PREVALENCE OF ODONTOGENIC RELATED MAXILLARY SINUS PATHOLOGY IN PATIENTS OF TEMPLE UNIVERSITY KORNBERG SCHOOL OF DENTISTRY

Abstract

ABSTRACT Objectives: Cone beam computerized tomography use is becoming more common in preparation for surgical planning and treatment diagnosis by clinicians. The scanning result gives clinicians a more accurate understanding of each patients’ anatomy, which aids in designing better treatment plan, avoidance of vital anatomy, etc. Modern treatments involving extraction of teeth has become more sophisticated due to advent of dental implant treatment. Along with the procedure, more sophisticated treatment techniques involving manipulation of sinus has flourished. Traditional periapical and panoramic radiograph are not as adapt at identifying sinus pathologies. As patients age, proximity of sinus floor and apex of teeth may become closely related where possibility of one affecting another is observed. This study aims to study the prevalence of odontogenic related pathologies in relation to maxillary sinus in the population who had CBCT images taken at Temple University Kornberg School of Dentistry. The study also looks in detail the relationship of such pathology in relation to teeth status, age, gender, and ethnicity. Methods: 821 CBCT scans completed at Temple University Kornberg School of Dentistry Department of Oral Maxillofacial Radiology from January 1st, 2009 to July 31, 2013 were evaluated with iCAT computer imaging software. Patients under 18, no posterior dentition, or complete edentulous were excluded from the study. A total of four hundred fourty four (444) CBCT scans were included in the study. Patients with odontogenic related maxillary sinus pathology were selected and teeth status, age, gender and ethnicity recorded. Individual scans had sinus pathology identified and examined for proximity and relationship to respective tooth/teeth. Each individual tooth’s status were also recorded. Chi-square test was conducted to verify validity Results: After reviewing 680 scans, only 444 were included in the study due to exclusions. Scans were subdivided by age (18-35: 77, 36-53: 113, 54-71: 188, 72> : 46), gender (280 male and 164 female), ethnicity (African American 86, Asian 45, Caucasian 291, Hispanic 22), tooth status (caries, 26, crown 87, healthy 31, impacted 11, root canal 88, restoration 58), tooth position ( 3rd molar 9, 2nd molar 86, 1st molar 138, 2nd premolar 20, 1st premolar 6, canine 3). Overall 63.06% of scans were classified as healthy, and 36.04% were classified as presenting odontogenic related maxillary sinus pathology. None of the parameters showed significant predilection to odontogenic related pathology, however, 1st molar has the highest risk of exhibiting pathology in the maxillary sinus with 2nd molar second. The pathology incidence rates are slightly higher in male patients 41% vs 34%. Age is not a significant factor as all age groups demonstrates similar incidence rate except 72> group. Dentition status showed root canal and crown being the most commonly associated with pathology at 29% each. In Caucasian population, crown and root canal was most commonly related. African American was restoration and healthy teeth. Asian population had the most link with large restorations. Conclusions: Maxillary 1st molar is the most commonly involved tooth with maxillary sinus pathologies with 2nd molar as second most common. Caucasian individuals had the most odontogenic related pathologies. In general, crown and root canal are associated with a significant number of pathologies found in the sinus and should be evaluated prior to any surgical evaluation prior to any sinus manipulative surgery or odontogenic treatment.