Dental Computed Tomography (CBCT) to Identify Dental Sources of Maxillary Sinusitis

CBCT by J. Morita Veraviewepocs 3De

As endodontists, the use of CBCT (Cone Beam Computed Tomography) has allowed us to cross this barrier and diagnose dental pathology which is adversely affecting the maxillary sinuses.  These images also allow us to communicate more effectively with patients and physicians who are trying to manage and treat these chronic sinus issues.  In order for dental and medical specialists to work together, new paths of communication must be developed.  CBCT (3D imaging) is helpful in bridging the communication gap between dentistry and medicine.

The following cases demonstrate the usefulness of CBCT in identifying odontogenic sources of chronic sinusitis.  Several radiographic findings are pointed out which help identify odontogenic sources for chronic sinusitis.  These common findings seen with high resolution CT imaging include:

1. Perforation of the floor of the Mx sinus
2. "Halo effect" elevation of the floor of the Mx sinus
3. Thickening of sinus membrane adjacent to odontogenic infection
4. Air bubbles in the sinus suggested of an acute sinusitis

CBCT for DIAGNOSIS
CBCT (J. Morita Veraviewepocs 3De) demonstrates a large periapical radiolucency around the buccal roots of #15.  The sagittal view shows elevation in the floor of the sinus (halo effect).  Coronal view shows arrow pointing to a missed mesio-buccal canal causing the endodontic infection. Air bubbles seen in the maxillary sinus are indicative of an acute sinusitis. Endodontic retreatment is required BEFORE sinus treatment.  Failure to address the odontogenic source of the sinus infection will result in recurrent sinus infections.

CBCT for DIAGNOSIS
CBCT (J. Morita Veraviewepocs 3De) demonstrates a large periapical radiolucency around the mesio-buccal root.  The sagittal and coronal views both show elevation in the floor of the sinus (halo effect) as well as perforation of the floor of the sinus.  Endodontic treatment is required BEFORE sinus treatment.  Failure to address the odontogenic source of the sinus infection will result in recurrent sinus infections.

CBCT for DIAGNOSIS
CBCT (J. Morita Veraviewepocs 3De) demonstrates a large periapical radiolucency around the buccal roots of #3.  The sagittal and coronal views both show elevation in the floor of the sinus (halo effect) as well as perforation of the floor of the sinus.  Endodontic treatment is required BEFORE sinus treatment.  Failure to address the odontogenic source of the sinus infection will result in recurrent sinus infections.

Fortunately, these high definition images also identify the problems with previous endodontic treatment and the solutions to remove the odontogenic source of infection.  These common endodontic findings include:

1. Missed (untreated) canals in a previously treated root canal
2. Short filled canals in a previously treated root canal
3. Iatrogenic damage in a previously treated root canal

Proper endodontic treatment of the dental infection is the first step in addressing the chronic sinusitis of odontogenic origen.  If sinus symptoms persist, following endodontic treatment, then referral to ENT is recommended.