Association between Cone-Beam Computed Tomography and Histological and Immunohistochemical Features in Periapical Lesions Correlated with Thickened Maxillary Sinus Mucosa

Abstract

Background and Objectives: Odontogenic sinusitis is a frequently underestimated pathology with fewer symptoms in patients with periapical lesions, periodontal disease, or iatrogenic foreign bodies in the maxillary sinus. The aim of our study was to determine the correlation between maxillary sinusitis and periapical lesions using cone-beam computed tomography (CBCT) imaging and histological and immunohistochemical investigations. Materials and Methods: A total of 1450 initial patients diagnosed with maxillary sinusitis in the Ear-Nose-Throat (ENT) Department, University of Medicine and Pharmacy “Grigore T. Popa” Iasi, Romania, were treated with anti-inflammatory drugs. Of these, 629 still had unresolved symptomatology and were later referred to the Dental Medicine departments for further investigations. Only 50 subjects with periapical lesions in the premolar/molar maxillary area were included in the present study. All the periapical lesions were observed on CBCT and classified using the Periapical Status Index (PSI) and the mean maxillary sinus mucosa thicknesses (MSMT). The enrolled patients underwent surgical procedures with the excision of periapical lesions. The excised samples were submitted to the histological and immunohistochemical investigations. Results: The 50 patients presented periapical lesions of their maxillary teeth in 328 dental units. There was a higher prevalence of periapical lesions in men than in women (chi-square test). We observed a significant difference between the mean MSMT of individuals with periapical lesions compared to those without (p < 0.01). Mean MSMT was 1.23 mm for teeth without periapical lesions and 3.95 mm for teeth with periapical lesions. The histopathological study identified 50% cases with periapical granulomas, 10% cases with periapical granulomas with cystic potential, and 40% cases as periapical cysts. Immunohistochemical stainings showed that CD4+ helper and CD8+ cytotoxic T lymphocytes, along with CD20+ B lymphocytes and CD68+ macrophages, were diffusely distributed in all periapical cysts and in some periapical granulomas, but CD79α+ plasma cells characterized especially periapical granulomas. Conclusions: The current study observed a significant correlation between CBCT maxillary mucosa thickness and type of periapical lesion. Chronic inflammatory lympho-histiocytic infiltrate predominates in periapical lesions, supporting the idea that lesion progression is determined by a humoral-type (CD20+ and CD79α+ B lymphocytes) but also by a cellular-type (CD4+ and CD8+ T lymphocyte population) immune mechanism.

Prevalence of Incidental Maxillary Sinus Anomalies on CBCT Scans: A Radiographic Study

“…Conversely, maxillary sinusitis can sometimes cause referred pain to the upper back teeth, making it difficult to pinpoint the exact source of the discomfort. Not all cases of periapical lesions lead to maxillary sinusitis, and not all cases of maxillary sinusitis are caused by dental infections [ 33 ]. Proper diagnosis and treatment by dental and medical professionals are crucial to effectively differentiate and manage these conditions.…”

Assessment of Bone Height Changes Based on the Cone–Beam Computed Tomography Following Intentional Replantation for Periodontally Compromised Teeth

“…In this study, most preoperative symptoms, including pain, mobility, PD, and BOP, decreased significantly, and the patients showed no occurrence of generalized root resorption, no evidence of periapical rarefaction, and no presence of slight localized evidence of root resorption. According to one previous study, the presence of periapical lesions is correlated with the maxillary sinus mucosa thickness (MSMT) [ 39 ]. In Figure 4 A,B,E,F, the MSMT decreased after the IR procedure.…”

Odontogenic Sinusitis: From Diagnosis to Treatment Possibilities—A Narrative Review of Recent Data

“…The causes for the production of OS may be due to [ 12 , 13 , 16 , 24 , 25 , 26 , 27 ]: infectious causes—dental and periodontal pathology: dental caries, endodontic infection caused by deep carious processes that develops with pulp and periapical complications and sometimes through complex endoparodontal lesions with an infrabony periodontal pocket as a starting point; iatrogenic causes—the most common cause of OS (55.97%): incorrectly performed sinus lift procedures, dental implants with dimensions and insertion axis not adapted to the individual clinical features, foreign bodies (perforations during endodontic treatments, overfilling of root canals beyond the apex with filling materials such as zinc-oxid eugenol or gutta percha), dental extractions with or without pushing a fragment of the root into the sinus cavity, orthognathic surgery, labio-palatine cleft surgery, Le Fort osteotomies; odontogenic cysts with sinus involvement; traumatic injures of the maxillary bone; tumoral—in the case of neoplasms. …”

“…There are many ways in which infection can reach the tooth apex. For example, deep complicated cavities that affect the dental pulp causing pulpitis and then periapical infections or through severe periodontal disease that spreads along the infrabony pocket and can even lead to secondary endodontic lesions [ 26 , 31 ]. If the infectious process is in contact with the Schneiderian membrane, it can lead to its inflammation, hypertrophy, and even rupture, causing the release of pro-inflammatory factors that cause edema, fibrosis, and cystic degeneration.…”