Clinical Paper Oral Surgery| Volume 48, ISSUE 12, P1570-1576, December 2019

Maxillary molar root protrusion into the maxillary sinus: a comparison of cone beam computed tomography and panoramic findings


      This study aimed to examine the prevalence of molar roots protruding into the maxillary sinus and to determine the panoramic radiographic signs as correlated with cone beam computed tomography (CBCT). CBCT images of 354 roots were assessed and classified into three types, according to the relationship between the root and maxillary sinus. The prevalence of root protrusion into the maxillary sinus was calculated then the panoramic images assessed. After excluding some unidentified roots on the panoramic images, 200 were investigated for panoramic signs, including (i) projection of the root apex into the sinus cavity, (ii) interruption of the maxillary sinus floor’s cortex, (iii) absence of periodontal ligament space, (iv) darkening of the involved root region, and (v) upward curving of the sinus floor. The respective correlation between the panoramic signs and CBCT types was assessed. Forty-six percent of roots showed protrusion into the sinus with the palatal root of the first molar having the greatest prevalence (33/200 roots). The panoramic signs ‘projection of the root apex in the sinus cavity’ and ‘darkening of the involved root apical region’ both strongly indicated root protrusion into the maxillary sinus (P < 0.05).

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        • Scuderi A.J.
        • Harnsberger H.R.
        • Boyer R.S.
        Pneumatization of the paranasal sinuses: normal features of importance to the accurate interpretation of CT scans and MR images.
        AJR Am J Roentgenol. 1993; 160: 1101-1104
        • Sharan A.
        • Madjar D.
        Maxillary sinus pneumatization following extractions: a radiographic study.
        Int J Oral Maxillofac Implants. 2008; 23: 48-56
        • Eberhardt J.A.
        • Torabinejad M.
        • Christiansen E.L.
        A computed tomographic study of the distances between the maxillary sinus floor and the apices of the maxillary posterior teeth.
        Oral Surg Oral Med Oral Pathol. 1992; 73: 345-346
        • Estrela C.
        • Nunes C.A.
        • Guedes O.A.
        • Alencar A.H.
        • Estrela C.R.
        • Silva R.G.
        • Pécora J.D.
        • Sousa-Neto M.D.
        Study of anatomical relationship between posterior teeth and maxillary sinus floor in a subpopulation of the Brazilian central region using cone-beam computed tomography - part 2.
        Braz Dent J. 2016; 27: 9-15
        • Jung Y.H.
        • Cho B.H.
        Assessment of the relationship between the maxillary molars and adjacent structures using cone beam computed tomography.
        Imaging Sci Dent. 2012; 42: 219-324
        • Kilic C.
        • Kamburoglu K.
        • Yuksel S.P.
        • Ozen T.
        An assessment of the relationship between the maxillary sinus floor and the maxillary posterior teeth root tips using dental cone-beam computerized tomography.
        Eur J Dent. 2010; 4: 462-467
        • Kwak H.H.
        • Park H.D.
        • Yoon H.R.
        • Kang M.K.
        • Koh K.S.
        • Kim H.J.
        Topographic anatomy of the inferior wall of the maxillary sinus in Koreans.
        Int J Oral Maxillofac Surg. 2004; 33: 382-388
        • Pagin O.
        • Centurion B.S.
        • Rubira-Bullen I.R.
        • Alvares Capelozza A.L.
        Maxillary sinus and posterior teeth: accessing close relationship by cone-beam computed tomographic scanning in a Brazilian population.
        J Endod. 2013; 39: 748-751
        • Ferguson M.
        Rhinosinusitis in oral medicine and dentistry.
        Aust Dent J. 2014; 59: 289-295
        • Punwutikorn J.
        • Waikakul A.
        • Pairuchvej V.
        Clinically significant oroantral communications – a study of incidence and site.
        Int J Oral Maxillofac Surg. 1994; 23: 19-21
        • Qureshi Z.U.R.
        • Rahman A.U.
        • Khan S.
        • Ansari S.R.
        Frequency and site distribution of oroantral fistula – a study.
        Pak Oral Dent J. 2012; 32: 196-198
        • del Rey-Santamaria M.
        • Valmaseda Castellón E.
        • Berini Aytés L.
        • Gay Escoda C.
        Incidence of oral sinus communications in 389 upper third molar extraction.
        Med Oral Patol Oral Cir Bucal. 2006; 11: 334-338
        • Visscher S.H.
        • van Minnen B.
        • Bos R.R.
        Closure of oroantral communications: a review of the literature.
        J Oral Maxillofac Surg. 2010; 68: 1384-1391
        • Bouquet A.
        • Coudert J.L.
        • Bourgeois D.
        • Mazoyer J.F.
        • Bossard D.
        Contributions of reformatted computed tomography and panoramic radiography in the localization of third molars relative to the maxillary sinus.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004; 98: 342-347
        • Lopes L.J.
        • Gamba T.O.
        • Bertinato J.V.
        • Freitas D.Q.
        Comparison of panoramic radiography and CBCT to identify maxillary posterior roots invading the maxillary sinus.
        Dentomaxillofac Radiol. 2016; 4520160043
        • Kirkham-Ali K.
        • La M.
        • Sher J.
        • Sholapurkar A.
        Comparison of cone-beam computed tomography and panoramic imaging in assessing the relationship between posterior maxillary tooth roots and the maxillary sinus: A systematic review.
        J Investig Clin Dent. 2019; (Epub ahead of print)e12402
        • Koch F.
        • Breil P.
        • Marroquin B.B.
        • Gawehn J.
        • Kunkel M.
        Abscess of the orbit arising 48 h after root canal treatment of a maxillary first molar.
        Int Endod J. 2006; 39: 657-664
        • Vijayan A.
        • Sreejith V.P.
        • Surendran R.
        • Ahamed G.
        Orbital abscess arising from an odontogenic infection.
        J Contemp Dent Pract. 2012; 13: 740-743
        • Huang C.H.
        • Brunsvold M.A.
        Maxillary sinusitis and periapical abscess following periodontal therapy: A case report using three-dimensional evaluation.
        J Periodontol. 2006; 77: 129-134
        • Hauman C.H.
        • Chandler N.P.
        • Tong D.C.
        Endodontic implications of the maxillary sinus: a review.
        Int Endod J. 2002; 35: 127-141
        • Nimigean V.R.
        • Nimigean V.
        • Maru N.
        • Andressakis D.
        • Balatsouras D.G.
        • Danielidis V.
        The maxillary sinus and its endodontic implications: clinical study and review.
        B-ENT. 2006; 2: 167-175
        • Selden H.S.
        Endo-antral syndrome and various endodontic complications.
        J Endod. 1999; 25: 389-393
        • Dimitrakopoulos I.
        • Papadaki M.
        Foreign body in the maxillary sinus: report of an unusual case.
        Quintessence Int. 2008; 39: 698-701
        • Shahbazian M.
        • Vandewoude C.
        • Wyatt J.
        • Jacobs R.
        Comparative assessment of panoramic radiography and CBCT imaging for radiodiagnostics in the posterior maxilla.
        Clin Oral Investig. 2014; 18: 293-300