Comparison of Maxillary Molar Roots with Maxillary Sinus in High-resolution CBCT: A Retrospective Study.

Background: The maxillary sinus is a pyramidal-shaped osseous cavity, and maxillary molars are found to be in close proximity to the sinus floor or even protruding into it. The present study was conducted to measure the relation between the roots and sinus floor and also the thickness of the bone using CBCT to determine age and gender differences. Materials and
Methods: The individuals were separated into two groups based on age: Those under 40 and those over 40 years. There were 25 men and 25 females in the study. Axial, coronal, and sagittal slices of the CBCT images were obtained.
Results: The first molar root distance and cortical bone thickness varied significantly between men and women, as well as across different ages. Mesiobuccal root with sinus floor was shown to have a substantial mean value for both sexes (P = 0.049 and P = 0.003). In females, the thickness of the buccal plate was 1.291 mm, whereas, in men, it was 2.447 mm (P = 0.000). There was a substantial difference in the thickness of the buccal plate between men and women who were at least 40 years old (P = 0.000).
Conclusion: This study suggests how important it is to look at anatomical features and bone thickness when determining a person's age and gender. Copyright:

INTRODUCTION

The maxillary sinus is a pyramid-shaped rigid cavity, with the base being addressed by the nasal antral divider and the tip lying in the zygomatic bone, and its development begins during the fetal period and continues after birth, and advancement continues until the fruition of the mature dentition emission sequence.[1] The lower third of the average divider and the buccoalveolar divider form the bent mass of the maxillary sinus, and its connection to root apices moves as a result of a person's age, size, and the amount of pneumatization of the maxillary sinus and the state of dental maintenance.[2]

The first and second maxillary molars have apices that are near to or even within the sinus depression, which may lead to oroantral fistulae or root dislodgement, especially for first and second maxillary molar apices.[3] Reviewers used cone shaft figured tomography to examine lengths of first molar roots from the maxillary sinus floor and cortical bone thickness, as well as how these factors relate to sex and different age groups in connection to a variety of age groups (CBCT).

MATERIALS AND METHODS

To conduct a retrospective study, the institution's review board had to provide its clearance. There were no patients with pathology in the maxillary posterior teeth who were included in the current study's samples. A total of 50 maxillary first molars in 50 individuals were analyzed using CBCT scans, which included 25 men and 25 females between the ages of 18 and 50, with each group comprising 22 and 28 participants. Digital imaging systems such as the Kodak 9000 C were used for the CBCT exams (Care stream Dental LLC, Atlanta, GA, USA). Patients were given written informed permission before imaging that included a provision allowing the pictures to be used in this study. The mid-sagittal plane was perfectly aligned. At 74 kvp, 10 mA, 10.80 s, and a tiny field of view (FOV) of 5 cm and 3.75 cm, the pictures were captured with an exposure range of 236 mGy.cm3 and a voxel size of 75 m. Software from Carestream Health Inc., St. Rochester, New York, USA was utilized to create the three-dimensional (3D) images. The CBCT pictures were divided into three dimensions, axial, coronal, and sagittal. CBCT images were utilized to investigate the root of the maxillary first molars, the maxillary sinus, and the cortical plate. Approval from ethical committee was obtained.

CBCT cross-sectional images revealed four distinct vertical correlations between the sinus floor and the first molar roots: Type 0, Type 1, Type 2 (where the root apex is positioned outside of the sinus's borders), and Type 3 (where the root apex is located inside of the sinus's borders) all need cortical border contact [Table 2, Figure 1]. Types 2 and 3 of the horizontal root-to-sinus floor connection were separated into three types. It was discovered that three separate kinds of sinuses existed: Type B, Type BP, and Type P. All three had their lowest points on the buccal side of the sinus floor; however, Type P had their lowest points on the palatal side. CT cross-sectional scans were utilized to measure the distance between Types 0 and 3 teeth and the sinus floor, respectively. It was measured from the root's apex to its inferior cortical wall along its longitudinal axis. There were positive values for apices below the sinus floor and negative values for apices above. It took 30 min to view the images on dual HP 2475 W monitors with a 1920 × 1200 resolution in a darkened quiet environment.; Hewlett-Packard, Houston, USA).

Table 2

Age correlation with the vertical type of root relationship with a floor of the maxillary sinus

	Type				Total
	0	1	2	3
Age group
<40 yr	9	3	2	2	16
>40 yr	19	4	1	0	24
Total	28	7	3	2	40

Figure 1

Showing various relationships of maxillary root relation with the sinus floor

Statistical analysis

Statistical software SPSS version 17.0 IBM, USA, was used to generate and evaluate the response frequencies. As long as the probability value was below the threshold of 0.05, the study was deemed significant, and P value 0.001 was regarded as very significant.

RESULTS

The first molar mesiobuccal root distance from the maxillary sinus floor was 3.067 mm (2.4107) for females and 1.437 mm (2.6452) for males, and results were found to be statistically significant (P = 0.05). (P = 0.049). Women's and men's distobuccal root lengths with the maxillary sinus floor measured at 2.721 mm (2.1710) and 1.545 mm (2.5681), respectively, although the results were declared non-significant because of the small sample sizes (0.125). Furthermore, the vertical distance of the maxillary first molar palatal root from the maxillary sinus floor was determined to be non-significant (P = 0.595) for both females and men [Table 1 and Figure 1]. Gender-specific vertical relationships between the first molar and maxillary sinus floor were divided into four categories based on CBCT cross-sectional pictures. In Type 0 (20 instances, 80%) and Type 0 (15 cases, 60%) correspondingly, there was no significant link between the two genders. A similar pattern was seen in the horizontal connection, where only eight patients had Type B and Type BP relationships with three instances among women (12%) and five among men (20%) who had no statistically significant outcomes (P = 0.497).

Table 1

Gender wise vertical relationship of roots of molars with a floor of the maxillary sinus

	Sex	n	Mean	P
Vertical relationship	F	20	3.067	0.049
Mesiobuccal root	M	20	1.437
Vertical relationship	F	20	2.721
Distobuccal root	M	20	1.545	0.123
Vertical relationship	F	20	3.003
Palatal root	M	20	2.549	0.595

It was found that there was no difference between the mean values of 1.519 mm (2.5893) for the mesiobuccal root of the maxillary first molar in group one and 2.729 mm (2.5564) in group two, indicating no significant difference (P = 0.097). Age groups 1 and 2 had significant differences in the distance from the distobuccal root of the first molar to the floor of the maxillary sinus, with a distance of 0.684 mm (1.9326) in group 1 and 3.027 mm (2.3215) in group 2 (P = 0.003). Among those in age groups 1 and 2, the palatal root of the maxillary first molar was found to be 1.621 mm (2.2467) and the maxillary sinus floor to be 3.478 mm (2.6948), a difference that was statistically significant (P-value 0.37) because it was less than 0.05. The information can be seen in the second table.

Positive gender connections were found in 20 instances (80%) of females and no negative relationships were found. There were 15 examples (60%) of positive relationships and 3 cases (10%) of negative relationships among men, indicating no significant association between the two sexes (P = 0.260). This study found that there was a significant (P = 0.200) but insignificant (12 instances, 54.54%) vertical association between each root of the first maxillary molar and the floor of the maxillary sinus for both groups 1 and 2. Only 8 participants were found to have a Type B and Type BP association, with group 1 having six instances (25%) and group 2 having two cases (7.14%) with a P value of 0.133 that revealed no significant result. Group 1 showed a positive age-wise association in 15 instances (68.18%), whereas group 2 showed a negative relationship in 4 cases (18.9%). There was a 75% positive correlation between group 2 and group 1 (21 out of 25 instances) and no negative correlation (P > 0.05) [Table 3].

Table 3

Age correlation with the horizontal type of root relationship with a floor of the maxillary sinus

	Horizontal relationship
	B	BP	Total
Age group
<40 yr	4	2	6
>40 yr	1	1	2
Total	5	3	8

The mean value

Women's buccal cortical plate bone thickness was measured at 1.285 mm (0.5053), whereas men's was 2.432 mm (1.2083), a significant difference (P = 0.000). There were no statistically significant differences between female and male palatal cortical plate measurements of 1.46 and 1.76 mm, respectively (P = 0.198). [Figure 2]. The thickness of the buccal cortical plate below 40 years, that is, group 1 exhibited a significant effect with a P value of 0.000 when compared to the gender of the participants [Table 4].

Figure 2

Showing vertical relationship of roots with the sinus floor

Table 4

Gender correlation with a thickness of the cortical plate

	Sex	n	Mean	P
Thickness of buccal cortical plate	F	20	1.285
	M	20	2.432	0.000
Thickness of palatal cortical plate	F	20	1.426
	M	20	1.726	0.198

DISCUSSION

When it comes to determining the gender, Type 0 (20 instances, 80%) and Type 0 (15 cases, 60%) were found to be the most prevalent relationships of the sinus floor that did not touch molar roots, respectively, in a previously published research. For age determination, Type 0 (12 occurrences, 54.54%) and Type 2 (21 instances, 75%) had the highest correlation. Despite the roots being separated from the sinus (Type 0) being more widespread in each second molar root, according to a study by Jung et al.[4] apical protrusion into the maxillary sinus (Type 3) of one or more second molar roots was the most common.

For the mesiobuccal base of the maxillary first molar to rise beyond the floor of the maxillary sinus, the mean worth was 3.067 mm (2.4107) for females and 1.437 mm (2.6452) for men, showing a significant result for sexual orientation (P esteem 0.049). There was a considerable difference in the mean value of the distance between the distobuccal base of the first molar and the floor of the maxillary sinus between age groups 1 and 2, with 0.684 mm (1.9326) and 3.027 mm (2.3215) being the most significant (P esteem 0.003). Two studies have shown that the mesiobuccal foundations of the next molar are closest to the sinus floor, whereas the distobuccal base of the next one is closest to the sinus floor, thus providing distinct outcomes.[567]

Haghanifar et al.[8] results evaluated for more common class 2 and class 0 were found to be more among males than females although the present study evaluated Type 0 in most of the patients irrespective of gender. The present holds its importance in relation to a study by Bajoria et al.[9] showed that the majority of the cases apices of the maxillary posterior teeth were touching the floor of the sinus and 294 out of 749 had sinus pathologies apices of which touching the sinus floor and 44 out of 82 cases apices of which were within the sinus cavity were diagnosed within sinus pathologies. Panoramic radiography alternatively can be employed for the relation; however, it becomes diagnostically difficult to evaluate in borderline cases where roots are very near or in contact with the maxillary sinus.[8]

The mean worth sexual orientation shrewd for the bone thickness of the buccal cortical plate for females was 1.285 mm (±0.5053) and for males 2.432 mm (±1.2083), which showed huge outcome (P esteem 0.000), when we looked at age bunch (<40 years and >40 years) with sex, then the thickness of the buccal cortical plate underneath 40 years, for example, bunch 1 showed huge outcome having P esteem 0.000, which was under 0.05. This was as per Jung who additionally demonstrated buccal thickness to be more than palatal bone.

CONCLUSION

For dent maxillofacial imaging, cone shaft processed tomography (CBCT) should be recommended as a time and cost-saving alternative to conventional clinical registered tomography (MDCT). Regardless of the imaging technology, kV, mA, openness time, and field of view, all contribute to the overall radiation dose that must be taken into account. ICRP 2007 estimates that a successful component of a regular dental convention check using MDCT is 1.5 to multiple times more noteworthy than a similar small field of view dental CBCT filter (International Commission on Radiological Protection: ICRP 2007).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.