Odontogenic maxillary sinus disease: a cone-beam computed tomography surveillance

The odontogenic maxillary sinus disease (endo-antral syndrome; EAS) is directly related to the spread of endodontic infections from upper premolars and molars with necrotic pulp. Cone-beam computed tomography (CBCT) images proved to be a reference diagnostic aid for detecting the etiological relationship between chronic apical periodontitis and maxillary sinusitis. There were retrospectively evaluated a total of 109 CBCT images (47 males and 62 females) from a pool of CBCT scans taken for routine diagnosis and treatment planning in consecutive 353 patients. The CBCT images were acquired with Veraviewepocs 3D P (R100) equipment (J. Morita MFG Corp., Kyoto, Japan). The scan parameters were 90 kV, 5 mA, 9.4 s exposure time, 125 μm spatial resolution and 40×40 mm field of view (FoV). The aim of this CBCT study was to find out the influence of space separating apical lesions and sinus floor on subsequent EAS. There were observed four categories of anatomical rapports, such as tangent contact, protruding contact, 1-2 mm separating interval, and over 2 mm separating interval. The highest incidence was recorded in molars for tangent contact (47.69%) and in premolars when the apical lesions were situated at 1-2 mm distance from sinus floor (7.69%). The abnormalities revealed on CBCT scans of maxillary sinus have been mucosal hyperplasia, dome-shaped opacification, periostitis, and sinus opacification with air-bubbles. A four class classification related to the anatomical distance between the chronic apical lesions and sinus floor was suggested.