Multi-structure segmentation in CBCT volumes: The ToothFairy2 challenge.

In situ repair of a fractured zygomatic implant.

Changing epidemiology of sinonasal cancer in the United States.

Sex determination from skeletal remains is a critical step in forensic identification, particularly when remains are fragmented. Forensic odontology contributes significantly through dental morphometric and non-morphometric assessments, both of which exhibit sexual dimorphism. However, reported accuracy varies, and findings remain inconsistent. This systematic review and meta-analysis aimed to evaluate the reliability of dental parameters for sex estimation. A comprehensive search of seven databases (PubMed, Scopus, EBSCO, Web of Science, Taylor & Francis, Wiley Library, and MDPI) was conducted in accordance with PRISMA guidelines (PROSPERO ID: CRD420251091284). Eligible studies were cross-sectional, published in English within the past 10 years, and assessed sex using dental morphometric or non-morphometric methods. Forty-six studies involving 8,053 individuals (4,059 males; 3,994 females) met the inclusion criteria. Of these, 44 assessed morphometric parameters and 4 assessed non-morphometric parameters. Mandibular and maxillary measurements were the most frequently analyzed and consistently demonstrated significant dimorphism (p < 0.05), whereas maxillary sinuses and palatal index showed no significance. Additional morphometric predictors included crista galli, mental foramen, and mastoid triangle. In contrast, pooled non-morphometric analyses involving 3,262 samples showed no significant association with sex estimation (p = 0.70). Overall, morphometric measurements provide more accurate and reliable tools for forensic sex determination than non-morphometric approaches. Further research is needed to validate non-morphometric parameters and address population heterogeneity in forensic applications.

This case report describes a rare presentation of bilateral intraoral sinus tracts of odontogenic origin associated with a maxillary right first molar (Universal #3). A key diagnostic challenge was differentiating an endodontic infection from vertical root fracture (VRF) in a previously treated tooth; no J-shaped probing defect was detected. The tooth was managed with single-visit nonsurgical root canal retreatment, resulting in symptom resolution and progressive radiographic healing. At nine-month follow-up, both sinus tracts had completely resolved, and the tooth remained asymptomatic and functional.

This study aims to propose an improved maxillary resection technique preserving Schneider's membrane and evaluate its clinical value in postoperative bone regeneration, complication control, and functional recovery. This study included 17 patients who were randomly divided into a modified group (with Schneiderian membrane preserved, n = 8) and a traditional group (n = 9). We compared the two groups on bone regeneration in the maxillary sinus floor after surgery, complication rates (oronasal fistula and empty nose syndrome), and functional recovery. After surgery, clear bone regeneration was seen in all patients in the modified group (bone height 1.89 ± 0.16mm, volume 614.30 ± 58.73mm³). The traditional group showed no effective bone regeneration (p < 0.001). None of the patients in the modified group developed oronasal fistula or empty nose syndrome. The modified group also had significantly better outcomes than the traditional group in postoperative bite force (180.63 ± 16.23N vs. 92.22 ± 29.75N, p = 1.8 × 10⁻⁶), swallowing function grade(2.75 ± 0.46 vs. 2.11 ± 0.33,p = 0.003) and total UW-QOL score (77.75 ± 5.56 vs. 66.11 ± 6.48,p = 0.001). This method reduces complication rates and improves functional recovery and quality of life. The modified technique leverages the bone-forming potential of the mucosa, enabling immediate closure of the oral-nasal communication and promoting gradual bone regeneration. This approach represents a conceptual shift from simple lesion removal toward functional and structural reconstruction, offering new possibilities for function preservation and structural restoration after maxillary tumor resection. Furthermore, given the small sample size of this study, subsequent validation in larger prospective studies could further facilitate its broader clinical application. Trial was retrospectively registered at clinicaltrials.gov [NCT07320417/2025-12-22].

ObjectivesSinonasal metastases are far rarer than primary sinonasal malignancies, hence seldom reported or analyzed in existing literature. To address these gaps, we have retrospectively analyzed 35 patients with sinonasal metastasis in a single university hospital in South Korea, over a 24-year period.MethodsFrom 1998 to 2022, among 11,814 pathology reports of sinonasal tissues, 35 (0.3%) were identified with sinonasal metastasis from solid organ cancers. Patients' clinical characteristics, presentation, primary tumor profiles, treatment modalities for the sinonasal metastasis, and overall survival (OS) were retrospectively reviewed and analyzed, in addition to the literature review.ResultsHepatocellular carcinoma (HCC) was the most common primary cancer (37.1%), followed by lung (14.3%), breast (11.4%), and thyroid (8.6%). The most common presentation was epistaxis (20%), however, 20% were identified incidentally. The nasal cavity (37.1%), sphenoid and maxillary sinus (31.4%), and skull base (34.3%) were the most prevalent metastatic locations. Although the median OS following a sinonasal metastatic diagnosis was 7.0 months, patients with isolated sinonasal metastasis, thyroid cancer- metastases, or definitive therapy for sinonasal metastasis had significant longer OS (p=0.037, 0.035, and p-trend=0.003, respectively).ConclusionIn our study, HCC was the most common primary cancer for sinonasal metastasis, contrasting with renal cell carcinoma prevalence in Western literature, suggesting that regional cancer incidence variations may influence sinonasal metastasis epidemiology. Despite the poor prognosis in general, in selected patients with thyroid cancer or solitary sinonasal metastases, the definitive treatment for the sinonasal metastasis may aid in an increased duration of survival.

Edentulism, a common condition, may be congenital or acquired later in life as a result of dental caries, periodontitis, aging, craniofacial trauma, or tumor resection. The rehabilitation of missing teeth can be achieved with dental implants. In cases of insufficient alveolar bone, several treatment options have been described in the literature, including maxillary sinus augmentation with bone grafting, the Le Fort I osteotomy, the angulated placement of conventional implants, and the use of specialized implants, such as zygomatic implants, which are anchored in the zygomatic bone. The aim of this retrospective study was to compare 2 surgical approaches - intrasinus and extrasinus - for the placement of zygomatic implants in patients with severe maxillary atrophy. The study was based on the medical records of patients who underwent zygomatic implant treatment conducted by the same surgeon at 2 dental facilities in Poland between 2004 and 2021. A total of 190 zygomatic implants placed in 69 patients of varying age and sex were included in the analysis. The follow-up period was 5 years. Two surgical approaches for zygomatic implant placement - intrasinus and extrasinus - were evaluated. Statistical analysis was performed using a significance level of 0.05. Differences between the groups were assessed using the χ2 test or Fisher's exact test, as appropriate. The zygomatic implants placed using the intrasinus approach demonstrated a 100% survival rate. In the extrasinus group, the osseointegration rate was 94.27%, with implant loss occurring in 7 patients. Maxillary sinusitis was observed in 7 patients. Soft-tissue atrophy occurred in 4 patients (8.33%) and involved 14 zygomatic implants placed using the extrasinus technique. Cutaneous fistulas developed in 2 patients treated with the extrasinus approach. One case of zygomatic bone fracture was reported in the extrasinus group. No statistically significant differences in the complication rates were observed between the intrasinus and extrasinus techniques for zygomatic implant placement. Both approaches appear to be equally effective for the rehabilitation of patients with severe maxillary atrophy.

A case of a patient with left maxillary molar pain unresponsive to standard dental treatment is presented. Advanced imaging revealed an aggressive lesion in the maxillary sinus with associated bone destruction, soft tissue extension, and diffusion restriction suggestive of malignancy. The lesion was subsequently confirmed as maxillary sinus carcinoma. This case highlights the diagnostic challenges associated with nonspecific temporomandibular disorder-like symptoms and emphasizes the importance of recognizing red flags as prompts for cross-sectional imaging and specialist referral, which are essential for ensuring an accurate diagnosis and improving clinical outcomes in patients with atypical or refractory orofacial pain.

Periodontal bone loss (PBL) is a traditional metric for periodontitis, but its ability to reflect the total regional inflammatory burden in the posterior maxilla is limited. This study aimed to develop and internally validate a preliminary cumulative odontogenic score (COS) by integrating periodontal and endodontic parameters to characterize their combined association with maxillary sinus membrane thickening (SMT). This retrospective cross-sectional study analyzed 1,056 dentate maxillary sinuses from 562 patients. Odontogenic variables, including PBL severity, endodontic treatment history, and periapical lesions, were assessed using cone-beam computed tomography (CBCT). Multivariable logistic regression using generalized estimating equations (GEE) was performed to identify independent factors associated with SMT (> 2mm). A COS (range 1-7) was derived from weighted β regression coefficients. Classification performance was evaluated through ROC analysis, calibration plots, and bootstrapping (1,000 resamples). SMT was prevalent in 46.3% of sinuses. PBL, periapical lesions, and endodontic treatment were all independent contributors to SMT (p < 0.001). The COS demonstrated significantly superior classification performance compared to PBL alone (AUC 0.718 vs. 0.602; p < 0.001) and exhibited adequate calibration (slope = 1.00). Internal validation via bootstrapping confirmed the stability of the associations. Each one-point increase in the COS was associated with a 30% increase in the odds of SMT. Using a clinically relevant threshold of COS > 3, the prevalence of SMT in the high-COS group was nearly double that of the low-COS group (59.9% vs. 30.5%). Integrating periodontal and endodontic conditions into a unified scoring framework provides a more adequate characterization of the dental-sinus association than individual parameters. The internally validated COS offers a structured approach for preoperative radiographic evaluation and can function as a preliminary cross-sectional risk categorization score to characterize interdisciplinary associations in the posterior maxilla.

Spontaneous rupture of primary liver tumors is a well-recognized and potentially life-threatening complication of hepatocellular carcinoma, whereas rupture of metastatic liver tumors is rare. We report the case of a 60-year-old woman with spontaneous rupture of liver metastasis from a mucosal melanoma, a rare subtype of malignant melanoma. Intraperitoneal bleeding was controlled by transcatheter arterial embolization, and liver tumor biopsy confirmed metastatic melanoma. The maxillary sinus was identified as the primary site. Based on the clinical course, the liver metastases appeared over a short period and progressed rapidly. In addition, contrast-enhanced computed tomography (CT) performed immediately before rupture showed overall poor but heterogeneous enhancement of the ruptured tumor, with a tortuous dilated intratumoral vessel penetrating the lesion. Three-dimensional CT angiography reconstructed from this CT dataset demonstrated that the penetrating vessel represented a tumor-feeding artery, which was morphologically more consistent with a pre-existing hepatic vessel altered by tumor progression than with a newly formed tumor neovessel. Although rare, rupture of metastatic liver tumors may be associated with rapid tumor growth. Importantly, a tortuous dilated intratumoral vessel identified on pre-rupture CT may represent an imaging feature associated with tumor fragility and impending rupture.

Maxillofacial fractures and ocular trauma are significant injuries in soccer, with potential functional, aesthetic, and visual consequences if unrecognized. Few reviews have specifically examined both injury patterns in this sport. The purpose of this narrative review is to synthesize the current literature to identify injury patterns associated with maxillofacial fractures and ocular trauma in soccer, thereby aiding clinicians in timely diagnosis and management. Given the heterogeneity and limited quality of the available evidence, this review also highlights areas where further research is needed. The zygoma was the most commonly fractured maxillofacial bone in soccer (32.8%), followed by the nasal (28.4%), mandibular (25.8%), orbital (6.5%), maxillary (3.6%), and frontal sinus (2.8%) regions. Among mandibular fractures, the angle was the most vulnerable site, accounting for 39.2% of cases. Head-to-head contact was the most frequent mechanism resulting in injury; however, although less common, arm or elbow impacts were more likely to result in fracture when they occurred. Ocular injuries most often present as orbital or eyelid contusions and lacerations (37.1%) and hyphemas (19.5%), with direct ball impact as the primary cause. Boys (60.4%-69.5%) were at greater risk than girls for ball sport-related ocular trauma, particularly those aged 2-9years, with soccer being the leading sport implicated. Overall, these trends are based largely on small case series, reflecting the low quality of available evidence. The zygoma is the most frequently fractured maxillofacial bone, typically resulting from head-to-head collisions. Direct soccer ball impact accounts for most ocular injuries in this sport, with orbital or eyelid contusions and lacerations most common, followed by hyphemas. Pediatric players may be particularly susceptible to soccer-related ocular trauma, possibly due to an underdeveloped orbital rim. Fundoscopic examination is essential after ball impact to detect vitreoretinal injury, even when visual acuity is normal. Further well-designed studies are needed to confirm these findings.

Conventional middle meatal antrostomy has limitations in surgical accessibility and may be associated with postoperative stenosis. Alternative approaches that improve access to the maxillary sinus while maintaining long-term patency are therefore needed. This study aimed to evaluate the safety and efficacy of a novel technique, translacrimal antrostomy (TLA). Unlike standard middle meatal antrostomy (MMA), TLA involves the removal of the inferior lacrimal bone to facilitate access to the anterior maxillary recesses. A retrospective review was conducted of 64 patients (81 sinuses) who underwent TLA at Seoul National University Hospital between March 2019 and January 2022. For comparison, 35 patients who underwent conventional MMA during the same period were also reviewed. Postoperative patency, mucosal status, and complications were evaluated at 1, 3, and 6 months using validated endoscopic criteria by 2 independent rhinologists. Indications for TLA included noninvasive fungal sinusitis (38%), odontogenic sinusitis (7%), and chronic rhinosinusitis (54%). Postoperatively, 85.2% of sinuses remained patent without narrowing, 74.1% demonstrated no mucosal edema, and 80.2% showed no discharge. The chronic rhinosinusitis group exhibited higher rates of mucosal edema and polypoid changes compared with the fungal sinusitis group (P=0.014). No postoperative epiphora, numbness, or epistaxis was observed. The mean procedural time was 5 minutes 11 seconds (±1.10min). Compared with conventional MMA, the TLA group demonstrated a lower incidence of postoperative mucosal edema (9.7% versus 34.2%, P = 0.050). In conclusion, TLA is a safe and effective procedure that allows additional access to the maxillary sinus.

This systematic review aimed to consolidate the clinical presentation, diagnostic and microbial findings, management approaches, and outcomes of maxillary sinus involvement caused by extruded endodontic filling materials. Searches were performed in PubMed, Web of Science, Embase, Scopus, ScienceDirect, and ProQuest up to August 2025. Observational studies reporting extrusion of filling material into the maxillary sinus, accompanied by clinical, imaging, and/or surgical descriptions, were included. Study quality was critically analyzed using the Joanna Briggs Institute tools. Of 4076 articles initially retrieved, 52 were selected for full-text reading, 39 met the inclusion criteria and were included, comprising 34 case reports and 5 case series. Maxillary first molars were the most frequently involved teeth (59%). Extrusion occurred predominantly during primary endodontic treatment. Filling material was identified in the left maxillary sinus in 21 cases (47%) and in the right maxillary sinus in 24 cases (53%). Clinical presentations ranged from incidental asymptomatic findings to severe manifestations such as acute sinusitis. In the included studies, diagnosis was established using radiographic and tomographic imaging as well as direct endoscopic evaluation. Surgical removal represented the most common definitive management approach. Clinical outcomes were predominantly favorable, with complete symptom resolution and functional recovery. Extrusion of endodontic filling materials into maxillary sinus most often involves maxillary first molars and is associated with clinically significant complications, particularly fungal sinusitis. The present findings emphasize the need for prevention, accurate diagnosis, and timely interdisciplinary care of this iatrogenic event.

BackgroundMisdiagnosis on radiographic examination is a significant risk for dentists and medical practitioners. This review focuses on an anatomical variation of the maxillary sinus that can mimic a radicular (periapical) cyst. Knowledge of morphological variations, their prevalence, and the radiographic criteria distinguishing these variations from true lesions is essential to ensure accurate diagnosis and appropriate treatment and to prevent unnecessary or potentially harmful interventions.ObjectiveThe aim of this study was to perform a systematic literature search of published cases and to present a clinical case illustrating a specific maxillary sinus variant, an enlarged sinus with a prominent alveolar recess that can mimic a periapical cyst on radiographs.MethodsAfter defining specific MeSH terms, a systematic literature search was conducted across three databases: Web of Science, PubMed, and Embase. Relevant articles reporting on enlarged maxillary sinuses with alveolar recesses resembling radicular cysts were identified and analyzed.ResultsFour articles describing the presence of an enlarged maxillary sinus with an alveolar recess resembling a periapical cyst were extracted from the literature.ConclusionKnowledge gaps regarding the alveolar recess of the maxillary sinus remain in the literature and should be addressed to avoid misdiagnosis. The findings also underscore the importance of three‐dimensional imaging, such as CT or CBCT, for accurate detection of this anatomical variant.

Maxillary sinus volume (MSV) influences sinus floor elevation, dental implant planning, and rhinologic decision-making. Anatomic variants [nasal septal deviation (NSD), concha bullosa (CB), maxillary sinus septa (MSS)] and mucosal thickening (MT) may alter aeration/ventilation and, consequently, MSV; prior reports are mixed. To compare MSV among normal, NSD, MSS, inferior concha bullosa (ICB), and mucosal thickening (MT >2mm) groups in an Iraqi CBCT cohort. A retrospective cross-sectional study of 200 adult CBCT scans obtained for dentomaxillofacial indications (2020-2025) at a tertiary center in Baghdad (5 independent groups; n=40 each). Reporting follows STROBE guidelines. Bilateral MS were segmented in OnDemand3D and averaged per subject (cm3). Assumptions were checked (Shapiro-Wilk; Levene). Given non-normality and heteroscedasticity, Welch ANOVA was the primary test; Games-Howell handled pairwise contrasts; Dunnett (two-sided) compared each variant versus normal. Effect sizes: partial η2, ω2, and Hedges g (95% CI). Assumptions were violated (Shapiro-Wilk P<0.05 in 4/5 groups; Levene P<0.001). Welch ANOVA showed a large between-group effect [F(4,≈96.41)=45.85, P<0.001; η2≈0.468; ω2≈0.456]. Mean MSV (cm3): ICB 15.05, MSS 14.17, normal 13.95, NSD 13.08, MT 12.08. Games-Howell: ICB>all and MT<all (all P<0.001); NSD<normal (Δ=0.88cm3, P=0.003); MSS≈normal (Δ=0.22cm3, P=0.91). Largest standardized contrast: ICB versus MT g=2.50. In this Iraqi CBCT cohort, ICB presented the largest MSV and MT the smallest; NSD showed a modest reduction versus normal, while MSS did not differ. A ventilation-pathway model (ostium/infundibulum geometry and mucosal disease) better explains volume differences than variant labels alone.

The present study aims to examine and classify the localization of canine teeth impacted in the maxilla for various reasons, their relationship with adjacent structures, and the developing pathologies by using cone beam computed tomography (CBCT). CBCT images taken for various reasons from 175 patients with maxillary impacted canine teeth that met the research criteria were examined. Demographic characteristics of the patients such as age and gender were recorded. The maxillary impacted canine teeth were examined by using CBCT in terms of their locations, relationship with the maxillary sinus, nasal floor and nasopalatine canal (NPC), relationship with adjacent teeth and the associated pathologies. A total of 209 maxillary impacted canine teeth of 175 patients were examined. Of the patients included in the study, 37.3% were male, while 62.7% were female. The mean age was found as 35 (age range 18-70). The rate of unilateral impacted canine teeth was 67.5% and 52.6% of the canine teeth were found to be located on the right side of the maxilla. Canine teeth were palatally impacted in 79% and 89% were found to be in a mesioangular position. The rate of canine teeth associated with the nasal cavity floor was found to be 7%, the rate of canine teeth with roots extending into the maxillary sinus was 6%, and the rate of canine teeth associated with NPC was found to be 15%. When the relationship of maxillary impacted canine teeth with the surrounding anatomical structures was examined, maxillary impacted canine teeth of male were found to have a higher relationship with the nasal cavity floor. The rate of pathologies associated with maxillary impacted canine teeth was found to be 22.5%. The most common pathologies were intracoronal resorption in maxillary canine teeth (8%) and root resorption in lateral incisors (7%). The results of the present study show that maxillary impacted canine teeth can remain for many years without causing pathology. However, it is crucial to evaluate them comprehensively by using CBCT when orthodontic or surgical intervention is planned.

Effect of Le Fort I osteotomy on the sinonasal region: three-dimensional study.

Although minor apical extrusion of calcium silicate-based sealers is relatively common, massive extrusion into the maxillary sinus is rare and may lead to severe complications when vital anatomical structures are involved. This case is notable for presenting palatal bone necrosis associated with calcium silicate-based sealer extrusion into the maxillary sinus in an adolescent, requiring staged surgical management. A 14-year-old female was referred one week after root canal treatment with severe spontaneous pain, palatal bone exposure, swelling, and purulent discharge. Radiographic and cone-beam computed tomography examinations revealed extensive extrusion of calcium silicate-based sealer into the maxillary sinus. Initial medical management included antibiotics, chlorhexidine mouthwash, saline irrigation, and analgesics. After symptomatic improvement, necrotic palatal bone was removed via local debridement. A lateral window sinus surgery was subsequently performed to eliminate the extruded material and associated granulation tissue while preserving the Schneiderian membrane. Two months later, nonsurgical endodontic retreatment was completed. Follow-up imaging demonstrated gradual resorption of the residual sealer and complete symptom resolution. Within the limitations of this case report, it can be concluded that massive extrusion of calcium silicate-based sealers-despite their recognized biocompatibility-may cause destructive complications when displaced into the maxillary sinus. Early diagnosis, appropriate surgical intervention, and careful endodontic retreatment are essential for successful outcomes. Preventive measures, including accurate working-length determination and controlled obturation pressure, remain critical to avoiding such adverse events.

Chronic sinonasal mucoceles are benign expansile lesions caused by obstruction of sinus drainage, resulting in mucus accumulation and potential complications including nasal obstruction, facial pain, and visual disturbances. While their clinical aspects are well-characterized, detailed histopathologic descriptions remain limited. We conducted a retrospective clinicopathologic analysis of six patients treated for chronic sinonasal mucoceles between 2014 and 2024. Clinical data, imaging studies (computer tomography (CT) and magnetic resonance imaging (MRI)), endoscopic findings, and histopathologic features were reviewed. The cohort included four male patients and two female patients (age range: 31-85 years, mean: 61 years). Five patients presented with rhinologic symptoms; one was asymptomatic, with the lesion discovered incidentally. Anatomically, four muoceles (67%) involved the frontal-ethmoidal sinuses; the remaining two affected the sphenoid and maxillary sinuses, respectively. CT imaging revealed sinus opacification in five patients, with one showing marked mucosal and bony thickening. Histologically, all specimens exhibited collapsed fibrous walls with hyalinized stroma, sparse cellularity, and absent or denuded epithelium-finding consistent with late-stage changes from chronic pressure and reparative remodeling. Immunohistochemistry confirmed myofibroblastic differentiation of stroma cells. All patients underwent successful endoscopic management without recurrence. Chronic sinonasal mucoceles may present as pseudotumors with distinctive collapsed, hyalinized fibro-membranous walls, distinguishing them from early-stage lesions. Recognition of these characteristic histopathologic features, in conjunction with clinical and radiologic findings, is essential for accurate diagnosis and to avoid overtreatment. Endoscopic surgical management remains an effective treatment with excellent outcomes.