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cone beam – international magazine of cone beam dentistry

I literature review _ current publications _“A guide to recognizing maxillary sinus pathology and for deciding on further preoperative assessment prior to maxil- lary sinus augmentation” by B. Friedland & R. Metson (Int J Periodontics Restorative Dent. 2014 Nov–Dec;34(6):807–15) ConeBeamComputedTomography (CBCT)isplay- ing an increasingly important role in diagnosis and treatment planning of dental implants, and can serve as an excellent preoperative tool prior to sinus graft- ingprocedures.Whenimplantsareplacedinthemax- illaryarch,considerationmustbegiventothepathol- ogy and anatomy of the maxillary sinuses. Studies showsthattheprevalenceofmucosaldiseasesecond- ary to endodontic a periodontal disease ranged from 5to38%. Theprevalenceofsinuspathologyfoundon CBCTonasymptomaticpatientshasbeenestimatedto range from 25 to 56%. The literature is in agreement thatamucosalthickeningof1–2mmorlessisnormal. Mucositis,themostcommonsinuspathology,isthe term for mucosal thickening and is associated most commonlywithapicalinfectionandallergies.Mucous drains from the sinus through the ostium, which is lo- catedsuperiorlyinthesinus,andshouldbeawayfrom thesurgicalareatobegrafted;thedisadvantageisthat there is no gravitational drainage due to the ostium’s superiorplacement.Thenextmostcommonpathology isamucousretentioncyst.Itnormallyappearsasdome shaped and is usually the result of a blocked mucous gland duct. Sinus polyps occur when there is inflam- mation and oedema in the lamina propria of the sinus membrane. Polyps are solid unlike retentions cysts, whicharefluidfilled.Bothappearsimilarradiographi- cally, although polyps are more likely to be peduncu- latedwhereasacystismorelikelytohaveabroadbase. Some less common sinus pathologies are a mucocele, whichiswhentheostiumisblockedandmucousaccu- mulatesinthesinus.Mucocelesareexpansileinnature and can cause sinus wall displacement. When dis- placementoccurs,itmakesiteasiertodifferentiatebe- tween a large mucous retention cyst and a mucocele. Benignandmalignanttumourscangrowlargeandare capableofdestroyinganysinusboundary. Opacities in the sinus can be antroliths, osteomas andexostoses.Antrolithsareopacitiesfrommineral- isation around organic material and are not attached tothebonywall,whereasosteomasandexostosesare attachedtothebonywall.Lastly,somepathologymay arisefromoutsidethesinusandinvadeintothesinus. Examples of these would be odontogenic cysts and radicular cysts. With CBCT imaging modalities, most sinus pathologies have a similar opacity, making it hard to distinguish between pathologies; greater emphasis should then be placed on evaluating the shape and distribution of lesions. It is therefore critical to have a scanoftheentiresinusuptotheorbitalfloor,because itisthesuperioraspectofthelesionthathelpstomake a final differentiation (e.g. dome shaped, straight or meniscus). A complete scan of the sinuses also helps todeterminewhethertheostiumisblocked.Ablocked ostiumwillhavegreaterlikelihoodofmorbidityfol- lowing implant surgery since bacteria and debris willnotbeabletoadequatelydrain.Itshouldbenoted thatreferraliswarrantedforanypatientsmanifesting sinuspathologyregardlessofwhetherornottheyare having bone grafting or implants placed. Fig. 1_Friedland B, Metson R; A guide to recognizing maxillary sinus pathology and for deciding on further preoperative assessment prior to maxillary sinus augmentation. Int J Periodontics Restorative Dent. 2014 Nov–Dec;34(6):807–15. Current and related literature abstracts Author_ Dr Barry A. Kaplan, USA 06 I cone beam3_2015 Fig. 1

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