Association between Periapical Lesions and Maxillary Sinus Mucosal Thickening: A Retrospective Cone-beam Computed Tomographic Study

By Shanbhag S, Karnik P, Shirke P, Shanbhag V

Date: 01/2013
Journal: JOE


  • Evaluate the relationship between teeth w/PA lesions or periodisease and sinus mucosal thickening via CBCT.


  • N= 243 patients (485 sinuses)
  • Exclusion criteria:  Scans of patients w/traumatic injuries and sinuses associated w/implants or augmentation. Scans that did not allow for complete visualization of the maxillary sinus in both coronal and axial views were also excluded.
  • Positive/negative control: 10 randomly selected scans were evaluated and measured twice by the radiographic investigator on 2 different days.
  • Control & Design: CBCT scans from Jan 2012 – July 2012 in Mumbai, India obtained using i-CAT 3D Imaging System (Operating parameters – 5-7 mA, 80 kV, 8×8 cm field of view, 0.25mm voxel, 20 s scan time). Single evaluator assessed images. Data analyzed via Pearson chi-square test, and multivariate logistic regression analyses used to determine odds ratios. P<.05 for all analyses.
  • Criteria of evaluation: Periapical lesions recorded when ≥ 1 Posterior Max tooth showed radiolucency. Sinus mucosa was either categorized as normal (≤2mm) or “thickened” (>2mm).  Thickened mucosa further categorized as 2-5mm, 5-10mm, >10mm. Type of thickening categorized as “flat” or “polypoid.”


  • 44.6% sinuses overall showed mucosal thickening >2mm
  • Thicker mucosae were twice as frequent in males and older patients (>40yoa)
  • “Flat” type of thickening (73.5%)  seen in majority of thickened mucosae
  • Over 80% of PA lesions in this study a/w sinus mucosal thickening
  • Odds Ratio of 9.75 for mucosal thickening in presence of PA lesion
  • Bivariate analysis w/perio disease significant, but multivariate not stat significant for thick mucosa

Clinical Significance:

Collaboration between otolaryngologists and dentists can enable early diagnosis and treatment of OMS (Odontogenic maxillary sinusitis).

Periapical lesions can be associated w/sinus mucosal thickening (not causal though).