The association between the periodontal status and the thickness of maxillary sinus membrane using cone‐beam CT

Background Maxillary posterior implant therapy is usually influenced by the anatomic structure of maxillary sinus and the conditions of mucosal membrane. In maxillary sinus lift surgery, the sinus membrane should be intact without causing inflammation. Common causes of odontogenic sinusitis are dental abscesses and periodontal disease. Aim/Hypothesis This study was conducted to determine the relationship between the periodontal condition of upper posteriors and the thickness of maxillary sinus membrane using cone-beam CT(CBCT). Material and Methods This study included 194 CBCT scans of dental patients. The thickness of the Schneiderian sinus membrane was evaluated at five points of reference (at the floor, at 3 mm and 10 mm, buccal and palatal) and the characteristics of the maxillary sinus membrane such as thickening and cyst were recorded by the criteria according to Patel et al.(1996) and Kanagalingam et al.(2009). Periodontal status of 378 posterior teeth was assessed by bone loss on available panoramic radiograph and available periodontal probing depth recording according to Arbes et al. (1999) and the periapical status was determined according to Lofthag-Hansen et al(2007). The thickness of the Schneiderian membrane was compared to the periodontal conditions by ANOVA and correlation analysis. Factors such as age, gender, or periapical status of the remaining adjacent posteriors that may affect the sinus membrane thickness were also evaluated using multivariate linear regression models. Results The thickness of the Schneiderian membrane exhibited a wide range(0.3 mm–31.0 mm) and was significantly associated with the radiologic periodontal status (r = 0.29˜0.36, P < 0.001). The linear regression model showed an association between both radiologic periodontal state and palatal probing depth, and the thickness of the Schneiderian membrane. Age, sex, or other dental status were not associated with the sinus mucosal thickening. Mucosal thickening was common in moderate to severe periodontitis (57.1 and 48.3%, compared to 16.7 in healthy to mild periodontitis) and mucosal cyst was significantly more frequent in severe periodontitis (21.7%, compared to 0˜1.4% in healthy to moderate periodontitis, P < 0.001). Conclusion and Clinical Implications Severe periodontal bone loss was significantly associated with mucosal thickening of the maxillary sinus and mucosal cysts. Periodontally compromised patients need to be properly diagnosed and managed prior to implant therapy. Future studies are needed to assess the therapeutic and prognostic impact of mucosal alterations in the maxillary sinus.