Khalil Marwa, Attia Dina, Sakr Haitham H
Oral Medicine, Periodontology, Oral Diagnosis, and Oral Radiology, Alexandria University, Faculty of Dentistry, Alexandria, EGY.
Pediatric Dentistry and Dental Public Health, Alexandria University, Faculty of Dentistry, Alexandria, EGY.
Cureus. 2024 Dec 29;16(12):e76578. doi: 10.7759/cureus.76578. eCollection 2024 Dec.
Background Odontogenic maxillary sinusitis arises mainly from dental origins, emphasizing the connection between dental health and sinus issues. Understanding these relationships is crucial for implant planning, sinus augmentation procedures, and managing post-extraction complications. This knowledge can help clinicians make informed decisions about treatment timing and approach. In this study, the influence of tooth periapical and periodontal conditions on maxillary sinus mucous membrane thickening using cone-beam computed tomography (CBCT) imaging was evaluated. Methods In this retrospective cross-sectional study, 124 patients who underwent CBCT for dental treatment covering 248 maxillary sinuses and 992 teeth were examined. Coronal and sagittal sections were examined to assess the maxillary sinus mucosal thickening (MT), the periodontal bone loss for maxillary posterior teeth, and their proximity to the maxillary sinus (RPMS). The mean ± standard deviation of quantitative variables was compared using a one-way ANOVA test. Multivariable logistic regression analysis was used to assess the relation between the different independent variables and MT of the maxillary sinus. P < 0.05 was considered to be statistically significant. Results MT was detected in 90 (72.6%) patients. We found 42 (33.9%) patients bilaterally. Grade 1 mucosal thickness was the most prevalent grade (72.5%), followed by Grade 2 (19.2%). Almost half the teeth examined were not in contact with the cortical borders of the sinus (56.0%). Most of the teeth showed mild to moderate periodontal bone loss (80.2%). Logistic regression analysis showed that the variables significantly associated with higher odds of MT of maxillary sinus occurrence were tooth location (second molar vs. first premolar AOR = 2.30, 95% CI: 1.29-2.79, first molar vs. first premolar AOR = 3.79, 95% CI: 1.82- 3.10, and second premolar vs. first premolar AOR = 1.57, 95% CI: 1.27-2.84), the relation of roots of posterior maxillary teeth to the sinus floor (Type 2 vs. Type 0 AOR = 2.27, 95% CI: 1.38-3.34, and Type 1 vs. Type 0 AOR = 2.24, 95% CI: 1.54-3.26), periodontal bone loss (severe vs. non-periodontitis AOR = 2.75, 95%CI: 1.29-5.86, and mild-moderate periodontitis vs. non-periodontitis AOR = 1.68, 95%CI: 1.19-4.93), and periapical and periodontal tooth condition (periapical lesion vs. extracted AOR = 32.7, 95% CI: 4.53-83.61, and no periapical lesion vs. extracted AOR = 19.8, 95% CI: 8.18-74.23). Conclusions Second molars, severe periodontal bone loss, and periapical lesions were associated with increased sinus MT risk, highlighting the need for dental health consideration in maxillary sinus management.
牙源性上颌窦炎主要源于牙齿问题，这凸显了牙齿健康与鼻窦问题之间的联系。了解这些关系对于种植规划、鼻窦增量手术以及处理拔牙后并发症至关重要。这些知识有助于临床医生在治疗时机和方法上做出明智的决策。在本研究中，使用锥形束计算机断层扫描（CBCT）成像评估了牙齿根尖和牙周状况对上颌窦黏膜增厚的影响。
在这项回顾性横断面研究中，对124例因牙科治疗接受CBCT检查的患者进行了检查，共涉及248个上颌窦和992颗牙齿。检查冠状面和矢状面，以评估上颌窦黏膜增厚（MT）、上颌后牙的牙周骨丧失情况以及它们与上颌窦的接近程度（RPMS）。使用单因素方差分析检验比较定量变量的均值±标准差。多变量逻辑回归分析用于评估不同自变量与上颌窦MT之间的关系。P < 0.05被认为具有统计学意义。
90例（72.6%）患者检测到MT。双侧均有MT的患者有42例（33.9%）。1级黏膜厚度是最常见的级别（72.5%），其次是2级（19.2%）。几乎一半的被检查牙齿未与鼻窦皮质边界接触（56.0%）。大多数牙齿显示轻度至中度牙周骨丧失（80.2%）。逻辑回归分析表明，与上颌窦MT发生几率较高显著相关的变量包括牙齿位置（第二磨牙与第一前磨牙相比，比值比[AOR]=2.30，95%置信区间[CI]：1.29 - 2.79；第一磨牙与第一前磨牙相比，AOR = 3.79，95%CI：1.82 - 3.10；第二前磨牙与第一前磨牙相比，AOR = 1.57，95%CI：1.27 - 2.84）、上颌后牙牙根与鼻窦底的关系（2型与0型相比，AOR = 2.27，95%CI：1.38 - 3.34；1型与0型相比，AOR = 2.24，95%CI：1.54 - 3.26）、牙周骨丧失（重度与无牙周炎相比，AOR = 2.75，95%CI：1.29 - 5.86；轻度 - 中度牙周炎与无牙周炎相比，AOR = 1.68，95%CI：1.19 - 4.93）以及牙齿根尖和牙周状况（根尖病变与已拔除相比，AOR = 32.7，95%CI：4.53 - 83.61；无根尖病变与已拔除相比，AOR = 19.8，95%CI：8.18 - 74.23）。
第二磨牙、严重的牙周骨丧失和根尖病变与鼻窦MT风险增加相关，这突出了在上颌窦治疗中考虑牙齿健康的必要性。
