Comparison of cone-beam computed tomography and panoramic imaging in assessing the relationship between posterior maxillary tooth roots and the maxillary sinus: A systematic review.

The objective of the present systematic review was to analyze research articles that compare the accuracy of panoramic imaging to cone-beam computed tomography (CBCT) in assessing the relationship between posterior maxillary tooth roots and the maxillary sinus. A comprehensive literature search was conducted using various databases. Initial searching yielded 64 results, and after exclusion, five full-text articles were eligible. All were cohort studies, and the CBCT and panoramic images were either obtained from a pre-existing database or patients were recruited specifically for the study. Analysis showed that a panoramic image is sufficient for accurately detecting when the roots are at distinct distance from the sinus. However, if the roots are either laterally or medially projecting over the sinus and "just touching" it, panoramic images generally misinterpret this position, and instead make the root appear to be in the sinus. There were mixed results for when the root tip penetrates the sinus. Some studies claimed there was high agreeance between both modalities in this situation, while others had a low level of agreeance. In these situations, ordering a CBCT should be strongly considered to properly assess oral surgery risk with regard to maxillary posterior teeth.