Tomographic evaluation of the effect of simvastatin topical use on alveolar bone microarchitecture, pain and swelling after mandibular third molar extraction: a randomized controlled trial.

OBJECTIVES: To evaluate the effect of a collagen sponge containing simvastatin on socket healing in terms of bone microarchitecture through tomographic analysis, pain, and swelling after impacted third molar extraction. MATERIALS AND METHODS: In this single-blind, split-mouth, randomized clinical trial, 29 patients undergoing impacted third molar extraction were allocated into two groups: (i) test group, a collagen sponge containing simvastatin was inserted within the sockets; and (ii) control group, in which sockets retained the clot. Bone volume (BV), bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular spacing (Tb.Sp), and gray scale were evaluated using cone beam computed tomography (CBCT) acquired immediately postoperative and 3 months after surgery. Pain, swelling, and wound healing were evaluated using the 10-point visual analogue scale, three extra-oral reference measurements, and the Landry index. RESULTS: In total, 22 participants remained in the study; no loss-to-follow-up was related to the intervention. BV and BV/TV were significantly higher at 3 months postoperatively in the test group compared with the control group and were correlated with greater bone trabeculation. Pain, edema, and the Landry index revealed a greater inflammatory response in the test group during early repair. Simvastatin contributed to bone healing, with no adverse effects or postoperative complications. CONCLUSIONS: The absorbable collagen sponge containing simvastatin improved BV, BV/TV, and trabecular bone, indicating the potential of this drug to induce the formation of autogenous bone. CLINICAL RELEVANCE: Intraosseous statins represent a promising, low-cost, and easy-to-use alternative for alveolar ridge preservation and bone regeneration. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (REBEC), No. RBR-523N7R.

Does the administration of meloxicam before head and neck radiotherapy reduce the risk of mandibular osteoradionecrosis? An animal model study.

OBJECTIVE: To assess whether the administration of meloxicam before head and neck radiotherapy reduces the risk of mandibular osteoradionecrosis in rats. MATERIAL AND METHODS: Sixty male Wistar rats were randomly divided into 6 groups (n = 10) according to the meloxicam administration and radiation therapy: control (C), irradiated (I), single dose of meloxicam (M1), single dose of meloxicam and irradiated (M1I), triple dose of meloxicam (M3), triple dose of meloxicam and irradiated (M3I). Meloxicam was administrated (20 mg/kg per dose) 1 h before the radiation therapy (single dose of 20 Gy) and 24 h and 48 h after the radiation therapy for groups with two additional doses. Ten days after the radiation therapy, the three right mandibular molars were extracted from all rats, who were euthanatized after 21 or 35 days (n = 5 per group). The mandibles were assessed by macroscopic evaluation and micro-CT analysis. RESULTS: The right hemimandibles of the irradiated groups revealed macroscopic signs of osteoradionecrosis, and those of the non-irradiated groups revealed complete gingival healing. A significant delay in alveolar socket healing in all irradiated groups was observed in the micro-CT assessment regardless meloxicam treatment. CONCLUSION: The administration of meloxicam before head and neck radiotherapy does not reduce the risk of mandibular osteoradionecrosis when associated to dental extractions. CLINICAL RELEVANCE: Since meloxicam has been shown to be a potential radiation-protective agent, and osteoradionecrosis physiopathology is believed to be related to an inflammatory process, possible interactions are relevant to be investigated.

Effect of resveratrol on the progression of experimental periodontitis in an ovariectomized rat model of osteoporosis: Morphometric, immune-enzymatic, and gene expression analysis.

OBJECTIVE: This study aimed to determine the role of resveratrol (RESV) on the progression of experimental periodontitis (EP) in ovariectomy rats (OVT). BACKGROUND: Estrogen deficiency is the main cause of osteoporosis and is related to higher periodontal attachment loss and reduction of alveolar bone. Zoledronate (ZLD) is an antiresorptive drug used to control osteoporosis but can lead to osteonecrosis of the jaw. RESV, a natural product, can reduce bone loss and control and prevent osteoporosis. Thus, this study aimed at investigating the effect of RESV on the progression of EP in estrogen-deficient rats. MATERIAL AND METHODS: The animals were subjected to the OVT or sham surgery to induce estrogen-deficiency and then were divided into the groups: OVT + RESV (n: 10); OVT + PLAC (n: 10): OVT + placebo; OVT + ZLD +PLA (n: 10); OVT + RESV +ZLD (n: 10): OVT + RESV and ZLD; SHAM (n: 10): non-ovariectomized animals + placebo. To induce estrogen deficiency, the rats were subjected to ovariectomy. Experimental periodontitis was induced by the placement of a ligature at the second maxillary molars. Daily administration of the placebo solution, resveratrol (10 mg/kg), and ZLD (0.1 mg/kg) was carried out for a period 42 days prior to initiation of EP, and then for another 28 days following ligature placement. After euthanasia, the specimens were processed for micro-CT and morphometric analysis of bone loss (linear measurement), and the gingival tissue surrounding the maxillary second molar was collected for the quantification of inflammatory markers using Luminex/MAGPix, of oxidative stress markers using ELISA assay, and gene expression analysis of bone markers, by real-time PCR. RESULTS: Morphometric and micro-CT analysis showed higher bone loss and lower bone density, respectively, in OVT + PLAC when compared to the other groups (P < .05). ZLD treated groups had lower alveolar bone loss, as well as, higher density and percentage of bone volume, when compared to OVT + RESV and SHAM + PLAC groups (P < .05). IL-4 levels were significantly lower in the OVT + PLAC group versus OVT + ZLD +RESV and SHAM + PLAC (P < .05). NADPH oxidase (nicotinamide adenine dinucleotide phosphate oxidase) levels were significantly lower OVT + RESV group when compared to OVT + PLAC (P < .05). OPG mRNA levels were lower in OVT + PLAC compared with the SHAM + PLAC group (P < .05). CONCLUSION: It can be concluded that resveratrol modulated alveolar bone loss during experimental periodontitis progression in estrogen-deficient rats by downregulating NADPH oxidase levels.

Is the digital radiographic detection of approximal caries lesions influenced by viewing conditions?

OBJECTIVES: The aim of this study was to assess the influence of different viewing conditions (combinations of computer display, horizontal viewing angle, and ambient lighting) on the detection of approximal caries lesions on digital radiographic images. STUDY DESIGN: Forty posterior teeth were mounted in a plaster block and radiographed by using a CMOS sensor-based system. Three oral radiologists assessed the radiographic images under different conditions of computer display (iMac 5K 27", Barco MDRC-2124, and Dell P2314H), horizontal viewing angles (90 degrees, 67.5 degrees, and 45 degrees), and ambient lighting (low, medium, and high) and were asked to detect the presence of approximal caries lesions, which were confirmed by means of micro-computed tomography (micro-CT), using a 5-point scale. The area under the receiver operating characteristic curve, sensitivity, and specificity were calculated and compared by analysis of variance testing (α = 0.05). Intra- and interobserver agreements were assessed with the Kappa test. RESULTS: Computer display, horizontal viewing angle, and ambient lighting did not significantly influence the diagnosis of approximal caries lesions. In general, moderate values of accuracy, low sensitivity, and high specificity were found for all viewing conditions. CONCLUSIONS: The viewing conditions assessed in this study did not influence the detection of approximal caries lesions on digital radiographic images. Dental practitioners are encouraged to find their most comfortable viewing condition for this diagnostic task.

A modified protocol of mandibular osteoradionecrosis induction in rats with external beam radiation therapy.

OBJECTIVE: To propose a modified protocol of mandibular osteoradionecrosis induction in rats with external beam radiation therapy. MATERIAL AND METHODS: A total of 45 male Wistar rats were used in this study. Firstly, 25 rats were divided into 5 groups (n = 5) according to the radiation dose protocol: without irradiation and irradiated with 15 Gy, 20 Gy, 25 Gy, or 30 Gy using a linear accelerator. Secondly, 15 other rats were divided into 3 groups (n = 5) according to the time of extraction of the three right mandibular molars: 7, 10, or 14 days after irradiation of 20 Gy. Lastly, dental extractions were performed in 5 other rats without irradiation (C-E10) for comparison with those of the group of dental extractions 10 days after irradiation (I-E10). RESULTS: The irradiated animals survived throughout the study period only at single doses of 15 Gy and 20 Gy. The suitable time for dental extractions after irradiation to induce mandibular osteoradionecrosis was defined as 10 days. Macroscopic evaluation of the right hemimandibles showed presence of osteoradionecrosis in I-E10 group and complete gingival healing in C-E10 group. CONCLUSION: A single radiation dose of 20 Gy focused on head and neck region combined with the extraction of the three mandibular molars 10 days after irradiation constitutes a feasible protocol of mandibular osteoradionecrosis induction in rats with external beam radiation therapy. CLINICAL RELEVANCE: Establishing a solid and widely available protocol of mandibular osteoradionecrosis induction is essential in the search for methods to prevent this complex disease.

Automatic exposure compensation and subjective image enhancement in the radiographic diagnosis of caries

Abstract This study aims to assess the influence of high-density material on the radiographic diagnosis of proximal caries in digital systems with automatic exposure compensation, and to evaluate the effect of subjective adjustment of brightness and contrast to undertake this diagnostic task. Twenty bitewing radiographs of forty posterior human teeth with non-cavitated carious lesions, confirmed by micro-CT, were obtained with two digital systems. A porcelain-fused-to-metal crown attached to a titanium implant was inserted into the exposed area, and all the radiographs were repeated. Five radiologists assessed the radiographs and diagnosed proximal carious lesions. Afterwards, the observers were asked to adjust image brightness and contrast, based on their subjective perception, and to reassess the images. Thirty percent of each experimental group was reassessed to test intraobserver reproducibility, totaling 208 images per observer. Intraobserver and interobserver agreements ranged from fair to substantial. Sensitivity, specificity, predictive values, and area under the ROC curve were calculated and compared for each radiographic system, using ANOVA (α = 0.05). Overall, presence of high-density material and adjustment of brightness and contrast did not significantly influence the radiographic diagnosis of proximal caries (p ≥ 0.05). Regarding Digora Optime, adjustment of brightness and contrast significantly increased (p < 0.05) the diagnostic accuracy of proximal carious lesions in the presence of high-density material. In conclusion, the presence of high-density material in the X-rayed region does not influence radiographic diagnosis of proximal caries. However, when it is present in the X-rayed area, subjective adjustment of brightness and contrast is recommended for use with the Digora Optime digital system.

Impact of micro-computed tomography reconstruction protocols on bone microarchitecture analysis.

OBJECTIVE: The aim of this study was to assess the influence of reconstruction protocols of micro-computed tomography (micro-CT) images on analyses of bone microarchitecture. STUDY DESIGN: Micro-CT images of the maxillae of 5 Wistar rats were reconstructed with different protocols by varying the levels of the following tools: smoothing filter (SF; 2-6); ring artifact correction (RAC; 5-15); and beam hardening correction (BHC; 15%-60%). A control protocol (P0; without any correction tool) and a standard protocol (SP; according to the manufacturer's recommendation: SF = 2; RAC = 5; BHC = 45%) were also obtained. For each protocol, 8 bone microarchitecture parameters were calculated (bone volume/total volume [BV/TV], bone surface/total volume [BS/TV], trabecular number [Tb.N], trabecular thickness [Tb.Th], trabecular separation [Tb.Sp], degree of anisotropy [DA], connectivity density [Conn.D], and total porosity [Po-tot]) by using CTAn software. Test protocols were compared with the SP by using 1-way analysis of variance and the Dunnet post hoc test (α = 0.05). RESULTS: An inverse relationship was observed between BHC tool levels and all microarchitecture parameters except BV/TV and Tb.Th. The combination of BHC and SF significantly influenced all microarchitecture parameters except for DA, for which all protocols were similar to the SP (P > .05). CONCLUSIONS: Calculation of bone microarchitecture parameters is influenced by the applied levels of artifact correction tools, mainly BHC and SF. It is necessary to standardize such tool levels for correct data interpretation.

Radiologic assessment of mandibular third molars: an ex vivo comparative study of panoramic radiography, extraoral bitewing radiography, and cone beam computed tomography.

OBJECTIVES: The aim of this study was to compare the performance of panoramic radiography (PAN), extraoral bitewing radiography (EBW), and cone beam computed tomography (CBCT) in the assessment of mandibular third molars. STUDY DESIGN: PAN and EBW were obtained to visualize 34 third molars. The teeth were evaluated by using PAN and EBW according to their positions, the presence of radiographic signs of proximity of the roots to the mandibular canal, the relationship of the roots to the canal, and the relationship of the second and third molars. Third molar position and root relationship with the canal were also assessed with CBCT. RESULTS: PAN and EBW showed significantly closer relationships compared with CBCT between the tooth and the mandibular canal (P ≤ .002). With regard to all other parameters, no differences were seen between PAN and EBW (P ≥ .072), although EBW, in comparison with PAN, showed a decreased overlap between the proximal surfaces of the second and third molars and a greater trend toward approximating root apices and the canal. CONCLUSIONS: In comparison with PAN, EBW showed a tendency to project the roots closer to the mandibular canal, but there was a decrease in the proximal surfaces overlapping the second molar. The relationship between the third molar and the mandibular canal appeared closer in PAN and EBW than in CBCT.

Cemento-Osseous Dysplasias: Imaging Features Based on Cone Beam Computed Tomography Scans

Abstract Imaging exams have important role in diagnosis of cemento-osseous dysplasia (COD). Cone beam computed tomography (CBCT) stands out for allowing three-dimensional image evaluation. This study aimed to assess the prevalence of cases diagnosed as COD on CBCT scans, as well identify the main imaging features related to these lesions. An analysis was performed in a database containing 22,400 radiological reports, in which all cases showing some type of COD were initially selected. These CBCT exams were reevaluated to confirm the radiographic diagnosis and determine the prevalence and distribution of the types of COD with regard to gender, age and preferred location, while describing its most common imaging aspects. Data were presented using descriptive analyses. There were 82 cases diagnosed as COD in the CBCT images (prevalence of 0.4%). The distribution of patients was 11 (13.4%) male and 71 (86.6%) female, with a mean age of 49.8 years (age-range 17-85 years). There were 47 (57.3%) cases of periapical COD, 23 (28%) of focal COD and 12 (14.6%) of florid COD. The mandible was more affected than the maxilla. In most cases, the lesions were mixed or hyperdense. All COD had well-defined limits and there were no cases of tooth displacement. In conclusion, periapical COD was the most common type and the most affected bone was the mandible. Imaging evaluation is critical for diagnosis and dentists should bear in mind all possible radiographic presentations of COD in order to prevent misleading diagnoses and consequently, inadequate treatments.

Resumo Os exames por imagem têm papel importante no diagnóstico da displasia cemento-óssea (DCO). A tomografia computadorizada por feixe cônico (TCFC) se destaca por permitir a avaliação tridimensional da imagem. O objetivo neste estudo foi avaliar a prevalência de casos diagnosticados como DCO nos exames de TCFC, bem como identificar as principais características de imagem relacionadas a essas lesões. Uma análise foi realizada em um banco de dados contendo 22.400 laudos radiológicos, no qual todos os casos que apresentavam algum tipo de DCO foram inicialmente selecionados. Estes exames foram reavaliados para confirmar o diagnóstico radiográfico e determinar a prevalência e distribuição dos tipos de DCO em relação ao sexo, idade e localização preferencial, além de descrever seus aspectos imaginológicos mais comuns. Os dados foram apresentados por meio de análise descritiva. Oitenta e dois casos foram diagnosticados como DCO nas imagens de TCFC (prevalência de 0,4%). A distribuição dos pacientes foi de 11 (13,4%) homens e 71 (86,6%) mulheres, com idade média de 49,8 anos (faixa etária de 17 a 85 anos). Houve 47 (57,3%) casos de DCO periapical, 23 (28%) de DCO focal e 12 (14,6%) de DCO florida. A mandíbula foi mais afetada que a maxila. Na maioria dos casos, as lesões foram mistas ou hiperdensas. Todas as DCO apresentaram limites bem definidos e não houve casos de deslocamento dentário. Em conclusão, a DCO periapical foi o tipo mais comum e o osso mais afetado foi a mandíbula. A avaliação da imagem é crítica para o seu diagnóstico e os dentistas devem ter em mente todas as possíveis apresentações radiográficas da DCO, a fim de prevenir diagnósticos enganosos e, conseqüentemente, tratamentos inadequados.

Prevalence of technical errors and periapical lesions in a sample of endodontically treated teeth: a CBCT analysis.

OBJECTIVES: The aims of this study are to identify the most frequent technical errors in endodontically treated teeth and to determine which root canals were most often associated with those errors, as well as to relate endodontic technical errors and the presence of coronal restorations with periapical status by means of cone-beam computed tomography images. METHODS: Six hundred eighteen endodontically treated teeth (1146 root canals) were evaluated for the quality of their endodontic treatment and for the presence of coronal restorations and periapical lesions. Each root canal was classified according to dental groups, and the endodontic technical errors were recorded. Chi-square's test and descriptive analyses were performed. RESULTS: Six hundred eighty root canals (59.3%) had periapical lesions. Maxillary molars and anterior teeth showed higher prevalence of periapical lesions (p < 0.05). Endodontic treatment quality and coronal restoration were associated with periapical status (p < 0.05). Underfilling was the most frequent technical error in all root canals, except for the second mesiobuccal root canal of maxillary molars and the distobuccal root canal of mandibular molars, which were non-filled in 78.4 and 30% of the cases, respectively. CONCLUSIONS: There is a high prevalence of apical radiolucencies, which increased in the presence of poor coronal restorations, endodontic technical errors, and when both conditions were concomitant. Underfilling was the most frequent technical error, followed by non-homogeneous and non-filled canals. CLINICAL RELEVANCE: Evaluation of endodontic treatment quality that considers every single root canal aims on warning dental practitioners of the prevalence of technical errors that could be avoided with careful treatment planning and execution.

Juxta-Apical Radiolucency: Prevalence, Characterization, and Association With the Third Molar Status.

PURPOSE: This study aimed to investigate the prevalence of juxta-apical radiolucency (JAR), assessing its association with third molar status and describing its radiologic features through panoramic radiography. MATERIALS AND METHODS: We evaluated 1,050 radiographs (1,830 third molars) for the presence of JAR. The JAR and control groups were classified according to the third molar's angulation, impaction, and root development. The presence of radiographic signs of proximity between the mandibular canal and third molar and the imaging features of JAR also were recorded. RESULTS: JAR was identified in 116 patients (11%) and 130 third molars (7.1%), being significantly associated with female patients and with the second and third decades of life. There also was an association with teeth with a vertical angulation and complete root formation. Radiographic signs of proximity to the mandibular canal were absent in 66.2% of JAR cases. In most cases, there was lamina dura in the juxta-apical area that appeared to overlap the mandibular canal and to have a cortical outline. CONCLUSIONS: JAR is not a rare imaging finding. Given its possible relationship with nerve injuries and its differential diagnostic possibilities, knowing the characteristics of JAR is important to assist professionals in treatment planning and making the correct diagnosis.

Cemento-Osseous Dysplasias: Imaging Features Based on Cone Beam Computed Tomography Scans.

Imaging exams have important role in diagnosis of cemento-osseous dysplasia (COD). Cone beam computed tomography (CBCT) stands out for allowing three-dimensional image evaluation. This study aimed to assess the prevalence of cases diagnosed as COD on CBCT scans, as well identify the main imaging features related to these lesions. An analysis was performed in a database containing 22,400 radiological reports, in which all cases showing some type of COD were initially selected. These CBCT exams were reevaluated to confirm the radiographic diagnosis and determine the prevalence and distribution of the types of COD with regard to gender, age and preferred location, while describing its most common imaging aspects. Data were presented using descriptive analyses. There were 82 cases diagnosed as COD in the CBCT images (prevalence of 0.4%). The distribution of patients was 11 (13.4%) male and 71 (86.6%) female, with a mean age of 49.8 years (age-range 17-85 years). There were 47 (57.3%) cases of periapical COD, 23 (28%) of focal COD and 12 (14.6%) of florid COD. The mandible was more affected than the maxilla. In most cases, the lesions were mixed or hyperdense. All COD had well-defined limits and there were no cases of tooth displacement. In conclusion, periapical COD was the most common type and the most affected bone was the mandible. Imaging evaluation is critical for diagnosis and dentists should bear in mind all possible radiographic presentations of COD in order to prevent misleading diagnoses and consequently, inadequate treatments.

Dosimetry in CBCT with Different Protocols: Emphasis on Small FOVs Including Exams for TMJ

Abstract This study aimed to estimate the absorbed dose in cone beam computed tomography (CBCT) exams according to different exposure parameters and size and position of the field of view (FOV). In addition was compared the absorbed dose of two smaller FOV scans with that of a larger FOV scan for evaluation of temporomandibular joint (TMJ), as it is a bilateral structure. CBCT scans were obtained on OP300 Maxio unit varying scanning mode (standard, high and endo) as well as size (5x5, 6x8 and 8x15 cm) and positioning of FOV. With a small FOV, different areas were scanned (maxilla or mandible, anterior or posterior and TMJ). Absorbed doses were determined using thermoluminescent dosimeters on the skin surface of sensitive organs of an anthropomorphic phantom. Endo mode showed the highest dose, followed by the high and standard modes in all FOV positions. With small FOV, doses were higher in the posterior region, especially in the mandible. Dose reduction occurred when small FOVs were used, but it was not proportional to FOV size reduction. For TMJ, the dose in a single acquisition with large FOV was greater than two acquisitions with small FOV, but lower than two acquisitions with medium FOV (6x8 cm). In conclusion, scanning mode, size and FOV position have great influence on the absorbed dose. Small FOV decreases the dose, but there is no linear relation between FOV size and dose. For bilateral exams of TMJ, double acquisition with small FOVs produces decrease in absorbed dose relative to a large FOV.

Resumo O objetivo deste estudo foi estimar a dose absorvida em exames de tomografia computorizada de feixe cônico (TCFC) de acordo com diferentes parâmetros de exposição, tamanho e posição do campo de visão (FOV, do inglês field of view). Além disso, comparou-se a dose absorvida em uma única aquisição com FOV grande com aquela em duas aquisições com FOVs menores para avaliação de estruturas bilaterais como a articulação temporomandibular (ATM). As aquisições de TCFC foram obtidas no aparelho OP300 Maxio, variando o modo de aquisição (standard, high e endo), bem como o tamanho (5x5, 6x8 e 8x15 cm) e o posicionamento do FOV. Com o FOV pequeno, foram escaneadas diferentes áreas (maxila ou mandíbula, anterior ou posterior e ATM). As doses absorvidas foram determinadas por meio da utilização de dosímetros termoluminescentes na superfície da pele em órgãos sensíveis de um phantom antropomórfico. O modo endo mostrou a dose mais alta, seguido pelos modos high e standard em todas as posições dos FOVs. Com um FOV pequeno, as doses foram maiores na região posterior, especialmente na mandíbula. A redução da dose ocorreu quando foram utilizados pequenos FOVs; contudo, essa redução não foi proporcional à redução do tamanho do FOV. Para a ATM, a dose em uma única aquisição com FOV grande foi maior que duas aquisições com FOV pequeno, porém inferior à dose de duas aquisições com FOV médio (6x8 cm). Em conclusão, o modo de aquisição, o tamanho e a posição do FOV têm grande influência na dose absorvida. FOVs pequenos apresentaram doses mais baixas em relação aos FOVs grandes, entretanto não há uma relação linear entre o tamanho do FOV e a dose absorvida. Para estruturas bilaterais como a ATM, a dupla aquisição com FOV pequeno representa uma diminuição na dose absorvida em relação a uma aquisição com FOV grande.

Juxta-apical radiolucency: relation to the mandibular canal and cortical plates based on cone beam CT imaging.

OBJECTIVE: To evaluate the relation of juxta-apical radiolucency (JAR) to the mandibular canal and cortical plates on cone beam computed tomography images, as well as to assess whether the presence of JAR is related to the position of the mandibular canal. STUDY DESIGN: Forty-seven JAR cases were evaluated by cone beam computed tomography. JAR position and its relationship to the mandibular canal and cortical plates were investigated. The position of the mandibular canal was recorded and compared with a control group. Descriptive analyses and χ2 tests were performed. RESULTS: A significant association was established between JAR and the position of the mandibular canal (P = .0193), which was positioned lingually in 59.6% of JAR cases. In most cases, JAR was located distal to the tooth (66%) and in contact with the mandibular canal, either with (53.2%) or without (40.4%) preservation of the cortical border of the canal. In 22 cases (46.8%), thinning of cortical plates was observed, but no statistical differences were found between buccal and lingual sides (P = .5728). CONCLUSIONS: The mandibular canal is located lingually in the third molar region in most JAR cases. JAR is located distal to the tooth and is generally in contact with the mandibular canal. These relations may increase the risk of nerve injury during surgical removal of third molars.

Association between Odontogenic Conditions and Maxillary Sinus Disease: A Study Using Cone-beam Computed Tomography.

INTRODUCTION: The maxillary sinus can be affected by dental infections because of its close relationship with upper teeth. This study aimed to assess the most common types of maxillary sinus alterations and to associate them with odontogenic conditions using cone-beam computed tomographic (CBCT) images. METHODS: CBCT scans of 400 patients showing sinus disease in 1 or both maxillary sinuses were evaluated. Sinus alteration was considered as follows: generalized or localized mucosal thickening (MT), maxillary sinusitis (MS), and retention cysts (RCs). The odontogenic conditions evaluated were inadequate endodontic treatment, periapical lesions, and periodontal bone loss. Descriptive and multiple logistic regression analyses were performed. RESULTS: Sinus diseases were observed in 85.9% of the maxillary sinuses. The most prevalent condition was generalized MT (65.2%) followed by localized MT (24.8%), MS (6.4%), and RCs (3.6%). Generalized MT was more related to males (odds ratio = 1.45, P < .05) and periodontal bone loss (P < .05). Localized MT was associated with periapical lesions (odds ratio = 3.09, P < .05) and showed a close anatomic relationship between teeth and the sinus floor (odds ratio = 2.77, P < .05). There were no statistically significant associations between either MS or RCs and the odontogenic conditions studied. CONCLUSIONS: The most prevalent sinus diseases were the generalized and localized MT, and they were the only ones related to odontogenic conditions (periodontal bone loss and periapical lesions, respectively). We emphasize that CBCT imaging is an appropriate method for evaluating the maxillary sinus findings and their associated odontogenic conditions.