How Reliably Does Stoma Position Identify the Offending Tooth? A Prospective Study of 100 Odontogenic Sinus Tracts

This study evaluated the spatial relationship between the clinical stoma site and the radiographic source of odontogenic sinus tracts, the distribution of stoma surface locations, and patient factors that predict shift.

This prospective study comprised 100 consecutive patients with draining intraoral sinus tracts. A size-25 gutta-percha cone was traced into each tract and a periapical radiograph obtained using the paralleling technique. Shift was measured in tooth units. Nonparametric and chi-square tests were applied (α = .05, two-tailed).

Of 100 patients, 80% showed shift. Only 20 (20%) had the stoma directly over the problematic tooth; among the 80 shifted cases, 49 (61.3%) showed 0.5-unit shift (stoma between 2 adjacent teeth), 26 (32.5%) showed 1-tooth-width shift, and 5 (6.2%) demonstrated 2-tooth-width shift. Buccal openings were most common (82%). Stoma surface location did not affect shift distance, direction, or occurrence (all P > .05). A moderate correlation was found between patient age and shift distance (Spearman r_s = 0.278, P < .05). Sex, jaw, tooth category, and stoma location did not predict the occurrence of the shift.

Sinus tract stomas were misleading in 80% of cases. The most common pattern was a 0.5-unit shift (stoma between 2 adjacent teeth), occurring in 61.3% of displaced cases. Stoma surface location did not predict shift. Patient age was significant in predicting shift magnitude. Gutta-percha cone tracing remains mandatory; clinicians should maintain a high index of suspicion in older patients.