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Abstract
Simple SummaryChanges in the sinus membrane, in the form of thickening or opacification, usually pose problems of differential diagnosis between rhinological and odontogenic causes, given the similarity in their clinical behaviour. The interrelation between tooth roots and the possibility of maxillary sinus involvement seems to be a key determinant. Moreover, the role played by iatrogenic factors, especially surgical interventions, such as dental extractions, or impacted teeth, as well as implant treatments, must be considered. The contribution of new imaging procedures, such as conventional computed tomography or cone beam computed tomography, has triggered an increase in the identification of dental aetiology as a cause of the unilateral opacification of the anterior paranasal sinuses with the predominant involvement of the maxillary sinus.The aim of this study was to identify the most relevant dental factors and iatrogenic causes in the development of pathological changes to the sinus membrane and to analyse their possible influence on the development of odontogenic sinusitis. A descriptive, observational study was designed, with 276 patients who had been evaluated via cone beam computed tomography, analysing possible sinus thickening factors, such as apical infections, endodontic treatments, periodontitis, radicular cysts and impacted teeth, as well as iatrogenic factors caused by implant treatments or the development of oroantral communications produced during tooth extraction manoeuvres. Among the dental factors, periodontitis (47.1%), apical pathology (23.5%) and endodontic treatments (23.1%) were the predominant causes of sinus membrane thickening that most frequently produced an occupancy between 2 and 10 mm. Regarding the implant treatments, the placement of implants through the floor of the maxillary sinus was the main cause (9.8%), followed by sinus elevation techniques (6.2%). Dental extraction was the first cause of oroantral communication (5.0%), being the procedure that caused the greatest thickening of the sinus membrane. This study highlights the importance of dental treatments and iatrogenic factors in sinus pathology, and the need for diagnostic interrelations between the different specialists who address this pathology.
Highlights
Pathological changes in the maxillary sinus range from inflammatory processes to others of a cystic and tumoural nature
Other authors have found that there are a variety of dental pathologies that can lead to odontogenic sinusitis, among which endodontic disease, periodontitis, oroantral communication or foreign bodies related to dental treatment stand out [8,9,10]
In order to avoid bias in the measurements, fifteen cone beam computed tomography (CBCT) were evaluated by the observers; in cases with contrasting evaluations, we determined that at least three of them should coincide with their determinations to establish a concordance, with an intraclass correlation coefficient (ICC) of >0.9 between observers
Summary
Pathological changes in the maxillary sinus range from inflammatory processes to others of a cystic and tumoural nature Among the former, maxillary sinusitis stands out, whose origin may be due to rhinological or odontogenic causes, and which is sometimes difficult to differentiate from the clinical point of view, so imaging diagnosis can play a relevant role [1]. Matsumoto et al [3] reviewed 190 CT scans of patients with unilateral sinus opacification, and found that more than 70% were attributed to odontogenic infection Another radiographic study conducted by Bomeli et al [4] found that the degree of opacification of the maxillary sinus was directly correlated with a concurrent dental source, finding that 79% of sinuses that were more than two-thirds opacified by liquid had an identifiable dental source. Other authors have found that there are a variety of dental pathologies that can lead to odontogenic sinusitis, among which endodontic disease, periodontitis, oroantral communication or foreign bodies related to dental treatment stand out [8,9,10]
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