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Published on: April 8, 2020
Influence of periapical lesion-sinus floor distance and histopathologic diagnosis on patterns of maxillary sinus
Ammar W Awadi1, Ramzi Sarkis1, Yanling Jiang1
1Department of Endodontics, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA.
Aim:
To evaluate the relationship between the histopathological diagnoses of maxillary periapical lesions obtained during periapical surgery and maxillary sinus changes of endodontic origin (MSEO).
Methodology:
Clinical, CBCT, and histopathological records of 39 cases that underwent periapical surgery on maxillary premolar and molar teeth between 2015 and 2019 were retrospectively reviewed, all of which had a preoperative CBCT scan acquired within three months prior to surgery and histopathological evaluation of periapical tissues. Maxillary sinus changes were assessed according to the radiographic MSEO criteria defined in the 2018 position statement of the American Association of Endodontists. The shortest linear distances between the lesion and the maxillary sinus floor, and between the root apex and the maxillary sinus floor, were measured on multiplanar Distance measurements were compared according to the presence and patterns of MSEO using generalized estimating equations (α = 0.05).
Results:
MSEO was detected on CBCT in 26 of 39 periapical lesions (64.9%), with equal distribution between periapical mucositis (PAM) and periapical osteitis (PAO) patterns. Periapical granuloma was the most frequent histopathological diagnosis (82.1%). Lesion-sinus floor and root apex-sinus floor distances were greater in cases without MSEO (mean differences: 2.03 mm and 2.55 mm, respectively; p < 0.05). In PAM cases, both distances were greater than those observed in PAO cases (p < 0.05).
Conclusions:
The findings indicate an association between MSEO and the proximity of the periapical lesion and root apex to the maxillary sinus floor, with shorter distances observed in osteoperiosteal response patterns.
Clinical Relevance:
Evaluating the proximity of maxillary periapical lesions to the sinus floor on preoperative CBCT may help clinicians anticipate sinus tissue response patterns during surgical management of maxillary posterior teeth.
