Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.
Department of Otorhinolaryngology, Head and Neck Surgery, Inselpital, University of Bern, Bern, Switzerland.
Clin Oral Implants Res. 2020 May;31(5):463-475. doi: 10.1111/clr.13582. Epub 2020 Feb 12.
To compare ear, nose, and throat (ENT) specialists and dentists assessing health or pathology of maxillary sinuses using cone beam computed tomography (CBCT).
Two ENT specialists and two oral surgeons assessed 100 CBCT datasets of healthy patients referred for dental implant placement in the posterior maxilla and decided on the possibility of sinus floor elevation or the necessity for further diagnostic examinations based solely on radiographic findings. Inter-rater agreements within the same specialty were calculated with Cohen's kappa and overall agreements with Fleiss kappa, and factors influencing the decisions taken were evaluated using regression analyses.
The correlation between all four raters was generally fair to moderate. The intra-specialty comparison showed a lower correlation between dentists than between ENT specialists. Absence of membrane thickening and total or subtotal sinus opacification showed the highest predictive value for a consensus in favor of sinus floor elevation and ENT referral, respectively. Flat membrane thickening with an irregular surface morphology was associated with disagreement between the examiners. Dome-shaped membrane thickenings were often considered as to be referred by dentists but not by ENTs.
The assessment of maxillary sinuses using CBCT imaging exhibited unsatisfactory agreement between ENT specialists and oral surgeons. Referral guidelines based on accidental CBCT findings that aim to diagnose relevant sinus pathologies early and avoid unnecessary diagnostics and/or therapies are needed, and an initial proposal for such recommendations is provided. Further research on correct interpretation of sinus findings and a validation of the present recommendations are required.
比较耳鼻喉科专家和牙医使用锥形束 CT（CBCT）评估上颌窦健康或病理的情况。
两位耳鼻喉科专家和两位口腔外科医生评估了 100 例健康患者的 CBCT 数据，这些患者因需要在后上颌植入牙而被转诊，并仅根据影像学结果决定是否可以进行鼻窦底提升或是否需要进一步的诊断检查。采用 Cohen's kappa 计算同专业内的组内一致性，采用 Fleiss kappa 计算总体一致性，并使用回归分析评估影响决策的因素。
四位评估者的相关性总体上为中等至良好。在专业内比较中，牙医之间的相关性低于耳鼻喉科专家之间的相关性。膜增厚缺失以及完全或部分窦腔混浊对上颌窦底提升和耳鼻喉科转诊的共识具有最高的预测价值。膜不规则增厚无明显增厚与评估者之间的分歧相关。穹顶状膜增厚常被认为需要由牙医转诊，但 ENT 医生不需要。
使用 CBCT 成像评估上颌窦的结果显示，耳鼻喉科专家和口腔外科医生之间的一致性不理想。需要制定基于 CBCT 偶然发现的、旨在早期诊断相关鼻窦疾病并避免不必要的诊断和/或治疗的转诊指南，并提供了初步建议。需要进一步研究正确解读窦腔发现并验证目前的建议。
