ANATOMICAL VARIATION OF MAXILLARY SINUS AND ITS RELATION WITH PERIODONTAL DISEASES IN KP POPULATION USING CBCT AND PERIODONTAL CLINICAL ASSESSMENT
Main Article Content
Keywords
maxillary sinus, periodontal disease, anatomical variations, CBCT, sinus pneumatization, mucosal thickening, root proximity, periodontal progression
Abstract
Background
The maxillary sinus shares a close anatomical relationship with the posterior teeth, which may influence periodontal disease progression. This study aimed to evaluate the impact of anatomical variations in the maxillary sinus on periodontal health using radiological assessment.
Methodology
A cross-sectional study was conducted at Khyber College of Dentistry Peshawar and Ayub College of Dentistry, Abbottabad, from March 2023 to March 2024. A total of 73 patients were included based on specific inclusion criteria. Periodontal parameters, including pocket depth, clinical attachment loss, bleeding on probing, and tooth mobility, were assessed clinically. Cone-beam computed tomography (CBCT) was used to evaluate sinus variations such as sinus septa, pneumatization, mucosal thickening, and proximity of the sinus floor to posterior tooth roots. Statistical analysis was performed using SPSS version 25, with chi-square and t-tests applied to determine significant associations (p < 0.05).
Results
Sinus floor pneumatization was significantly associated with increased periodontal attachment loss (p = 0.025), suggesting a role in bone resorption. Mucosal thickening correlated with deeper periodontal pockets and greater inflammation (p = 0.019). The presence of sinus septa was also linked to more severe periodontal conditions (p = 0.048), likely due to altered sinus drainage and localized pressure effects. Root proximity to the sinus was another significant factor, with cases of close contact showing higher rates of periodontal deterioration (p = 0.041). Smoking and snuff missing teeth adjacent to the sinus further contributed to disease severity.
Conclusion
This study highlights the influence of maxillary sinus anatomical variations on periodontal disease progression. Factors such as sinus pneumatization, mucosal thickening, and root proximity may exacerbate periodontal breakdown, reinforcing the need for a multidisciplinary approach in diagnosis and treatment planning. CBCT imaging plays a vital role in identifying these variations, allowing for more effective periodontal management.
The maxillary sinus shares a close anatomical relationship with the posterior teeth, which may influence periodontal disease progression. This study aimed to evaluate the impact of anatomical variations in the maxillary sinus on periodontal health using radiological assessment.
Methodology
A cross-sectional study was conducted at Khyber College of Dentistry Peshawar and Ayub College of Dentistry, Abbottabad, from March 2023 to March 2024. A total of 73 patients were included based on specific inclusion criteria. Periodontal parameters, including pocket depth, clinical attachment loss, bleeding on probing, and tooth mobility, were assessed clinically. Cone-beam computed tomography (CBCT) was used to evaluate sinus variations such as sinus septa, pneumatization, mucosal thickening, and proximity of the sinus floor to posterior tooth roots. Statistical analysis was performed using SPSS version 25, with chi-square and t-tests applied to determine significant associations (p < 0.05).
Results
Sinus floor pneumatization was significantly associated with increased periodontal attachment loss (p = 0.025), suggesting a role in bone resorption. Mucosal thickening correlated with deeper periodontal pockets and greater inflammation (p = 0.019). The presence of sinus septa was also linked to more severe periodontal conditions (p = 0.048), likely due to altered sinus drainage and localized pressure effects. Root proximity to the sinus was another significant factor, with cases of close contact showing higher rates of periodontal deterioration (p = 0.041). Smoking and snuff missing teeth adjacent to the sinus further contributed to disease severity.
Conclusion
This study highlights the influence of maxillary sinus anatomical variations on periodontal disease progression. Factors such as sinus pneumatization, mucosal thickening, and root proximity may exacerbate periodontal breakdown, reinforcing the need for a multidisciplinary approach in diagnosis and treatment planning. CBCT imaging plays a vital role in identifying these variations, allowing for more effective periodontal management.
References
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2. Benjaphalakron N, Jansisyanont P, Chuenchompoonut V, Kiattavorncharoen S. Evaluation of the maxillary sinus anatomical variations related to maxillary sinus augmentation using cone beam computed tomography images. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 2021;33(1):18-25.
3. Sarilita E, Muhammad RM, Nugraha HG, Murniati N, Yusuf HY, Takeshita Y, et al. Anatomical relationship between maxillary posterior teeth and the maxillary sinus in an Indonesian population: a CT scan study. BMC Oral Health. 2024;24(1):1014.
4. Mays S, Stark S, Zakrzewski S, Vekony A. Which types of bony changes in the maxillary sinus indicate chronic sinusitis? International Journal of Paleopathology. 2024;46:16-23.
5. Awadi AW. Histopathology of endodontic lesions and their correlation to the radiographic changes in the maxillary sinus using CBCT scans: Boston University; 2022.
6. Khalil M, Attia D, Sakr HH. The Impact of Posterior Maxillary Teeth on Maxillary Sinus: Insights From Cone-Beam Computed Tomography Analysis. Cureus. 2024;16(12).
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8. Zhang T, He Z, Tian H. Association between periodontal status and degree of maxillary sinus mucosal thickening: a retrospective CBCT study. BMC Oral Health. 2021;21:1-6.
9. Dogan ME, Uluısık N, Yuvarlakbaş SD. Retrospective analysis of pathological changes in the maxillary sinus with CBCT. Scientific reports. 2024;14(1):15529.
10. Bergo BR, Oliveira IG, Carneiro LS, de Andrade Carvalho R, de Andrade ALDL. Analysis of anatomical variations in the frontal and maxillary sinuses and their relevance in dentistry. Brazilian Journal of Health Review. 2024;7(1):5534-46.
11. Ordinola-Zapata R, Azevedo B, Tataryn RW, Versiani MA. Maxillary Dental Anatomy and Physiology: Endodontic and Periodontal. Otolaryngologic Clinics of North America. 2024;57(6):927-39.
12. Gomes AEdN, Bueno CEdS, Martin ASD, Stringheta CP, Fontana CE, Rocha DGP, et al. Association of Maxillary Sinus Reactions and Periapical Pathology in the Maxillary Posterior Teeth: Evaluation Using Cone Beam Computed Tomography. Brazilian Dental Journal. 2024;35:e24-5973.
13. Zadsirjan S, Sheikhi M, Dakhilalian A, Feli M. Association of inflammatory periapical lesions with maxillary sinus abnormalities: a retrospective cone-beam computed tomography study. Journal of Dentistry. 2021;22(4):273.
14. Somayaji K, Muliya VS, Kg MR, Malladi UK, Nayak SB. A literature review of the maxillary sinus with special emphasis on its anatomy and odontogenic diseases associated with it. The Egyptian Journal of Otolaryngology. 2023;39(1):173.
15. Bisla S, Gupta A, Singh H, Sehrawat A, Shukla S. Evaluation of relationship between odontogenic infections and maxillary sinus changes: A Cone Beam Computed Tomography-based study. Journal of Oral Biology and Craniofacial Research. 2022;12(5):645-50.
16. Valenzuela-Fuenzalida JJ, Baez-Flores B, Sepúlveda RÁ, Medina CM, Pérez R, López E, et al. Anatomical variations and abnormalities of the maxillary region and clinical implications: A systematic review and metaanalysis. Medicine. 2023;102(38):e34510.
17. Perlea P, Nistor CC, Preoteasa CT, Gheorghiu IM, Mladin OA, Iliescu AA. Odontogenic maxillary sinus disease: a cone-beam computed tomography surveillance. Romanian Journal of Morphology and Embryology. 2024;65(3):507.
18. Ayyildiz H, Akgunlu F. Are maxillary sinus variations related to maxillary sinus diameters? Oral Radiology. 2023;39(2):425-36.
19. Jiang Y, Cui W, Chen J, Wu Q, Wang H, Zheng L, et al. Clinical, radiographic characterizations and complications of maxillary molar in a periodontitis population: a retrospective study based on CBCT radiography. Clinical Oral Investigations. 2023;27(5):2335-46.
20. Yeung AWK, Hung KF, Li DTS, Leung YY. The use of CBCT in evaluating the health and pathology of the maxillary sinus. Diagnostics. 2022;12(11):2819.
21. Aguori EA, Ersan N, Dölekoğlu ZS, Ilgüy D. Proximity of healthy posterior teeth to the maxillary sinus floor in relation to mucosal thickening: a CBCT study. Oral Radiology. 2023;39(3):536-43.
22. de Almeida Rodrigues P, Pinheiro VV, de Moura JDM, da Silva DCB, Tuji FM. Anatomical proximity of upper teeth and local factors associated with the thickness of the maxillary sinus membrane: a retrospective study. Giornale Italiano di Endodonzia. 2021;35(2).
23. Dumitrescu A, Martu M-A, Nemtoi A, Sirghe A, Chelaru L, Tatarciuc D, et al. Association between cone-beam computed tomography and histological and immunohistochemical features in periapical lesions correlated with thickened maxillary sinus mucosa. Medicina. 2021;57(8):840.
24. Shrestha B, Shrestha R, Lin T, Lu Y, Lu H, Mai Z, et al. Evaluation of maxillary sinus volume in different craniofacial patterns: a CBCT study. Oral Radiology. 2021:1-6.
2. Benjaphalakron N, Jansisyanont P, Chuenchompoonut V, Kiattavorncharoen S. Evaluation of the maxillary sinus anatomical variations related to maxillary sinus augmentation using cone beam computed tomography images. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 2021;33(1):18-25.
3. Sarilita E, Muhammad RM, Nugraha HG, Murniati N, Yusuf HY, Takeshita Y, et al. Anatomical relationship between maxillary posterior teeth and the maxillary sinus in an Indonesian population: a CT scan study. BMC Oral Health. 2024;24(1):1014.
4. Mays S, Stark S, Zakrzewski S, Vekony A. Which types of bony changes in the maxillary sinus indicate chronic sinusitis? International Journal of Paleopathology. 2024;46:16-23.
5. Awadi AW. Histopathology of endodontic lesions and their correlation to the radiographic changes in the maxillary sinus using CBCT scans: Boston University; 2022.
6. Khalil M, Attia D, Sakr HH. The Impact of Posterior Maxillary Teeth on Maxillary Sinus: Insights From Cone-Beam Computed Tomography Analysis. Cureus. 2024;16(12).
7. Rey-Martínez MH, Ruiz-Sáenz PL, Martínez-Rodríguez N, Barona-Dorado C, Meniz-García C, Cortés-Bretón Brinkmann J, et al. Analysis of the radiological changes of the sinus membrane using cone beam computed tomography and its relationship with dental treatments. A retrospective study. Biology. 2022;11(2):165.
8. Zhang T, He Z, Tian H. Association between periodontal status and degree of maxillary sinus mucosal thickening: a retrospective CBCT study. BMC Oral Health. 2021;21:1-6.
9. Dogan ME, Uluısık N, Yuvarlakbaş SD. Retrospective analysis of pathological changes in the maxillary sinus with CBCT. Scientific reports. 2024;14(1):15529.
10. Bergo BR, Oliveira IG, Carneiro LS, de Andrade Carvalho R, de Andrade ALDL. Analysis of anatomical variations in the frontal and maxillary sinuses and their relevance in dentistry. Brazilian Journal of Health Review. 2024;7(1):5534-46.
11. Ordinola-Zapata R, Azevedo B, Tataryn RW, Versiani MA. Maxillary Dental Anatomy and Physiology: Endodontic and Periodontal. Otolaryngologic Clinics of North America. 2024;57(6):927-39.
12. Gomes AEdN, Bueno CEdS, Martin ASD, Stringheta CP, Fontana CE, Rocha DGP, et al. Association of Maxillary Sinus Reactions and Periapical Pathology in the Maxillary Posterior Teeth: Evaluation Using Cone Beam Computed Tomography. Brazilian Dental Journal. 2024;35:e24-5973.
13. Zadsirjan S, Sheikhi M, Dakhilalian A, Feli M. Association of inflammatory periapical lesions with maxillary sinus abnormalities: a retrospective cone-beam computed tomography study. Journal of Dentistry. 2021;22(4):273.
14. Somayaji K, Muliya VS, Kg MR, Malladi UK, Nayak SB. A literature review of the maxillary sinus with special emphasis on its anatomy and odontogenic diseases associated with it. The Egyptian Journal of Otolaryngology. 2023;39(1):173.
15. Bisla S, Gupta A, Singh H, Sehrawat A, Shukla S. Evaluation of relationship between odontogenic infections and maxillary sinus changes: A Cone Beam Computed Tomography-based study. Journal of Oral Biology and Craniofacial Research. 2022;12(5):645-50.
16. Valenzuela-Fuenzalida JJ, Baez-Flores B, Sepúlveda RÁ, Medina CM, Pérez R, López E, et al. Anatomical variations and abnormalities of the maxillary region and clinical implications: A systematic review and metaanalysis. Medicine. 2023;102(38):e34510.
17. Perlea P, Nistor CC, Preoteasa CT, Gheorghiu IM, Mladin OA, Iliescu AA. Odontogenic maxillary sinus disease: a cone-beam computed tomography surveillance. Romanian Journal of Morphology and Embryology. 2024;65(3):507.
18. Ayyildiz H, Akgunlu F. Are maxillary sinus variations related to maxillary sinus diameters? Oral Radiology. 2023;39(2):425-36.
19. Jiang Y, Cui W, Chen J, Wu Q, Wang H, Zheng L, et al. Clinical, radiographic characterizations and complications of maxillary molar in a periodontitis population: a retrospective study based on CBCT radiography. Clinical Oral Investigations. 2023;27(5):2335-46.
20. Yeung AWK, Hung KF, Li DTS, Leung YY. The use of CBCT in evaluating the health and pathology of the maxillary sinus. Diagnostics. 2022;12(11):2819.
21. Aguori EA, Ersan N, Dölekoğlu ZS, Ilgüy D. Proximity of healthy posterior teeth to the maxillary sinus floor in relation to mucosal thickening: a CBCT study. Oral Radiology. 2023;39(3):536-43.
22. de Almeida Rodrigues P, Pinheiro VV, de Moura JDM, da Silva DCB, Tuji FM. Anatomical proximity of upper teeth and local factors associated with the thickness of the maxillary sinus membrane: a retrospective study. Giornale Italiano di Endodonzia. 2021;35(2).
23. Dumitrescu A, Martu M-A, Nemtoi A, Sirghe A, Chelaru L, Tatarciuc D, et al. Association between cone-beam computed tomography and histological and immunohistochemical features in periapical lesions correlated with thickened maxillary sinus mucosa. Medicina. 2021;57(8):840.
24. Shrestha B, Shrestha R, Lin T, Lu Y, Lu H, Mai Z, et al. Evaluation of maxillary sinus volume in different craniofacial patterns: a CBCT study. Oral Radiology. 2021:1-6.
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Published
Jan 15, 2025
Article Details
How to Cite
Dr. Hafsa Bibi, Dr. Abdul Hafeez Khan, Dr. Nadira Hameed, Dr. Aisha Sadaf, Dr. Mehak Shafiq, & Dr. Nabila Momin Khan. (2025). ANATOMICAL VARIATION OF MAXILLARY SINUS AND ITS RELATION WITH PERIODONTAL DISEASES IN KP POPULATION USING CBCT AND PERIODONTAL CLINICAL ASSESSMENT. Journal of Population Therapeutics and Clinical Pharmacology, 32(1), 945-953. https://doi.org/10.53555/vfa8bp52
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Author Biographies
Dr. Hafsa Bibi
FCPS Diagnostic Radiology, Department of Radiology, Women and Children Hospital, Abbottabad, Pakistan
Dr. Abdul Hafeez Khan
Assistant Professor, Department of Anatomy, Khyber Medical College, Peshawar, Pakistan
Dr. Nadira Hameed
Assistant Professor, Department of Anatomy, Fazaia Ruth Pfau Medical College, Karachi, Pakistan
Dr. Aisha Sadaf
Assistant Professor, Department of Anatomy, Khyber Medical University, Institute of Dental Sciences, Kohat, Pakistan
Dr. Mehak Shafiq
Senior Demonstrator, Department of Anatomy, Central Park Medical College, Lahore, Pakistan
Dr. Nabila Momin Khan
Assistant Professor, Department of Anatomy, Rehman Medical College, Peshawar, Pakistan
How to Cite
Dr. Hafsa Bibi, Dr. Abdul Hafeez Khan, Dr. Nadira Hameed, Dr. Aisha Sadaf, Dr. Mehak Shafiq, & Dr. Nabila Momin Khan. (2025). ANATOMICAL VARIATION OF MAXILLARY SINUS AND ITS RELATION WITH PERIODONTAL DISEASES IN KP POPULATION USING CBCT AND PERIODONTAL CLINICAL ASSESSMENT. Journal of Population Therapeutics and Clinical Pharmacology, 32(1), 945-953. https://doi.org/10.53555/vfa8bp52