Abstract
Objective To determine the relationship between the height of the periapical lesions adjacent to the maxillary sinus and the thickness of the Schneider membrane evaluated with cone-beam tomography. Materials and Methods. The universe was made up of 2432 tomography scans and a sample of 976, by systematic random sampling, and took into account those that presented any of the variables and/or both. For the relationship analysis, the sample was distributed according to sex, maxillary side, and age; it was formed between 18 and 86 years, in age groups of 18–36 years, 37–48 years, 49–59 years, and 60–86 years. The quantitative variables of the statistic descriptive analysis, hypothesis tests, and Spearman correlation were recorded. Results A significantly low correlation (p < 0.010) was observed between the periapical lesions and the thickness of the Schneider membrane in women (rho = 0.38) and men (rho = 0.32); in the same way, a significantly low correlation was observed in the age groups of 18–36 years (rho = 0.27) and 37–48 years (rho = 0.28), while a significantly moderate correlation was observed in the age groups of 49–59 years (rho = 0.45) and 60–86 years (rho = 0.44), and with respect to the sides, a significantly low correlation (rho = 0.28) was obtained for the right side and a significantly moderate correlation (rho = 0.45) was obtained on the left side. Conclusion We found that the height of the periapical lesions and the thickness of the Schneider membrane are significantly related according to age, sex, and maxillary side, this relationship being accentuated at an older age and on the left side.
Highlights
Another advantage of using tomographies is that we can make exact measurements of the findings and make statistical analysis without risk of obtaining biases. is is why this research aims to evaluate whether or not there is a correlation between Schneider membrane and adjacent periapical lesions using cone-beam tomography as an instrument because SM is richly vascularized at the level of its own lamina, presenting cells of the connective tissue that could react with inflammatory chemical mediators that in turn stimulate plasma extravasation of the blood vessels below the epithelium, causing a thickening of SM
Among the studies that found a significant correlation between the thickening of the Schneider membrane and the periapical lesions, we have that of Aksoy and Orhan [1] because they demonstrated a direct relationship between both variables associated with age, sex, and teeth missing; Nunes et al [3] showed in their study that the posterior teeth with periapical lesions had the highest frequency of sinus anomalies, Sheikhi et al [5] in their study showed that Schneider’s membrane thickening was directly related with periapical bone loss, and Shanbag et al [6] in their study concluded that the thickening of the Schneider membrane is significantly related to periapical lesions more frequently in the male sex
Aksoy and Orhan [1] evaluated tomography scans of 294 patients and determined that the thickening of the sinus mucosa was greater than 2 mm with periapical lesions coinciding with the values obtained in this study because values greater than 3 mm were obtained for both sexes; on the other hand, Aksoy and Orhan [1] obtained a significant correlation between SM and PL thickening according to age and sex, differing with this study because it was determined that if there is a correlation between LP and MS, but this is not significant for the sex variable, it coincides as to the moderate correlation for age for the groups of 48–59 and 60–86 years
Summary
Schneider’s membrane involvement may be due to different factors; in several studies, periapical lesions have been identified as the main cause of this [1,2,3,4,5,6]. is can be observed by means of auxiliary examinations, such as conebeam tomography, in such a way that if we find periapical lesions (PL) adjacent to the maxillary sinus; in many cases, they produce some alteration directly to Schneider membrane (SM), and this relation can even be observed clinically in the patient as is the case of sinusitis as a result of an infectious complication of the periapex. e most frequent diseases affecting the maxillary sinus are acute rhinosinusitis (ARS), chronic rhinosinusitis (CRS), pseudocyst, retention cyst, and mucocele. e persistence of the chronic inflammation can promote an epithelial damage with metaplastic changes, epithelial shedding, loss of ciliated cells, and increase of goblet cells, leading to an impaired function [7].in everyday clinical practice, mucosal thickening of the maxillary sinus is a common radiographic finding in asymptomatic patients; mucosal lining of more than 4 mm is considered to be pathological [8].
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