Maxillary Posterior Teeth Research Articles

Evaluation Of The Frequency, Localization And Relationship Of Maxillary Sinus Pathologies With Dental Pathologies By Cone Beam Computed Tomography (CBCT)

Background: The proximity of the root tips of the maxillary posterior teeth to the maxillary sinus causes odontogenic infection to become a potential source of maxillary sinusitis. This study aims to evaluate the relationship between dental pathologies and maxillary sinus abnormalities using cone beam computed tomography (CBCT). Material and Method: In this study, 300 patients who applied to our clinic for any reason 600 maxillary sinus cone beam computed tomography images of the patient were analyzed retrospectively. Maxillary sinus diseases and dental pathologies categoized among themselves. Results: The age of all patients ranged between 18 and 77 years, with a mean age of 41.38 (±14.39) years. No pathology was detected in 359 (59.8%) of the maxillary sinuses examined which were considered healthy sinuses. The most common pathology in 241 (40.2%) of the maxillary sinuses in the imaging area was mucosal thickening (MT). A statistically significant relationship was detected between teeth with periapical lesions (PL) and MT (p<0.05). No statistically significant relationship was found between restorative applications, oro-antral fistula (OAF), periodontal bone loss (PBL), and maxillary sinusitis (MS) (p<0.05). Conclusion: Odontogenic infections and inflammatory events are the causes of maxillary sinus pathologies and may play a role in their formation. CBCT, maxillary posterior teeth and maxillary sinüs in demonstrating the relationship between and in the diagnosis of odontogenous sinus pathlogies is quite useful.

Clinical challenges of biomechanical performance of narrow-diameter implants in maxillary posterior teeth in aging patients: A finite element analysis.

This study evaluated the biomechanical performance of narrow-diameter implant (NDI) treatment in atrophic maxillary posterior teeth in aging patients by finite element analysis. The upper left posterior bone segment with first and second premolar teeth missing obtained from a patient's cone beam computed tomography data was simulated with cortical bone thicknesses of 0.5 and 1.0 mm. Three model groups were analyzed. The Regimen group had NDIs of 3.3 × 10 mm in length with non-splinted crowns. Experimental-1 group had NDIs of 3.0 × 10 mm in length with non-splinted crowns and Experimental-2 group had NDIs of 3.0 × 10 mm in length with splinted crowns. The applied load was 56.9 N in three directions: axial (along the implant axis), oblique at 30° (30° to the bucco-palatal plane compared to the vertical axis of the tooth), and lateral load at 90° (90° in the bucco-palatal plane compared to the vertical axis of the tooth). The results of the von Mises stress on the implant fixture, the elastic strain, and principal value of stress on the crestal marginal bone were analyzed. The axial load direction was comparable in the von Mises stress values in all groups, which indicated it was not necessary to use splinted crowns. The elastic strain values in the axial and oblique directions were within the limits of Frost's mechanostat theory. The principal value of stress in all groups were under the threshold of the compressive stress and tensile strength of cortical bone. In the oblique and lateral directions, the splinted crown showed better results for both the von Mises stress, elastic strain, and principal value of stress than the non-splinted crown. In conclusion, category 2 NDIs can be used in the upper premolar region of aging patients in the case of insufficient bone for category 3 NDI restorations.

Multilevel Modeling Analysis of Odontogenic Risk Factors and Nasal Septum Deviation Associated with Maxillary Sinus Mucosal Thickening: A Cone-Beam Computed Tomography Study.

(1) Background: In this study, the impact of odontogenic risk factors with nasal septum deviation on maxillary sinus mucosal thickening was assessed using Cone-beam computed tomography CBCT. (2) Methods: A total of 328 maxillary sinus regions from 164 patients (85 males and 79 females) were examined. Images were interpreted by dental specialists and Otolaryngologists. Coronal and sagittal sections were examined to assess the proximity of the root tips of posterior maxillary teeth (RPMT) to the maxillary sinus. The periodontal bone loss for all maxillary posterior teeth was also assessed. Consequently, maxillary sinus mucosal thickening (MT) was further classified into three gradings. Multilevel modeling regression analysis was used due to the hierarchical structuring of the data. Four models were developed, a null model with no factors, a model with tooth-level factors (RPMT, PBL, tooth condition, and root length), a model with patient-level factors (gender and nasal septum deviation), and a model with combined patient- and tooth-level factors. Regression estimates (AOR) and 95% confidence intervals (CIs) of individual and tooth factors were calculated. (3) Results: Multilevel regression analysis showed that RPMT was significantly associated with MT of maxillary sinus (p < 0.001), where patients who had RPMT > 0 had higher odds of MT of maxillary sinus. Tooth condition was also found to be significantly associated with MT of maxillary sinus, where teeth with failed RCT (p < 0.001) and teeth with restorations (p < 0.008) had higher odds of MT of maxillary sinus (AOR = 2.87, 95%CI 1.65, 4.42, AOR = 1.64, 95%CI 1.14, 2.36, respectively). (4) Conclusions: In order to plan preoperative treatment for maxillary posterior teeth, it is important to assess the anatomical relationship between the sinus floor and the root tips of the maxillary posterior teeth. Additionally, we establish a better understanding of the clinician before surgical intervention is conducted.

Comparison of alveolar bone morphology after expansion with hybrid and conventional Hyrax expanders.

To compare the buccal and palatal bone changes of maxillary posterior teeth produced by hybrid hyrax (HH) and conventional hyrax (CH) expanders in growing patients. A sample of 32 patients with posterior crossbites in the late mixed dentition was recruited and randomly allocated into two groups. Group HH was composed of 18 individuals with a mean age of 10.7 years (six female, 12 male) treated with a hybrid expander with two anterior parasagittal miniscrews. Group CH was composed of 14 individuals with a mean age of 11.4 years (six female, eight male) treated with a conventional Hyrax expander. Cone-beam computed tomography (CBCT) exams were obtained before expansion (T1) and after 11 months when the expander was removed (T2). Buccal and palatal bone plate thickness and height of maxillary posterior teeth were measured. Intergroup comparisons were performed using t or Mann-Whitney tests (P < .05). The CH group showed greater decreases of the buccal bone plate height (mean change: 1.27 mm) at the maxillary first premolars compared to the HH group (mean change: 0.11 mm, P = .001). No intergroup difference was found for changes in the buccal and palatal bone thickness. Hybrid expanders showed a tendency to cause less negative impact on the buccal bone plate height of first premolars compared to conventional Hyrax expanders. However, the difference was not clinically significant. Both hybrid and conventional Hyrax expanders are safe for the alveolar bone morphology in the late mixed dentition.

Evaluating anchorage loss in upper incisors during distalization of maxillary posterior teeth using clear aligners in adult patients: A prospective randomized study.

: To evaluate the effect of clear aligner treatment and differential sequence distalization of maxillary posterior teeth on anchorage loss in the upper incisors (U1s). : This study used lateral cephalometries and digital models of 12 patients treated with 33% sequential distalization (group 1, mean age: 22.9 ± 0.7 years, five males, seven females) and 12 treated with 50% sequential distalization (group 2, mean age: 25.83 ± 0.5 years, three males, nine females) acquired before and after distalization of upper second premolars (U5) and upper first molars (U6) and upper second molars (U7). The amount of distalization was determined as 2.5 mm in both the groups. Independent Samples t test was used to compare normally distributed parameters. Mann-Whitney U and Wilcoxon tests were used to compare parameters that were not normally distributed. : In both groups, the posterior teeth significantly moved by tipping distally and the U1s were displaced anteriorly. Increase in maxillary posterior transverse width (P < 0.001) and distopalatal rotation were observed in U5, U6, and U7 after distalization. It was also observed that U1 was significantly more proclined (1.82°; P < 0.001) and protruded (0.62 mm; P < 0.001), and the overjet (0.45 mm; P < 0.001) increased more in group 1 than in group 2. : After sequential distalization of maxillary posterior teeth, more anchorage loss was observed in the anterior region in group 1 than in group 2.

Periodontal Lesions among Maxillary Sinus Mucosal Thickening Visiting the Department of Oral Medicine and Radiology of a Tertiary Care Centre.

Maxillary sinus due to its proximity to posterior maxillary teeth could be affected by their pathology. Since cone beam computed tomography is the go-to for 3-D imaging in dental set-up. This study aimed to find out the prevalence of periodontal lesions among maxillary sinus mucosal thickening visiting the Department of Oral Medicine and Radiology of a tertiary care centre. This descriptive cross-sectional study was conducted in the Department of Oral Medicine and Radiology of a tertiary care centre from 01 February 2021 to 30 June 2021 after obtaining ethical approval from the Institutional Review Committee. The medical records from 01 January 2019 to 31 December 2019 were retrieved. The identification of maxillary sinus mucosal thickening of more than 3 mm, in cone beam computed tomography images, was registered separately for the right and left sinuses of each patient. The presence of periodontal lesions of posterior teeth was recorded. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Among 195 maxillary sinus mucosal thickening, periodontal lesions were found in 74 (37.95%) (31.14-44.76, 95% Confidence Interval) maxillary sinuses of 46 patients. The mean age was 53.67±12.72 years and 30 (65.21%) were males. The prevalence of periodontal lesions among maxillary sinus mucosal thickening in CBCT images was similar to other studies done in similar settings. cone beam computed tomography; maxillary sinus; periodontal disease; prevalence.

Measuring Maxillary Posterior Tooth Movement: A Model Assessment using Palatal and Dental Superimposition.

Since the introduction of Invisalign by Align Technology, Inc. in 1999, questions and debates have persisted regarding the precision of Invisalign (clear aligner) therapy, particularly when compared to the use of traditional fixed appliances. This becomes particularly significant in cases involving anteroposterior, vertical, and transverse corrections, where precise comparisons are of paramount importance. To address these inquiries, this study introduces a meticulously devised protocol, placing a primary emphasis on digitally superimposing the movement of maxillary posterior teeth to facilitate accurate analysis. The sample included 25 patients who had completed their first series of Invisalign (clear) aligners. Four maxillary digital models (pre-treatment, post-treatment, ClinCheck-initial, and final models) were digitally superimposed using the palate rugae and dentitions as stable references. A software combination was used for model superimposition and tooth segmentation. Transformation matrices then expressed the differences between the achieved and predicted tooth positions. Thresholds for clinically relevant differences were at ±0.25 mm for linear displacement and ±2° for rotation. Differences were assessed using Hotelling's T-squared tests with Bonferroni correction. The mean differences in rotation (2.036° ± 4.217°) and torque (-2.913° ± 3.263°) were significant statistically and clinically, with p-values of 0.023 and 0.0003 respectively. De-rotation of premolars and torque control for all posterior teeth were less predictable. All mean differences for the linear measurements were statistically and clinically insignificant, except that the first molars seemed slightly (0.256 mm) more intruded than their predicted position. The clear aligner system appears to meet its prediction for most translational tooth movements and mesial-distal tipping in maxillary posterior teeth for non-extraction cases with mild to moderate malocclusions.

Endodontic Retreatment of Maxillary First Molar with Three Roots and Seven Canals: A Case Report

A 25-year-old female existing with mild pain and discomfort during mastication in her right posterior maxillary tooth. On clinical examination, the maxillary first molar tooth was restored with a composite filling. The tooth did not respond to heat or cold test, and it was tender to percussion. Radiograph examination revealed poor obturation of the canals and the periodontal ligament space was broad but there was no definitive periapical radiolucency. Conservative non-surgical root canal treatment was performed; a total of seven root canals were detected and they were obturated by using the calcium-based sealer. Radiograph with RVG and CBCT also confirmed that all seven canals were properly obturated. Twelve months later, there were no clinical or radiographic changes of the treated tooth. These findings suggested that careful examination of the floor of the pulp chamber with RVG and CBCT help to find extra root canals.

Comparison of plaque control record measurements obtained using intraoral scanner and direct visualization.

Intraoral scanner (IOS) can acquire three-dimensional color images of teeth. Thus, the detection of areas with plaque adhesion stained by plaque-disclosing solutions using an IOS could be a potential oral hygiene evaluation method. This study aimed to verify the usefulness of obtaining O'Leary's plaque control record (PCR) measurements using an IOS in clinical practice. Twenty patients with >20% PCR measurements who underwent oral prophylaxis were enrolled in this study. A plaque-disclosing gel was applied to stain the areas with plaque adhesion, and the dentition was scanned using the IOS. The PCR values obtained via the direct method and those obtained using the digital image were compared for the entire dentition, maxillary total area, the labial and palatal aspects of the maxillary anterior teeth, the buccal and palatal aspects of the maxillary posterior teeth, mandibular total area, the labial and lingual aspects of the mandibular anterior teeth, and the buccal and lingual aspects of the mandibular posterior teeth. The IOS group tended to have higher values than the direct observation group. The labial and palatal aspect of the maxillary anterior teeth, the labial and lingual aspects of the mandibular anterior teeth did not differ significantly between the groups. Plaque adhesion was visualized easily and conclusively using an IOS. As the large tip size often hinders its use, it is necessary to develop a smaller IOS tip in the future.

Prevalence and reasons for tooth extraction among adult patients attending the Teaching Hospital at College of Dentistry/ Mustansiriyah University

Materials and Methods: The present study included 2165 patients (2500 teeth were extracted) attending Oral Surgery clinic of the teaching hospital at College of Dentistry/ Mustansiriyah University during the period from October 2016 to May 2017. The patients’ ages ranged between (15-77 years). A standard case sheet for Oral Surgery clinic was filled with all the necessary information such as age, gender, tooth to be extracted and reasons of tooth extraction.&#x0D; Results: Dental caries and its complications were the primary cause of teeth extraction with (80.3%) followed by periodontal diseases (13.4) and other causes (6.4%). Tooth extraction due to dental caries was higher in males (59.2%) than females (40.8%). Tooth extraction due to periodontal diseases was also high in males (72.2%) compared to females (27.8%) with high significance (p= 0.000). In age groups 30-39 years and 40-49years, extraction due to dental caries was found equally high being 22.4%, while extraction due to periodontal diseases was high in age group ≥60 (38.3%) and in age group 50-59 (32.6%) with high significance (p = 0.000). Extraction of maxillary posterior teeth constituted (44.9%) and mandibular posterior teeth (37.8%), the posterior teeth were the most common teeth extracted because of caries, while mandibular anterior teeth (27.5%) followed by maxillary posterior teeth (26.6%) were the most common teeth extracted due to periodontal diseases with high significance (p = 0.000).&#x0D; Conclusion: Dental caries was the primary cause for tooth extraction followed by periodontal diseases. There was a significant correlation between the reasons for tooth extraction and the patient’s gender, age and tooth position. The study showed the need for a comprehensive preventive plans and effective educational campaigns to reduce the need for tooth extraction among adults and increase patient’s awareness toward better oral health status.

The Relation of Maxillary Posterior Teeth Roots to the Maxillary Sinus Floor Using Panoramic and Computed Tomography Imaging in a Sample of Kurdish People

The relation of maxillary posterior teeth roots to the maxillary sinus floor is important for diagnosing and planning of many surgical procedures. In order to determine of this relation two imaging technique were used in this study.Paired panoramic radiographs and computed tomography images of maxilla from 27 subjects were taken and analyzed in the teaching hospitals of Sulaimani city during the period from Jan to Aug 2009. For both imaging modalities a total of 146 maxillary teeth were grouped according to their topographic relationship to the inferior border of the maxillary sinus followed Kwak et al. classification, were 0 indicated no contact between the root and inferior border of the maxillary sinus); 1 indicated that the root is in contact with the inferior border of the maxillary sinus; 2 indicated that the root is projecting laterally on the maxillary sinus cavity but its apex is outside the sinus boundaries; 3 and 4 indicated that the teeth roots that projected on the maxillary sinus cavity. Then roots were measured according to their projection lengths in the sinus cavity.Results of this study show that there was a high correlation between the two imaging technique for classification 0 and 1 relations. The OPG showed statistically significant (P&gt;0.001) longer root projection in the sinus cavity in comparison with the root protrusion into the sinus measured by using CT images.As conclusion; for the majority of the roots projecting on the sinus cavity in panoramic radiographs, no vertical protrusion into the sinus was observed in CT images. Roots protrude into the sinus in the CT showed shorter projection length in comparison with panoramic radiography. Panoramic radiographs can provide adequate assessment about relation of the maxillary sinus floor. CT is indicated to provide the information about the relation to the maxillary sinus floor when there is protrusion detected in panoramic images.

Orthodontic Correction of an Anterior Open Bite with Periodontally Compromised Upper Incisors Using Miniscrews

This case report describes the camouflage treatment of a patient with an anterior open bite, bimaxillary skeletal protrusion with a mild class II skeletal pattern, reduced periodontium with generalized slight bone loss, localized severe bone loss at the maxillary upper incisors, and a tongue thrust habit. Orthodontic treatment included modifying the resting posture of the tongue and sectionally intruding maxillary posterior teeth while controlling the extrusion of mandibular posterior teeth using temporary anchorage devices (TADs), followed by sectional mechanics at the maxillary arch and continuous arch mechanics at the mandibular arch, along with interpromximal reduction at the mandibular teeth and inter-arch elastics from the mandibular teeth to the maxillary TADs to minimize orthodontic force magnitude and duration specifically applied to periodontally compromised maxillary incisors. The patient’s chief complaint was addressed, and treatment objectives were achieved, with good esthetic and occlusal outcomes. Stability was shown over a 56-month follow-up period.

Assessment of Stability of Early Loaded Nano Coated Hydroxyapatite Implants in Posterior Maxilla

Aim: The aim of the study was to assess the stability after early loading of nano coated hydroxyapatite implants in posterior maxilla. Methodology: This study was conducted on nine patients with at least a missing one maxillary posterior tooth. Ten Nano-coated hydroxyapatite implants (ETIII NH implant by Hiossen) were inserted in nine patients, and then subjected to early loading according to the secondary stability readings taken by Osstell®. Implant stability was measured at the time of implant insertion (T0), 4 (T1), 6 (T1 modified), weeks, and 4 months (T2) post-operative. Cone-beam computed tomography (CBCT) was performed in all patients before starting the treatment. Nine implants healed well except for one implant that failed due to infection. Results: Secondary stability results after 6 weeks of implant incretion were sufficient enough for implant loading, there was significant difference (F= 12.642, DF 3, P value &lt;0.001) among T0, T1, T1 modified, and T2. Conclusion: Nano-coated hydroxyapatite implants are of good choice in posterior maxilla and they can be early loaded.

Assessment of Relationship between Maxillary Sinus Floor and Maxillary Posterior Teeth Root Tips Position in a Sample of Egyptian Population using CBCT: An Observational Cross-Sectional Study

Assessment of Relationship between Maxillary Sinus Floor and Maxillary Posterior Teeth Root Tips Position in a Sample of Egyptian Population using CBCT: An Observational Cross-Sectional Study

Distribution of the intraosseous branch of the posterior superior alveolar artery relative to the posterior maxillary teeth.

Preoperative identification of the intraosseous posterior superior alveolar artery (PSAA) is critical when planning sinus surgery. This study was conducted to determine the distance between the cementoenamel junction and the PSAA, as well as to identify factors influencing the detection of the PSAA on cone-beam computed tomography (CBCT). In total, 254 CBCT scans of maxillary sinuses, acquired with 2 different scanners, were examined to identify the PSAA. The distance from the cementoenamel junction (CEJ) to the PSAA was recorded at each maxillary posterior tooth position. Binomial logistic regression and multiple linear regression were employed to evaluate the effects of scanner type, CBCT parameters, sex, and age on PSAA detection and CEJ-PSAA distance, respectively. P-values less than 0.05 were considered to indicate statistical significance. The mean CEJ-PSAA distances at the second molar, first molar, second premolar, and first premolar positions were 17.0±4.0 mm, 21.8±4.1 mm, 19.5±4.7 mm, and 19.9±4.9 mm for scanner 1, respectively, and 17.3±3.5 mm, 16.9±4.3 mm, 18.5±4.1 mm, and 18.4±4.3 mm for scanner 2. No independent variable significantly influenced PSAA detection. However, tooth position (b=-0.67, P<0.05) and scanner type (b=-1.3, P<0.05) were significant predictors of CEJ-PSAA distance. CBCT-based estimates of CEJ-PSAA distance were comparable to those obtained in previous studies involving cadavers, CT, and CBCT. The type of CBCT scanner may slightly influence this measurement. No independent variable significantly impacted PSAA detection.

Association between periapical odontogenic lesions and maxillary sinus mucosal thickening: A retrospective computed tomography analysis

Introduction: The maxillary sinuses are located in the middle of the nasal cavity and are thought to have the greatest air gaps. Cone-beam computed tomography (CBCT) imaging was used to characterize the radiographic connection between the apices of posterior maxillary teeth and the floor of the maxillary sinus. This study aims to evaluate the degree of apical periodontitis and the sinus mucosal thickness and find the associations between the patient’s age and gender and the degree of apical periodontitis with sinus mucosal thickness. Materials and Methods: A retrospective analysis of 364 individuals with maxillary sinuses which appears clearly within limited-field CBCT images was performed. It was also categorized and noted how the maxillary sinus floor related to the root tips and periapical lesions. In addition, the patient’s age gender, side, and level of apical periodontitis in relation to maxillary sinus mucosal (MSM) thickness were evaluated. Results: The MSM class and periapical index (PAI) were statistically significantly correlated (P 0.001). In comparison to respondents with PAI score I, respondents with PAI score V had 47.89 times the odds of having a higher MSM class (odds ratio [OR] =47.89, P = 0.05). Age and MSM thickening were not substantially correlated (P = 0.298), whereas gender and MSM thickening were strongly correlated (OR = 1.56, P = 0.05). Conclusions: The result of this study showed a clear association between the periapical lesions and MSM thickening.

A case report of incidental finding of compound odontoma on a panoramic radiograph

Objectives: The purpose of this case study was to report the compound odontoma’s founding in a panoramic radiograph. Case Report: An 11-year-old female patient came with her parents to the pedodontics of Dental Hospital Padjadjaran Bandung with the chief complaint of a palatal bite with an unerupted left maxillary posterior tooth. Then the patient took the panoramic and cephalometry radiographs to confirm the diagnosis. The result from the panoramic radiograph was that there were multiple radioopaques with a tooth-like structure contained, surrounded by a radiolucent band, and the lesion had a corticated, well-defined border. Radiodiagnosis has been established as a compound odontoma associated with an unerupted maxillary second premolar. Conclusion: Compound odontoma is a benign tumor that often occurs at the age of tooth development and often causes delayed tooth eruption. Panoramic radiographs as radiographic aids play a very important role in identifying these tumors.

Comparison of Commercially available denture teeth with available natural teeth dimensions among genders

Background: Selecting the artificial teeth is an art, every prosthodontist should learn the art to fulfill the esthetic and functional requirement of the patient. It gives a pleasing, expressive and confident life to the patient. Aim: To compare the dimensions of natural maxillary and mandibular anterior and posterior teeth with the dimensions of three commercially available denture teeth such as Acryrock,Biorock and Ivoclar Vivadent along with gender consideration. Materials and Methods: The length and width of the natural anterior and posterior teeth from dentate casts of 23 males and 77 females were examined by a single examiner using a digital vernier caliper on a straight line and using a flexible ruler . These dimensions were also measured in three denture teeth mold charts: Acryrock, Biorock, Ivoclar vivadent. The dimensions thus obtained are compared between the three systems of artificial teeth and natural teeth for selecting the best system of artificial teeth for complete denture prosthesis. Results: This present study concludes that the width of available natural maxillary anterior teeth matches with the dimensions of all the three commercially available denture teeth such as Ivoclar Vivadent, Acryrock, Biorock. But the mandibular anterior and posterior teeth of maxillary and mandibular dentate cast dimensions were matching only with the Ivoclar vivadent teeth set irrespective of the genders. Conclusion: From this study, the determination of the size of anterior and posterior artificial teeth using the natural teeth dimensions for fabrication of complete denture prosthesis was proved statistically and mathematically.

Case Report: Case report: Rapidly progressing tooth wear dominated by intrinsic and extrinsic erosion

Tooth wear is multi-factorial presenting as a combination of abrasion, attrition, and erosion. This case report represents a case of combined tooth wear in a 46-year-old Indo-Trinidadian male, with a predominant erosive component with both the clinical signs and features of intrinsic and extrinsic erosion. This patient case is unique since the wear predominated by dental erosion has occurred rapidly evidenced by the physical clinical appearance of a lack of compensation and the upper left premolars and molars relatively unaffected by the overall effects of tooth wear. This lack of compensation, where opposing teeth have not supra-erupted to maintain inter-arch stability, and the maintenance of occlusal vertical dimension on the left due to the non-worn posterior maxillary teeth, provides the benefit of simplifying subsequent restorative management. The medical and diet history corroborates the diagnoses of intrinsic and extrinsic erosion respectively. Complications noted with rapid tooth wear, such as dentine sensitivity and pulpal necrosis are known sequelae of tooth wear however the patient presented in this case report shows a concomitant high caries experience and poor oral hygiene. Cases such as the one presented here require not only comprehensive dental management, utilizing a restorative approach but also medical referral for confirmation of a diagnosis and management of gastroesophageal reflux disease. Inherent to the management of this patient should be a multidisciplinary medical and dental approach, with confirmation and management of the cause of the intrinsic erosion as well as restorative dental management, together with dietary counseling to mitigate the effect of intrinsic and extrinsic sources of acid on dental hard tissue. A key lesson learned from this case is the importance of history and targeted questioning when trying to determine the cause of tooth wear dominated by intrinsic and extrinsic erosion.

Evaluation of Association between Maxillary Posterior Teeth Periapical Pathologies and Maxillary Sinus Mucosal Changes—A Cone-Beam Computed Tomography (CBCT) Study

Abstract Introduction Odontogenic infections are one of the common causes of maxillary sinusitis. With the close proximity of the roots of maxillary posterior teeth to the sinus floor, the infection may spread into the sinus causing sinus mucosal thickening. This study aims to evaluate the association between maxillary posterior teeth periapical pathologies and maxillary sinus mucosal changes using cone-beam computed tomography (CBCT) images. Methods One-hundred six maxillary posterior teeth with periapical lesions were included in this study and were assessed using CBCT images by two maxillofacial radiologists. The proximity of the roots to the sinus floor, the proximity of the top edge of the periapical lesion to the sinus floor, and the sinus mucosal changes associated with the periapical lesions were studied. The size of the periapical lesion was measured and scored using CBCT periapical index. Mucosal thickening more than 2 mm was considered pathological and the type, pattern, and severity of mucosal thickening were assessed. Data were analyzed using chi-squared tests at a level of significance set at p-value less than 0.05. Results Among the 106 teeth with periapical lesions, 99 teeth (93.4%) revealed the presence of maxillary sinus mucosal thickening. The prevalence of mucosal thickening increased significantly with the presence of cortical bone destruction, the close proximity of the root, and the periapical lesion to the sinus floor. The generalized type of mucosal thickening was more prevalent with larger periapical lesions and a significant increase in the severity of the thickening was observed closer spatial relationship of the root to the sinus floor. Conclusion Periapical pathologies of maxillary posterior teeth often cause sinus mucosal thickening. The early diagnosis and management of these pathologies will be helpful in preventing the spread of infection into the maxillary sinus.