature. Results: Head orientation is of the utmost importance in guaranteeing correct image acquisition. Symmetry, occlusal plane inclination, mandibular condyles localization, cervical spine position, aspect of upper teeth root apexes, exposure parameters, and metal and motion artefacts are factors that greatly affect the image quality of a successful PAN. Conclusions: Several factors are the basis for PAN performance; therefore, a systematic approach that takes into account correct patient positioning and preparation is strongly suggested to improve overall examination quality.

Intrusion of maxillary molar roots into the maxillary sinus in a sample of the Egyptian population using cone beam computed tomography

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.

Evaluation of the distance between the root apices of the upper first molars and the hard palate in an Eastern Mediterranean population: A retrospective study

OBJECTIVE

The aims of this retrospective study were, first to evaluate the distance between the root apices of the upper first molars and the palatal plane (PP), and second to determine the validity (accuracy) of the use of cephalometric radiographs or panoramic X-rays compared to cone beam computed tomography (CBCT) in determining this distance.

MATERIAL AND METHODS

The distance was calculated from the root apices of the first molars to PP, on the cephalometric radiographs of 204 subjects and then 57 measurements were compared to those obtained on panoramic X-rays and CBCT images, in order to find a statistically significant difference according to age, sex, side, vertical and sagittal skeletal patterns, and to determine if 2D radiographs are suitable for this task.

RESULTS

The distance increased significantly in subjects after 20 years of age and in hyperdivergent patients, but was not influenced by sex, side or anteroposterior position of the mandible. No statistical significance was found between the calculated measurements on cephalometric and CBCT radiographs, but both were different from those taken on panoramic X-rays.

CONCLUSIONS

Cephalometric radiographs are reliable in the assessment of the distance between the roots of the upper molars and the PP. In hyperdivergent and adult patients, posterior teeth have enough space between their roots and the upper limit of the hard palate to undergo intrusion mechanics using miniscrews, but care must be taken while planning and managing these movements in order to minimize the unwanted side effects.

Comparison of panoramic radiography and cone-beam computed tomography for assessing radiographic signs indicating root protrusion into the maxillary sinus

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.

Cone Beam Computed Tomography in Oral and Maxillofacial Surgery: An Evidence-Based Review

Cone Beam Computed Tomography (CBCT) is a valuable imaging technique in oral and maxillofacial surgery (OMS) that can help direct a surgeon’s approach to a variety of conditions. A 3-dimensional analysis of head and neck anatomy allows practitioners to plan appropriately, operate with confidence, and assess results post-operatively. CBCT imaging has clear indications and limitations. CBCT offers the clinician 3-dimensional and multi-planar views for a more accurate diagnosis and treatment without the financial burden and radiation exposure of conventional computed tomography (CT) scans. Furthermore, CBCT overcomes certain limitations of 2-dimensional imaging, such as distortion, magnification, and superimposition. However, CBCT lacks the detailed depiction of soft tissue conditions for evaluation of pathologic conditions, head and neck infections, and temporomandibular joint (TMJ) disc evaluation. This review evaluates the evidence-based research supporting the application of CBCT in the various fields of oral and maxillofacial surgery, including dentoalveolar surgery, dental implants, TMJ, orthognathic surgery, trauma, and pathology, and will assess the value of CBCT in pre-operative assessment, surgical planning, and post-operative analysis when applicable. Additionally, the significant limitations of CBCT and potential areas for future research will be discussed.