Prevalence and Predisposing Factors of Periapical Mucositis: A Cross-Sectional Study

Periapical mucositis (PAM) is defined as inflammation of the periapical tissues and localized oedema of the maxillary sinus mucosa, typically resulting from periradicular disease. Radiographically on cone-beam computed tomography (CBCT), PAM presents as mucosal thickening or a dome-shaped soft tissue expansion along the floor of the maxillary sinus, adjacent to the affected root apex. Although several studies have evaluated PAM, their findings vary considerably. This study aims (1) to evaluate the prevalence of PAM in maxillary posterior teeth amongst patients at NYU College of Dentistry, Department of Endodontics, and (2) to identify predisposing factors associated with PAM.

CBCT evaluation and chart review were conducted at NYU College of Dentistry from 2016 to 2021. A total of 586 scans were screened, and 335 scans were included. The presence of PAM, periapical osteoperiostitis, maxillary sinus floor bony erosion, age, sex, pulpal and periapical diagnosis, size of the lesion, the vertical and horizontal distance between the sinus floor and roots, number of roots with apical lesions, type of tooth and iatrogenic errors during treatment were recorded. Chi-square, Fisher's exact tests and logistic regression were used to analyse the data.

Of the 335 scans included, 13 presented with mucositis without periradicular disease and were excluded from the analysis. A total of 322 scans were analysed. The prevalence of PAM was 55.5%. The presence of maxillary sinus floor bone erosion was associated with 7.56 times higher odds of PAM than those without sinus floor erosion (p < 0.001). Each incremental increase in CBCTPAI was associated with a 1.43-fold increase in the odds of PAM occurrence (p = 0.004).

PAM was present in over half of patients presenting with apical periodontitis affecting the posterior maxillary dentition. Maxillary sinus bony floor erosion and periapical lesion size were predisposing factors to PAM development.