Clinical and radiographic assessment and restoration of maxillary sinus function in relation to oro-antral fistula closure: a systematic review.

BACKGROUND: The purpose of this study was to determine current practice in assessment of maxillary sinus health during oro-antral fistula closure. METHOD: A systematic review using specific MeSH headings between 1990 and September 2021 on Medline, Ovid, and PubMed was performed. The inclusion criterion was closure of oro-antral fistula in adult patients. Exclusion criteria were oro-antral fistula arising in children; or from trauma, malignancy, or developmental abnormality; or any osteonecrotic lesion of bone. Risk of bias for individual papers was not assessed. Oxford Centre for Evidence Based Medicine levels of evidence were recorded. RESULTS: 4309 papers were identified, and 119 were eligible for review. Nineteen were from otolaryngology (16%), 25 from combined ear, nose, and throat (ENT) and oral/oral and maxillofacial (OS/OMF) surgery (21%), and 75 from OS/OMF surgery (63%). Preoperative rhinoscopy and cross-sectional imaging were reported in 33 papers (28%), reflecting the role of ENT with or without OS/OMFS. Sixty-eight did not record any formal assessment of maxillary sinus health (57%), of which 60 were from OS/OMF surgery (50%). Use of computed tomography was reported in 58 papers (49%), and use of cone beam computed tomography was reported in 8 papers (7%) but did not correlate with assessment of sinus health. DISCUSSION: Most surgery for oro-antral fistual closure was undertaken without objective assessment of maxillary sinus health, pre- or postoperatively. The involvement of ENT was associated with formal assessment of maxillary sinus health.

An evaluation of referrals requesting third molar tooth removal: clinical diagnosis and treatment outcome.

Introduction To determine the reasons why patients are referred requesting removal of third molar teeth.Method Prospective evaluation of referrals requesting removal of third molar teeth only. Following review of symptoms, clinical, and if appropriate, radiographic findings, a diagnosis according to pre-defined criteria was made, and verified by a senior member of staff.Results 662 individual referrals were received requesting removal of 1,117 individual third molar teeth, of which 73% were for mandibular teeth. A total of 195 teeth (17.6%) were not removed as there was no disease process or insufficient symptoms. In 124 cases (11.1%) a diagnosis of temporomandibular disorders was made with no dental surgery being required. Other reasons for patients not proceeding to surgery were: no symptoms or sign of disease; symptoms were from an adjacent tooth; only single episode of pericoronitis; late incisor crowding; and cervical sensitivity.Conclusion While most patients referred did proceed to have removal of third molar teeth, a significant proportion had symptoms related to chronic orofacial pain that would not have been influenced by removal of third molar teeth. The overall incidence of temporomandibular disorders within the patient sample, either as a primary, secondary or tertiary diagnosis was 18.7%.

The accuracy of dental panoramic tomographs in determining the root morphology of mandibular third molar teeth before surgery.

OBJECTIVE: The objective of this study was to assess the accuracy of dental panoramic tomograph (DPT) in the presurgical assessment of mandibular third molar teeth by correlating the radiologic interpretation with surgical findings. STUDY DESIGN: DPTs of 300 mandibular third molar teeth were assessed by 9 staff oral surgeons for root morphology and proximity to the inferior alveolar neurovascular bundle. Detailed records were made at surgery. RESULTS: The sensitivity and specificity for observation of root curvatures (+/-15%) were 29% and 94%, respectively. The sensitivity and specificity of determining an intimate relationship between the root and the neurovascular bundle were 66% and 74%, respectively. Kappa analysis demonstrated poor levels of agreement between radiologic interpretation and surgical findings when the number of roots was determined (0.191) and also when the roots were fused or separate (0.466). CONCLUSION: Using DPTs to assess mandibular third molar teeth before surgery gives poor diagnostic accuracy of anatomic form and structures.