Correlation between maxillary sinus floor topography and relative root position of posterior teeth using Orthopantomograph and Digital Volumetric Tomography

Abstract

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.

Comparison of cone‐beam computed tomography and panoramic imaging in assessing the relationship between posterior maxillary tooth roots and the maxillary sinus: A systematic review

“…An OPG is usually sufficient in detecting when root tips are a distinct distance from the sinus. Lopes et al found 78% agreeance between both modalities when the root tip was a distinct distance from the sinus, and Kalkur et al found 85% agreeance in the same situation . Hassan found 56.1% correlation, and while this value is lower than the other studies, it represented the highest correlation between CBCT and OPG in this study.…”

“…Hassan found 56.1% correlation, and while this value is lower than the other studies, it represented the highest correlation between CBCT and OPG in this study. These results showed that OPG is accurate in assessing this relationship. Evidently, when the OPG shows a distinct distance between the roots and the sinus, it is unnecessary to order a CBCT.…”

“…Kalkur et al studied 510 teeth in total, where 133 were class 0, 189 were class 1, 101 were class 2, 51 were class 3, and 36 were class 4 . When CBCT showed class 0, OPG correctly identified 50 of these cases, but misidentified 51 as class 1 and 31 as class 3.…”

“…Shahbazian et al found that in second premolars, when OPG showed an intimate relationship with the sinus, the CBCT revealed that 63% of them were positioned laterally, and not actually in/contacting as suggested by the OPG . Kalkur et al found that when CBCT determined the tooth to be laterally projecting and not in the sinus, 87% of the OPG readings of the same teeth determined that the teeth projected into the sinus, which is incorrect . These results show a high level of disagreement between the two modalities when the root is laterally projecting over the sinus.…”

“…In this situation, the risk of sinus perforation during extractions or apicoectomy becomes high; therefore, it is important to identify this early, to plan effectively, and inform the patient of the risk of perforation. Kalkur et al found that out of 189 cases of touching the sinus, but not in it, OPG correctly identified 73, but misidentified 85 cases as being in the sinus . Hassan found only 26% agreement between the two modalities .…”