Clinical Research

Cone-beam Computed Tomography Evaluation

of Maxillary Sinusitis
Michelle Maillet, DDS, MS,* Walter R. Bowles, DDS, MS, PhD,† Scott L. McClanahan, DDS, MS,†
Mike T. John, DDS, PhD,‡ and Mansur Ahmad, BDS, PhD§

Abstract
Introduction: Dental pain originating from the maxil-
lary sinuses can pose a diagnostic problem. Periapical
lesion development eliciting inflammatory changes in
D ental pain originating from the maxillary sinuses can pose a diagnostic problem for
the dental clinician. Because of the close proximity of the roots of the maxillary
posterior dentition to the floor of the sinus, along with a common innervation, there
the mucosal lining can cause the development of a sinus- is potential for pathosis of the sinus to cause dental symptoms (1). Likewise, pulpal
itis. The purpose of this study was to describe the radio- inflammation or infection can affect the integrity of the sinus floor. The development
graphic characteristics of odontogenic maxillary sinusitis of a periapical lesion in teeth whose root apices are close to or extending into the maxil-
as seen on cone-beam computed tomography (CBCT) lary sinuses could elicit inflammatory changes in the mucosal lining and, subsequently,
scans and to determine whether any tooth or any tooth the development of sinusitis (2).
root was more frequently associated with this disease. The extension of periapical inflammation into the maxillary sinus was first
Methods: Eighty-two CBCT scans previously identified described in 1943 by Bauer (3).This was a cadaver study with microscopic evaluation
as showing maxillary sinus pathosis were examined of sections of human teeth, alveolus, and sinus. Periapical inflammation was shown to
for sinusitis of odontogenic origin in both maxillary be capable of affecting the sinus mucosa with and without perforation of the cortical
sinuses. Results: One hundred thirty-five maxillary bone of the sinus floor. Infection and inflammatory mediators are able to spread directly
sinusitis instances with possible odontogenic origin or via bone marrow, blood vessels, and lymphatics to the maxillary sinus (3). When the
were detected. Of these, 37 sinusitis occurrences were ostium is blocked, the patient may experience pain with symptoms in the face, eye, nose,
from nonodontogenic causes, whereas 98 instances and oral cavity, including swelling. They may also experience a vague headache (4) and
were tooth associated with some change in the integrity with chronic sinusitis may complain of postnasal drip, dental pain, and a sore throat
of the maxillary sinus floor. The average amount of (5).
mucosal thickening among the sinusitis cases was 7.4 Cone-beam computed tomography (CBCT) provides detailed three-dimensional
mm. Maxillary first and second molars were 11 times images of the structures scanned. The use of CBCT scans in endodontic practice could
more likely to be involved than premolars, whereas allow for improved treatment planning of surgical procedures by showing the size and
either molar was equally likely to be involved. The location of the lesion in relation to other anatomic structures. Computed tomography
root most frequently associated with odontogenic sinus- scanning has become the standard in medicine for visualizing the maxillary sinuses
itis is the palatal root of the first molar followed by the because of the ability to visualize both bone and soft tissue in multiple views with
mesiobuccal root of the second molar. Conclusions: thin sectioning (6). Because an unresolved sinusitis may be exacerbated by an
Changes in the maxillary sinuses appear associated untreated dental condition, having both axial and coronal views allows the clinician
with periapical pathology in greater than 50% of the to assess the relationship of a periapical lesion to a sinus floor defect and any resultant
cases. Maxillary first or second molar teeth are most changes in the soft tissue of the sinus (7). In the case of odontogenic sinusitis, using
often involved, and individual or multiple roots may be CBCT technology could allow for improved treatment planning in combining both
implicated in the sinusitis. The use of CBCT scans can nonsurgical and surgical dental and medical treatments (8).
provide the identification of changes in the maxillary Sinusitis of odontogenic origin has traditionally been considered to account for
sinus and potential causes of the sinusitis. (J Endod approximately 10% of sinusitis cases (7). In the maxilla, odontogenic infections will
2011;37:753–757) most frequently spread through the thin buccal alveolar wall and into the buccal vesti-
bule. The floor of the sinus is composed of dense cortical bone; therefore, sinus infec-
Key Words tions from a dental source were thought to be uncommon, but they can occur,
Cone-beam computed tomography, odontogenic sinus- particularly in the case of a pneumatized sinus in which the Schneidarian membrane
itis, root apex can be easily penetrated by pathogens. Also, the labial levator and orbicularis oculi
muscles attach to the lateral wall of the maxilla, which forms the anterior wall of the

From *Private Practice, Halifax, Nova Scotia, Canada; and the Divisions of †Endodontics, ‡TMD and Orofacial Pain, and §Oral Medicine Diagnosis and Radiology,
University of Minnesota School of Dentistry, Minneapolis, Minnesota.
Address requests for reprints to Dr Walter R. Bowles, Department of Restorative Sciences, Division of Endodontics, University of Minnesota School of Dentistry, 8-166
Moos Tower, 515 Delaware Street SE, Minneapolis, MN 55455. E-mail address: [email protected]
0099-2399/$ - see front matter
Copyright ª 2011 American Association of Endodontists.
doi:10.1016/j.joen.2011.02.032

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Clinical Research
sinus. These muscle attachments can direct infection into the sinus via criteria: carious tooth, tooth with defective restoration, or extraction
soft-tissue spaces (5). site with or without radiographically evident periapical lesion and
Using computed tomography scanning, Obayashi et al (9) found mucosal thickening limited to the area of the tooth or extraction
over 70% of the patients diagnosed with maxillary dental infection site in question (Fig. 1C).
showed changes in the maxillary sinus. When sinusitis is of odontogenic 3. Sinusitis of nonodontogenic origin: a soft-tissue density mass within
origin, it may be the result of periapical infection or inflammation, peri- the sinuses is a sinusitis of nonodontogenic origin if it fulfills the
odontal disease, perforation of the sinus during extraction, or root tips following criteria: teeth are noncarious, have coronal and/or
or other foreign objects being forced into the sinus during surgical endodontic restorations of good quality without radiographically
treatment (4). evident periapical lesion or if extracted, intact or healing socket
The purpose of this retrospective study was to describe the radio- and mucosal thickening is not limited to any tooth (Fig. 1D and E).
graphic characteristics of odontogenic maxillary sinusitis as seen on 4. Sinusitis of undetermined origin: a soft-tissue density mass within
CBCT scans and to determine whether any tooth, or any tooth root, the sinuses is a sinusitis of undetermined origin if it fulfills the
was more frequently associated with this disease. following criteria: carious tooth, tooth with defective restoration,
presence of a periapical lesion, or a disrupted socket and mucosal
Materials and Methods thickening is not limited to any tooth (Fig. 1F).
Study Scans In the case of a diagnosis of odontogenic sinusitis, the etiologic
Approval for this study was obtained from the University’s Institu- tooth was recorded as well as the root associated with the periapical
tional Review Board. The investigators initially examined 871 CBCT lesion. If the tooth had previous endodontic therapy, this was recorded
radiology reports from 2006 to 2008 that a board-certified oral and as well as the presence of extruded material. In addition, the integrity of
maxillofacial radiologist had previously identified as showing sinusitis the medial and lateral walls and floor of the sinus was noted. The inves-
in one or both of the maxillary sinuses. The radiologist had 18 years tigators recorded disruption in the bone and/or any sclerosing of these
of experience in interpreting cross-sectional imaging and at the time walls.
of the study had interpreted about 3,000 CBCT scans. Based on these Mucosal thickening was measured at the point of maximum thick-
radiology reports, 82 CBCT scans were included in the study. Inclusion ness from the sinus floor. In the event of discrepancy between individual
criterion was the presence of the words ‘‘maxillary sinusitis’’ in the reviewers’ measurements, consensus was reached by re-evaluating the
radiographic impression section of the report. Exclusion criteria scan together. In those images in which the sinuses contained fluid, the
were totally edentulous maxilla and the presence of motion or beam distinction of the mucosal thickness was not possible and images were
hardening artifacts in the maxillary periapical areas. The age of the termed as sinusitis of undetermined origin (diagnostic criterion
patients ranged from 18 to 87 years, with a mean age of 57.3 years. 4).Dome-shaped radiopacities in the maxillary sinus were recorded
The patient pool included 49 men and 33 women. CBCT scans were but classified as polyps or retention pseudocysts. These were consid-
taken using a dentomaxillofacial volumetric imaging system, CBCT, ered to be pathological entities of nonodontogenic origin.
on a Next Generation i-CAT (Imaging Sciences, Hatfield, PA). Voxel
size in the study population ranged from 0.25 mm to 0.40 mm. The
acquisition time was 27 seconds or less. The total volume of the Measurement of the Mucosal Thickening
acquired data was available to the observers. The thickness of the mucosa was determined at the maximum
thickness from the sinus wall using the measurement tool provided
in the iCATVision software. The threshold of measurement reliability
Observers was 0.25 or 0.40 mm depending on the voxel size of the scan.
Two observers (an endodontic resident and a board certified oral
and maxillofacial radiologist) were calibrated by reviewing and discus-
sing 20 CBCT scans that had normal sinus findings or previously diag- Results
nosed sinusitis. For the study, the scans were reviewed by both the From the database of 871 CBCT scan radiology reports, 82 reports
observers independently on a Dell 24-inch nonglossy monitor (1,920 (9.4%) contained a conclusion of ‘‘maxillary sinusitis.’’ From these 82
 1,200 resolution) with a Dell Precision Workstation using iCATVison scans, we detected 135 instances of findings involving sinusitis with
software (Imaging Sciences). Each scan was reviewed in axial, coronal, a potential odontogenic origin (Fig. 3). In 98 instances (100 teeth
and sagittal sections and in the ‘‘implant’’ view for assessing individual were shown to be associated with sinusitis, but 2 teeth were involved
tooth/root. If there was a disagreement on the diagnosis, a consensus in 2 instances, providing sinusitis of odontogenic origin with 100 teeth),
was reached after a discussion between the two observers. it was noted that teeth were associated with some change in the integrity
of the maxillary sinus floor. Of the odontogenic cases, 3 occurrences
Diagnostic Criteria for Sinusitis were first premolars, 8 were second premolars, 55 were first molars,
and 34 were second molars. Of these 98 odontogenic cases, 28 were
For the purposes of this study, diagnostic criteria for sinusitis diag-
nosis were developed based on published literature (10). These criteria considered to be indeterminate because the sinusitis was not limited
to a diseased or defectively restored tooth (diagnostic criterion 4).
divided maxillary sinusitis into four categories, with line diagrams
Although odontogenic etiology in these 28 cases was present with
shown in Figure 1 and sample CBCT pictures shown in Figure 2:
disruption of the sinus floor in the area of the teeth involved, the extent
1. Normal sinus: a sinus is considered normal if it has no mucosal of the sinusitis was large and considered indeterminate even though
thickening detected on the images or uniform mucosal thickening tooth-associated changes were present. When considering the total
less than 2 mm (11). The adjacent teeth may be healthy, carious, number of maxillary posterior teeth (534 teeth) included in examina-
pulp exposed, restored, extracted, and with or without radiograph- tion, 3 of 132 maxillary first premolars, 8 of 141 maxillary second
ically evident periapical lesion (Fig. 1A and B). premolars, 55 of 137 maxillary first molars, and 34 of 124 maxillary
2. Sinusitis of odontogenic origin: a soft-tissue density mass within the second molars showed odontogenic etiology for the sinusitis. Thirty-
sinuses is a sinusitis of odontogenic origin if it fulfills the following seven other occurrences were because of nonodontogenic causes,

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Figure 1. (A and B) Normal sinus mucosal thickening of less than 2 mm. Adjacent teeth may be healthy, carious, pulp exposed, restored, extracted, and with or
without radiographically evident periapical lesion. (C) Sinusitis of an odontogenic origin. Mucosal thickening limited to carious tooth, tooth with defective resto-
ration with or without radiographically evident periapical lesion, or extraction site. (D and E) Sinusitis of a nonodontogenic origin. Mucosal thickening is not limited
to any tooth, periapical lesions, or extraction socket. (F) Sinusitis of an undetermined origin. A possible odontogenic source is present, but mucosal thickening is
not limited to any carious tooth, tooth with defective restoration, a periapical lesion, or a disrupted socket.

with common findings of fluid in the sinuses and sclerosis of the sinus etiology, 55% were from maxillary first molars, and 34% were from
floor and the lateral wall of the sinus. No sclerosis of the medial wall was maxillary second molars. Among all 100 teeth associated with maxillary
noted. In six of these cases, the medial wall of the maxillary sinus was sinusitis, 21 had previous root canal therapy, and 2 of the 21 cases had
disrupted, but all of these cases involved sinus pathology of nonodon- extruded root canal filling material.
togenic or indeterminate origin and included sinonasal polyposis, soli-
tary polyps, cancer, mucoceles, retention cysts, antroliths, fungal
sinusitis, or sinusitis lacking dental etiology. Discussion
There were 35 cases of sinusitis in patients who had existing For this study, we developed radiographic diagnostic criteria for
premolars and molars. Sinusitis was more likely to be associated with sinusitis of odontogenic origin. The diagnostic criteria are a modifica-
the molars with an odds ratio of 11 (molars were 11 times more likely tion of the classification by Abrahams and Glassberg (10). This existing
to be associated with sinusitis than premolars). There were 48 cases of classification, which was developed by medical radiologists, did not
sinusitis in patients who had existing first and second molars. In these evaluate carious lesions or endodontic status of the involved tooth.
instances, sinusitis was equally likely to be associated with either molar We found that our modified classification system allowed comprehen-
(odds ratio of 1). Two cases had two separate teeth involved with the sive analysis of sinusitis of an odontogenic origin. In this study, odonto-
sinusitis, which included one case with a premolar and molar and genic sinusitis was identified as a localized thickening of the mucous
one case with a first and second molar. membrane of the maxillary sinus. The tooth most commonly associated
In many instances, multiple roots were implicated in the sinusitis. with these findings was the maxillary first molar. This finding is consis-
The first premolar group involved solely the buccal root in one instance tent with previous reports (9, 12). However, these reports did not
and solely the palatal root in one instance. In the third case, both roots address the involvement of a particular root with sinusitis. In our
were involved with disruption of the sinus floor. Of the eight second study, the palatal root of the first molar was most commonly
premolars associated with maxillary sinusitis, six were single-rooted associated with the perforation of the sinus floor. What is perhaps
teeth. In the remaining two, one case involved the buccal root and surprising about these findings is the fact that the palatal root of the
the other involved both the buccal and palatal roots. In the first molar first molar is not the closest root to the sinus. The mesiobuccal root
group, 38 of the 55 teeth involved the palatal root, 18 involved the me- of the maxillary second molar is on average 0.67 mm closer to the
siobuccal root, and 17 involved the distobuccal root. In the second sinus than the palatal root of the first molar (13). The first molar erupts
molar group, 27 of the 34 cases involved the mesiobuccal root, 10 earlier (by 4–5 years), however, and is therefore more susceptible to
involved the palatal root, and 8 involved the distobuccal root. No third caries, restorations, and occlusal wear over time than the second molar.
molars were evaluated during the investigation. This could account for more frequent periapical pathosis and subse-
The average amount of mucosal thickening noted among the quent extension of this pathosis into the sinus. When the second molar
sinusitis cases was 7.4 mm. The cortical bone in the floor of the sinus was involved, pathosis associated with the mesiobuccal root was the
was disrupted in all cases in which a dental etiology was identified. We most common etiology. The cortical bone in the floor of the sinus
saw an association of this thickening with a periapical lesion from was disrupted in all cases in which dental etiology was identified.
carious or heavily restored teeth. The tooth most commonly associated The maxillary sinuses are variable in size depending not only on
with these findings was the maxillary first molar, and the palatal root of the individual but also on the individual’s age. These sinuses complete
the first molar was most commonly associated with the perforation of their growth between the ages of 12 and 14 years concurrently with the
the sinus floor. The distribution of teeth associated with maxillary sinus- eruption of the maxillary teeth and growth of the maxillary alveolar
itis is shown in Figure 4. Of the sinusitis cases with an odontogenic process. In some people, expansion of the maxillary sinuses will

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Figure 2. (A) A CBCT scan (coronal section) through the skull at the level of the first molar. Carious maxillary first molars with periapical lesions (red arrow) are
associated with localized thickening of mucosa (green arrow) in both maxillary sinuses. (B) A CBCT scan (coronal section) through the skull at the level of the first
molar. Nonodontogenic sinusitis. The left maxillary sinus is filled with fluid and contains air bubbles (red arrow). The first maxillary molar has an intact restoration,
has root canal therapy of good quality, lacks a periapical lesion, and the corticated floor of the sinus remains intact. (C) A CBCT scan (coronal section) through the
skull at the level of the first molar. Sinusitis of an indeterminate origin. Both molars are heavily restored. The root perforates the maxillary sinuses. The sinuses are
filled, making localization of the source of inflammation impossible.
continue throughout life, resulting in an inferior displacement of the computed tomography images have shown that sinusitis of
floor of the sinus toward the root apices of the maxillary posterior teeth. odontogenic origin is not a rare condition; rather, as high as 86% of
On occasion, the roots of the maxillary teeth project into the sinus cavity, sinusitis cases have a potential odontogenic source (9, 15, 16). This
with the apices surrounded by sinus mucoperiosteum (5). is exemplified by a recent report of five patients who had undergone
Radiographically, the normal maxillary sinus has a shape that is an average of 2.8 sinus surgeries in which the sinusitis persisted with
inconsistent, with many loci and lobulations (14). Because it is air symptoms for 3 to 15 years until the true cause of the problem, their
filled, the sinus is radiolucent, but it has clearly defined margins (2). dental infection, was treated (17). What is even more important is
In the case of a diseased sinus, a clinician may observe clouding (opa- that three of these five patients had been seen by their respective dentists
cifying), mucosal thickening, and/or accumulation of fluid (4). Rak et (they underwent examination and dental radiographs) and told that
al (11) reviewed 128 magnetic resonance images of the paranasal there was no dental pathology, which shows that unrecognized periap-
sinuses and found that 4 mm of mucosal thickening was significantly ical infection can be a cause of sinusitis. Obayashi et al (9) found that
related to clinical symptoms. The authors determined that 1 to 2 mm 71.3 % of cases of dental infection were associated with changes in the
of mucosal thickening was a normal variant (11). Other authors have maxillary sinus. In that study, periapical pathosis was diagnosed first,
found that mucosal thickening of 4 mm or more was significantly asso- followed by radiographic examination of the sinuses. The present study
ciated with clinical symptoms (9). The average amount of mucosal first noted sinus pathology and then evaluated the dentition. When we
thickening noted during this investigation was 7.4 mm. The current consider all the sinusitis cases (135) and examine the odontogenic
investigation was a retrospective study of existing scans only, and did cases (70 as two teeth were associated in two cases each), there exists
not include patient symptoms, or the reasons for the referral for
CBCT scans.
Based on a study by Maloney and Doku in 1968 (2), several 60
reports had indicated that only 10% to 12% of sinusitis cases have an
% teeth associated with sinusitis

odontogenic source (5, 7). However, more recent works based on

50

40

30

20

10

0
1st Premolar 2nd Premolar 1st Molar 2nd Molar

Figure 3. From 82 scans, 135 instances of findings involving sinusitis with Figure 4. The incidence of 100 maxillary posterior teeth possibly involved
potential odontogenic origin were detected. The breakdown of cases from with maxillary sinusitis. Periapical disease from the first and second maxillary
these 135 sinusitis instances are shown. molars is by far the largest contributor.

756 Maillet et al. JOE — Volume 37, Number 6, June 2011

 Clinical Research
a 51.8% incidence of odontogenic sinusitis (70/135). Without consid- associated with changes in the maxillary sinus; and (7) the root most
ering the indeterminate cases of sinusitis, there existed 65.4% (70/[70 frequently associated with odontogenic sinusitis is the palatal root of
odontogenic + 37 nonodontogenic cases]) of the maxillary sinusitis the first molar followed by the mesiobuccal root of the second molar.
cases associated with maxillary posterior teeth having periapical
pathology, which closely matches the occurrence rate found by Obaya-
shi et al (9). Acknowledgments
It is important to note that although this study did not address the The authors deny any conflicts of interest related to this study.
issue of sinusitis associated with peri-implantitis, this condition has
been noted in the literature (18), and the identifying factors for odon-
togenic sinusitis could also be applied to a dental implant. Having more References
accurate data available at the time of diagnosis can lead to better treat- 1. Radman WP. The maxillary sinus—revisited by an endodontist. J Endod 1983;9:
ment planning. The use of CBCT in the endodontic practice could 382–3.
provide the clinician with important information regarding the size 2. Maloney PL, Doku HC. Maxillary sinusitis of odontogenic origin. J Can Dent Assoc
and location of a periapical lesion, which could affect a clinician’s treat- (Tor) 1968;34:591–603.
ment decision (8). If a tooth has been previously treated, there are 3. Bauer W. Maxillary sinusitis of dental origin. Am J Orthod Oral Surg 1943;29:133–51.
4. Thunthy KH. Diseases of the maxillary sinus. Gen Dent 1998;46:160–5.
several factors that will influence the decision whether to retreat or 5. Brook I. Sinusitis of odontogenic origin. Otolaryngol Head Neck Surg 2006;135:
not and whether the retreatment should be surgical or nonsurgical 349–55.
(19). A clinician who has elected for a surgical retreatment approach 6. Nishimura T, Iizuka T. Evaluation of odontogenic maxillary sinusitis after conserva-
may be better prepared for the surgery if they are aware of whether tive therapy using CT and bone SPECT. Clin Imaging 2002;26:153–60.
7. Mehra P, Murad H. Maxillary sinus disease of odontogenic origin. Otolaryngol Clin
or not the sinus had been perforated by the periapical lesion. Depend- North Am 2004;37:347–64.
ing on the size of the perforation, surgical endodontics may not be rec- 8. Nair UP, Nair MK. Maxillary sinusitis of odontogenic origin: cone-beam volumetric
ommended, or a hospital setting may be selected for the surgical computerized tomography-aided diagnosis. Oral Surg Oral Med Oral Pathol Oral
procedure. The accurate identification of changes in the maxillary sinus Radiol Endod 2010;110:e53–7.
with a dental cause could also improve the quality of life for those 9. Obayashi N, Ariji Y, Goto M, et al. Spread of odontogenic infection originating in the
maxillary teeth: computerized tomographic assessment. Oral Surg Oral Med Oral
patients with remaining symptoms after dental treatment. During this Pathol Oral Radiol Endod 2004;98:223–31.
investigation, 28 cases had an extensive sinusitis as well as odontogenic 10. Abrahams JJ, Glassberg RM. Dental disease: a frequently unrecognized cause of
pathosis. For these patients, combined therapy between the dentist and maxillary sinus abnormalities? AJR Am J Roentgenol 1996;166:1219–23.
an otolaryngologist may be required. 11. Rak KM, Newell JD 2nd, Yakes WF, Damiano MA, Luethke JM. Paranasal sinuses on
MR images of the brain: significance of mucosal thickening. AJR Am J Roentgenol
Cone-beam technology has many applications including temporo- 1991;156:381–4.
mandibular joint evaluation, orthodontic evaluation, implant treatment 12. Arias-Irimia O, Barona-Dorado C, Santos-Marino JA, Martinez-Rodriguez N, Marti-
planning, oral surgery, and the assessment of craniofacial trauma and nez-Gonzalez JM. Meta-analysis of the etiology of odontogenic maxillary sinusitis.
reconstruction (20). The main drawbacks to including CBCT in Med Oral Patol Oral Cir Bucal 2010;15:e70–3.
endodontic practice are the high financial cost and the higher radiation 13. Eberhardt JA, Torabinejad M, Christiansen EL. A computed tomographic study of the
distances between the maxillary sinus floor and the apices of the maxillary posterior
dose as compared with conventional radiography. However, in many teeth. Oral Surg Oral Med Oral Pathol 1992;73:345–6.
cases, the information gained could be of paramount importance. 14. Poyton HG. Maxillary sinuses and the oral radiologist. Dent Radiogr Photogr 1972;
45:43–50.
15. Bomeli SR, Branstetter BFt, Ferguson BJ. Frequency of a dental source for acute
Conclusions maxillary sinusitis. Laryngoscope 2009;119:580–4.
The following conclusions can be made: (1) radiographic diag- 16. Lopatin AS, Sysolyatin SP, Sysolyatin PG, Melnikov MN. Chronic maxillary sinusitis of
nostic criteria for sinusitis of odontogenic origin were developed for dental origin: is external surgical approach mandatory? Laryngoscope 2002;112:
this study; (2) odontogenic sinusitis can be identified as a localized 1056–9.
thickening of the mucous membrane of the maxillary sinus associated 17. Longhini AB, Branstetter BF, Ferguson BJ. Unrecognized odontogenic maxillary
sinusitis: a cause of endoscopic sinus surgery failure. Am J Rhinol Allergy 2010;
with a carious or heavily restored tooth with a periapical lesion or 24:296–300.
extraction site; (3) in patients with maxillary sinusitis, over half of the 18. Costa F, Emanuelli E, Robiony M, Zerman N, Polini F, Politi M. Endoscopic surgical
cases appear to be associated with odontogenic pathology; (4) molars treatment of chronic maxillary sinusitis of dental origin. J Oral Maxillofac Surg 2007;
are 11 times more likely than premolars to be associated with odonto- 65:223–8.
19. Friedman S. Considerations and concepts of case selection in the management of post-
genic sinusitis when both teeth are present; (5) first and second molars treatment endodontic disease (treatment failure). Endod Topics 2002;1:54–78.
are equally likely to be associated with odontogenic sinusitis when both 20. Cotton TP, Geisler TM, Holden DT, Schwartz SA, Schindler WG. Endodontic appli-
molars are present; (6) in this study, the first molar was most frequently cations of cone-beam volumetric tomography. J Endod 2007;33:1121–32.

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