Deep Learning Models for Evaluating the Anatomical Relationship Between Posterior Maxillary Teeth and Maxillary Sinus in Panoramic Radiographs

The purpose of this retrospective study was to compare the performance of cone-beam computed tomography (CBCT) and panoramic radiography in detecting the presence and location of maxillary sinus septa. This study included radiographic examination of 104 maxillary sinuses of 52 individuals (26 females, 50% and 26 males, 50%) whose panoramic radiographs and CBCT images were obtained for several dental causes which were examined by the consensus of four dentomaxillofacial radiologists. The posterior maxillary segments in proximity of maxillary sinus were classified as edentulous and dentate maxillary segments. The location of maxillary sinus septa was classified as primary septa and secondary septa according to the presence of maxillary tooth at the affected site. The maxillary sinus septa were divided into three categories (anterior, middle and posterior) according to its relation with posterior maxillary teeth. Data were statistically analyzed with chi-square and Fisher's exact tests. The septa were found in 23.1% and 29.8% of the maxillary sinuses on panoramic radiography and CBCT images, respectively. The majority of maxillary sinus septa were observed in dentate posterior maxillary segments on both panoramic (45.8%) radiography and CBCT (64.5%) images. Statistically significant differences (p<0.001) were found between panoramic radiography and CBCT images for presence, location and neighborhood with the posterior maxillary teeth of maxillary sinus septa. The results of this study demonstrated the low reliability of panoramic radiography images in the detection of maxillary sinus septa. CBCT images can provide valuable information to the clinicians about the presence and location of maxillary sinus septa.

Background: Having knowledge about the anatomical and pathological relationship between the maxillary posterior root tip and the maxillary sinus floor is very significant for preoperative treatment planning. Aims and Objectives: The purpose of the present study was to compare the accuracy of original panoramic radiographs and digital panoramic images over cone beam computed tomography (CBCT) images in evaluating the relationship between the maxillary posterior teeth and the maxillary sinus floor, and to verify the accuracy of the signs of the relationship between the roots of the maxillary posterior teeth and maxillary sinus on the panoramic radiographs over CBCT images. Materials and Methods: From 106 subjects (47 males and 59 females; mean age = 39 years; range = 18-67 years) referred to our university, a pair of panoramic and CBCT images was selected for further analysis. The relationship between the maxillary posterior teeth, the maxillary sinus, and panoramic radiography signs (root projection into the sinus, interruption of the maxillary sinus floor cortex, absence of lamina dura, darkening of the root apex, and curvature of the sinus floor on the root apex) associated with the protrusion of root apexes into the sinus was evaluated. Results: The P values of the data obtained from the original and invert enhanced panoramic images were .53 and .52, respectively, and there was no statistically significant difference in the accuracy of the 2 methods ( P &gt; .05). Conclusion: The root projection into the sinus is an indicative sign of root protrusion into the sinus on CBCT.

The purpose of this study was to assess whether and how the information obtained by means of cone beam computed tomography (CBCT) on maxillary posterior teeth differs from that obtained by panoramic radiography. From 157 subjects (mean age 48 years, range 19-84 years; 89 females) referred to the oral imaging center, a pair of panoramic and CBCT images was selected for further analysis. Both imaging modalities were analyzed to determine the topographic relationship of maxillary teeth to the sinus floor. Pathologic conditions, apical periodontitis, and presence of soft tissue thickening were also examined with both techniques. CBCT showed an intimate relationship of the first and second molar with the maxillary sinus in 54 and 38%, respectively. Thirty-nine apical periodontitis lesions causing reactive changes in the maxillary sinus were detected by CBCT, while just six of them were diagnosed with panoramic imaging. A total of 26 teeth with apical extension to the maxillary sinus were detected with CBCT, from which two could be identified with panoramic radiography. This study emphasizes that anatomical and pathological involvement of the maxillary sinus in relation to posterior teeth is considerably high. It is of clinical importance that the 3D nature of CBCT imaging allowed a better assessment of the relationship between the maxillary sinus and posterior root apices compared to the low detection on panoramic radiographs. CBCT imaging can be a valuable adjunct in radioanatomical and radiodiagnostic observations in the posterior maxilla. It may better visualize maxillary sinus involvement for posterior upper teeth than panoramic radiography.

PurposeThe aims of this study were first, to compare panoramic radiography with cone-beam computed tomography (CBCT) for evaluating topographic relationships, such as the classification of maxillary posterior teeth and their distance to the maxillary sinus floor; and second, to determine the relationship between maxillary sinus pathology and the presence of apical lesions.Materials and MethodsIn total, 285 paired CBCT and panoramic radiography records of patients (570 maxillary sinuses) were retrospectively analyzed. Both imaging modalities were used to determine the topographic relationship of the maxillary posterior teeth to the sinus floor. Mucosal thickening >2 mm was considered a pathological state. Data were analyzed using the chi-square, Wilcoxon, and Mann-Whitney U tests. Odds ratios (ORs) and confidence intervals (CIs) were calculated.ResultsThe closest vertical distance measurements made between posterior maxillary teeth roots and the maxillary sinus on panoramic radiography and CBCT scans showed statistically significant differences from each other (P<0.05). Compared to panoramic radiography, CBCT showed higher mean values for the distance between the maxillary sinus floor and maxillary posterior teeth roots. The CBCT images showed that at least 1 apical lesion adjacent to the right maxillary sinus increased the risk of maxillary sinus pathology by 2.37 times (OR, 2.37; 95% CI, 1.58-3.55, P<0.05).ConclusionPanoramic radiography might lead to unreliable diagnoses when evaluating the distance between the sinus floor and posterior roots of the maxillary teeth. Periapical lesions anatomically associated with maxillary sinuses were a risk factor for sinus mucosal thickening.

AI model to detect contact relationship between maxillary sinus and posterior teeth

The relationship between the maxillary sinus (MS) and the root apices of posterior teeth is of significant clinical relevance as it influences the diagnosis and treatment planning when operating in the posterior areas of the maxilla. The aim of this study, therefore, is to assess this anatomic relationship and evaluate the propensity of roots of posterior maxillary teeth to be intruded into the MS space using cone-beam computed tomography (CBCT) scanning. One thousand CBCT scans of patients, aged 20 years or above, were analyzed in the study. The distance from the MS floor to the root apices of the posterior teeth was measured and the relationship between the MS and the posterior teeth roots were recorded, based on Kwak's and Didilescu's classification. Based on Kwak's classification, type I configuration was frequently observed in the maxillary posterior teeth, followed by type II. Based on Didilescu's classification, the longest distance, among premolars, was observed between the palatal root of the left 1st premolar and MS, i.e., 8.2467 mm. Among molars, the longest distance was observed between mesiobuccal root of the right first molar and MS, i.e., 5.8966 mm. The shortest distance, among premolars, was observed between the buccal root of the left second premolar and MS, i.e., 3.5500 mm, and among molars, the shortest distance was between the mesiobuccal root of the left second molar and MS, i.e., 1.3556 mm. From the present study, it may be concluded that, among the central Indian population, mesiobuccal root of the second molars and buccal root of the second premolars show the closest proximity to the MS floor. Therefore, any surgical or endodontic intervention in the vicinity of these roots must be performed with utmost care.

BACKGROUND: The topographical description of the relationship between the upper posterior roots and the maxillary sinus is essential for decreasing the risk of complications during surgical or nonsurgical procedures and to detect possible sinus pathologies. For the evaluation, the most commonly used imaging method is panoramic radiography. This study aims to investigate the reliability of panoramic radiography according to cone-beam computed tomography (CBCT), which is extremely successful in the three-dimensional evaluation, by examining the relationship between the maxillary teeth and the sinus floor. MATERIALS AND METHODS: A total of 350 teeth were analyzed according to their topographic relationship to the maxillary sinus using panoramic and CBCT images. Two parameters were used to evaluate the safety of the panoramic radiograph on the posterior maxillary region. First, the topographic relationship was classified according to the criteria organized by Shahbazian et al. and compared both the imaging methods by the McNemar–Bowker test. Then, the diagnostic reliability test was performed for panoramic radiography according to the topographic classification. Second, 248 linear vertical measurements were made between the apexes of the roots and the sinus floor in the maxillary posterior region and then compared between the panoramic and the CBCT images. RESULTS: The McNemar–Bowker test showed that there was a significant relationship between the two imaging methods in both the dental groups (premolar teeth P = 0.030 and molar teeth P = 0.014). Furthermore, a total of 124 measurements were analyzed using the Mann–Whitney U-test and no statistically significant difference was found between the two imaging methods (P = 0.576). CONCLUSION: Although reliable results were obtained in panoramic radiographs when compared to CBCT images, panoramic radiography may not be sufficient before the surgical procedure. Nevertheless, when the posterior maxillary teeth are not too close to the sinus floor, panoramic radiographs can be used safely for the initial diagnostic evaluation.

To measure and analyze the thickness of the maxillary sinus mucosa under different relationships between the maxillary posterior teeth apex and the maxillary sinus floor on cone beam CT (CBCT). A total of 987 patients requiring implant surgery due to dentition defect or loss were selected from Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2020 to December 2022. The maxillary posterior teeth most closely related to the maxillary sinus were observed on CBCT, the tooth position and root apex were recorded, and the vertical distance between the apex of the posterior tooth and the base of the maxillary sinus was measured. According to the distance between the root apex and the maxillary sinus floor, the posterior teeth were divided into three categories: Class Ⅰ: the distance between the root apex and the maxillary sinus floor (d ＞0 mm); Class Ⅱ : the root apex was attached to the maxillary sinus floor and the cortical bone of the maxillary sinus floor was continuous (d=0 mm); Class Ⅲ : apical protrusion into the maxillary sinus floor(d＜0 mm). The thickness of the thickest part of the maxillary sinus floor mucosa was measured. The distance between the root and the maxillary sinus floor and the thickness of the maxillary sinus mucosa were compared under different root-sinus floor relationship, and the correlation analysis was performed. SPSS 26.0 software package was used to analyze the data. Among the 1974 maxillary sinuses of 987 patients, there were 450 maxillary sinuses with Class I relationship between the posterior root apex and the maxillary sinus floor, while 126 (28%) of the maxillary second molar proximal root and the maxillary sinus floor were the most closely related. In ClassⅠrelationship, the average distance from root to the maxillary sinus floor was (2.9±2.7) mm, and the average thickness of the maxillary sinus mucosa was (2.9±4.0) mm. There was no correlation between the distance from root to the maxillary sinus floor and the thickness of the maxillary sinus mucosa. There were 808 maxillary sinuses with ClassⅡ relationship between the posterior root apex and the maxillary sinus floor, among which 132 (16.3%) maxillary first molars had the closest relationship with the maxillary sinus floor. In Class Ⅱ relationship, the average thickness of the maxillary sinus mucosa was (3.0±4.6) mm. There were 249 maxillary sinuses with Class Ⅲ relationship between the posterior tooth root apex and the maxillary sinus floor, among which 87 (34.9%) palatal roots of the maxillary first molar were the most closely related to the maxillary sinus floor. The average distance from the root to the maxillary sinus floor was (-1.9±-1.4) mm, and the average thickness of maxillary sinus mucosa was (2.4±4.9) mm. There was a positive correlation between them (r=0.18, P=0.004). The most common relationship between the posterior maxillary tooth apex and the maxillary sinus floor is Class Ⅱ. The palatal root of the first molar is most closely related to the maxillary sinus floor, the mesiobuccal root of the second molar ranks second. The thickness of the maxillary sinus mucosa varies on the relationship between the different maxillary posterior teeth apex and the maxillary sinus floor. The average thickness of the maxillary sinus mucosa in Class Ⅲ is thicker than Class Ⅱ and Class I. In Class Ⅲ, as the distance from the apices to the maxillary sinus floor increases, the thickness of maxillary sinus mucosa increases.

Prediction of extraction difficulty for impacted maxillary third molars with deep learning approach

This study was conducted to assess the vertical and horizontal relationship between the maxillary sinus floor and maxillary posterior teeth roots using cone beam computed tomography. In this cross-sectional study, the CBCT images presented in the radiology department of Hamadan dental school was used. From 450 observed CBCT, 340 of them did not have the inclusion criteria of the study and ultimately 110 CBCT were selected. Totally 214 first premolars, 217 second premolars, 220 first molars and 220 second molars were included. For evaluating the relationship between the maxillary sinus floor and the posterior maxillary teeth, the classification implemented in the study of Jung in 2009 was used. The relation was evaluated by two radiologists twice with a 2-week time interval. One hundred and ten patients with a mean age of 31.06 ± 9.7 years were assessed. Type 0 relationship (the maxillary sinus floor is located above the root tip) was most frequently observed with the first and second premolars. The most common type observed in the first and second molars was type 3 (apical protrusion is seen over the maxillary sinus floor). The relation between different types and gender was statistically meaningful, while no statistically significant difference was found between the right and left side assessments. This study showed that although most of the teeth did not have contact with the sinus floor, but the more posterior the maxillary teeth, the more probability for root protruding into the maxillary sinus. It also confirmed that protrusion of teeth roots into the maxillary sinus is more common in male than female. Knowing the anatomical relation between the posterior teeth and the maxillary sinus, help the clinician in preoperative treatment planning of the posterior maxillary teeth and avoid problems that may occur during dental practice.

To measure passive tactile threshold of implant-supported single crowns (ISSC) in six orthogonal orientations, to analyze impact factors, and to guide the occlusal adjustment in a personalized manner. The passive tactile thresholds of 24 implant-supported single crowns (5 maxillary anterior teeth, 7 maxillary posterior teeth and 12 mandibular posterior teeth) from 19 ISSC patients (8 men and 11 women, from 25 years old to 56 years old) were measured in six orthogonal orientations (four horizontal orientations of labial or buccal, lingual, mesial and distal, and two axial orientations of apical and coronal) using a digital test system for tactile function of teeth.SPSS 19.0 for windows was used to analyze impact factors, using double-sided test, with a significance level of 0.05. Paired-samples t test was used to test the difference between implant-supported single crowns and the controlled natural teeth, and between different time points. One-way ANOVA was used to test the difference between different orientations, maxilla-mandibular anterior-posterior, and men-women. The passive tactile thresholds of ISSC and control teeth were (1282 ± 709) and (40 ± 40) mN respectively. The difference was of statistical significance (P < 0.001). The passive tactile thresholds of buccal-lingual, mesial-distal and axial of ISSC were (1334 ± 696), (1102 ± 605) and (1412 ± 791) mN respectively, of which, the difference between mesial-distal and axial was of statistical significance (P < 0.05). The passive tactile thresholds of ISSC of maxillary anterior teeth, posterior teeth and mandibular posterior teeth were (1003 ± 616), (1302 ± 620) and (1386 ± 769) mN respectively, of which, the difference between maxillary anterior teeth and posterior teeth was of statistical significance (P < 0.05). The passive tactile thresholds of ISSC of men and women were (1751 ± 784) and (946 ± 393) mN respectively, the difference was of statistical significance (P < 0.001). The passive tactile thresholds of ISSC of one-week and one-month after wearing the teeth were (1421 ± 826) and (1411 ± 814) mN respectively, the difference was of no statistical significance (P > 0.05). The passive tactile threshold of ISSC was more than 65 times as much as that of the natural teeth. There was statistical significance between different orientations, between maxillary anterior and posterior teeth, and between men and women. No statistical significance was found between maxillary and madibular posterior teeth and between one-week and one-month after wearing the teeth.

Introduction: Panoramic radiograph is frequently prescribed by dentists for implant planning and, hence, accurate assessment of anatomical structures in panoramic radiograph is of utmost importance. Aims: The aim of the present study is to know the accuracy of panoramic radiograph in assessment of relationship between maxillary sinus floor and posterior teeth roots, and the distance from alveolar crest to nasal floor by comparing it with that of cone-beam computed tomographic (CBCT) image. Materials and Methods: Panoramic and CBCT images of 30 patients were analyzed. The topographic relationship of each root of posterior teeth to the maxillary sinus floor was evaluated and classified into three classes. The distance from the peak point on maxillary alveolar crest to nasal floor was measured in panoramic radiograph as well as in CBCT image. All the measurements were made by built-in measurement tools. Results: Class 1 roots in panoramic radiograph showed high agreement (86%) with CBCT image, followed by class 0 (76%). There was a significant difference in the measurements of alveolar bone height (ABH) in the nasal floor region with a P value of 0.018. Conclusion: Panoramic radiograph is reliable in assessment of nasal floor and maxillary sinus, provided position of the patient, distortion, and the inherent magnification factor are taken into consideration.

In modern dentistry, radiographic imaging is crucial for examining the connection between the maxillary sinus floor and the root apices of the maxillary posterior teeth, particularly when the periapical region is affected by pathology that could result in infectious, inflammatory, or traumatic changes in the maxillary sinus. This study aimed to investigate the prevalence of periapical pathologies in the maxillary posterior teeth and their relationship with maxillary sinus mucosal thickening by using cone-beam computed tomography scans. This retrospective study was conducted on 420 digitized CBCT images which were scanned in sagittal, axial, and coronal views. Out of 420 total images, 223 (53.1%) were of males and 197 (44.9%) were of females. The data were analyzed using SPSS version 28. A total of 2936 posterior maxillary teeth were tested for periapical pathology (PP), 1477 on the right side and 1459 on the left side. In terms of gender, there was no significant relationship between PP in maxillary posterior teeth on both sides and mucosal thickness of the maxillary sinus (p > 0.05). A significant relationship was found between PP in maxillary posterior teeth on both sides and maxillary sinus mucosal thickening (p < 0.05). This study concluded that the prevalence of periapical pathology in the maxillary posterior teeth was significantly associated with a rise in the incidence of maxillary sinus mucosal thickening. Moreover, the primary causative factor for the pathophysiology of the odontogenic maxillary sinus was the periapical pathology in both maxillary first molars.

Background: Maxillary sinus and its close proximity to the oral cavity make it a common clinical concern for medical and dental practitioners. Due to anatomical complexities, it is difficult to evaluate the relation between the root apices of maxillary posterior teeth and the floor of maxillary sinus which is essential for diagnosis of sinus pathology, understanding the path of dental infection and planning of dental treatment.Aims and Objectives: To correlate the topographic relationship of the maxillary sinus floor to the maxillary posterior teeth roots as imaged by pairs of Orthopantomograph (OPG) and Digital Volumetric Tomography images (DVT).Materials and Methods: A total of 510 maxillary teeth from 85 patients were classified according to their topographic relationship to the maxillary sinus and measured according to their projection lengths on the sinus cavity using OPG and DVT modalities.Results: In cases of classification 0, 85% and in classification 1 , 55.3% cases shows similar classification in both OPG and DVT. 28.5% of cases in both imaging modalities show classification 2. Only 15.9% of teeth roots exhibits classification 3. 11.1% of cases showed classification 4.The panoramic radiograph showed a statistically significant 2.24 times longer root projection on the sinus cavity in OPG comparison to DVT images.Conclusion: Teeth roots projecting in to the sinus in OPG, shows no vertical protrusion in to the sinus in DVT images. Hence DVT was better than OPG with measurements that were more exact and closer to anatomical reality.Asian Journal of Medical Sciences Vol.8(1) 2017 26-31

BackgroundUnderstanding 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.MethodsThis 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.ResultsOverall, 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.ConclusionsMaxillary 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.