The relation between Schneiderian membrane thickening and radiodiagnostic features of periapical pathology

Oliveira-Santos, Nicolly; Leite, André Ferreira; Petitjean, Eline; Torres, Andres; Van der Veken, Dominique; Curvers, Frederik; Pinto, Jáder Camilo; Lambrechts, Paul; Jacobsi, Renhilde

doi:10.1590/0103-6440202405775

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Article • Braz. Dent. J. 35 • 2024 • https://doi.org/10.1590/0103-6440202405775 copy

The relation between Schneiderian membrane thickening and radiodiagnostic features of periapical pathology

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study aimed to assess the relationship between Schneiderian membrane thickening and periapical pathology in a retrospective analysis of Cone Beam Computed Tomography (CBCT) images. For this, 147 CBCT scans containing 258 sinuses and 1,181 teeth were assessed. Discontinuation of the lamina dura, widening of the periodontal ligament space, apical periodontitis (AP), and partly demineralized maxillary sinus floor associated with AP were considered periapical pathology. Maxillary sinus mucosal thickening (MSMT) was classified as odontogenic or non-odontogenic. An irregular band with a focal tooth associated thickening and local thickening related to a root were considered odontogenic types of MSMT. The relation between the imaging features of periapical pathology and the type and thickness of MSMT was determined by logistic regression and linear mixed model, respectively. In addition, linear regression and Mann Whitney test evaluated the relation and demineralization of the AP lesion towards the sinus floor (p≤0.05). The odds of having an odontogenic type of MSMT were significantly higher when a periapical pathology was present in the maxillary sinus. Eighty-two percent of AP partly demineralized towards the sinus floor were associated with an odontogenic MSMT. Both AP lesions partly demineralized towards the sinus floor and, with increased diameter, led to increased MSMT. In conclusion, there is an 82% risk of having an odontogenic type of MSMT with the presence of AP partly demineralized towards the sinus floor. More thickening of the maxillary sinus mucosa is seen with larger AP lesions and partial demineralization of the sinus floor.

Key Words:
apical periodontitis; cone-beam computed tomography; maxillary sinus; Schneiderian membrane

Type of maxillary sinus mucosal thickening	n/N (%)
Invisible thickening	115/258 (44.6%)
Regular band	27/258 (10.5%)
Irregular band of nonodontogenic origin	33/258 (12.8%)
Irregular band with focal tooth associated thickening	25/258 (9.7%)
Local thickening in relation with a root	27/258 (10.5%)
Local thickening on the maxillary sinus floor but not in relation with a root	27/258 (10.5%)
Full opacification	4/258 (1.5%)

	Root sign
Description of the periapical pathology	Absent	Present	N	P
Root infection	2.07 (1.49 - 2.65)	3.23 (2.48 - 3.98)	121	<0.0001
Root infection and touching/protruding relation root-sinus floor	2.13 (1.56 - 2.71)	3.94 (2.93 - 4.94)	45	<0.0001
AP	2.13 (1.54 - 2.71)	3.45 (2.57 - 4.33)	64	0.0002
AP and touching/protruding relation AP-sinus floor	2.15 (1.57 - 2.73)	3.78 (2.77 - 4.79)	44	0.0002
AP and partial demineralization sinus floor	2.16 (1.58 - 2.74)	5.24 (3.84 - 6.63)	19	<0.0001

Type of periapical pathology	Type of thickening
Frequency (%)	invisible	regular band	irregular band of nonodontogenic origin	irregular band with focal tooth associated thickening	local thickening in relation with root	local thickening not in relation with root	full opacification	Total
No periapical pathology	87 (54.4)	20 (12.5)	21 (13.1)	0 (0.0)	7 (4.4)	22 (13.7)	3 (1.9)	160
Root infection + distant relation root-sinus floor	10 (47.6)	1 (4.8)	4 (19.0)	3 (14.3)	2 (9.5)	1 (4.8)	0 (0.0)	21
Root infection + touching/protruding relation root-sinus	5 (25.0)	0 (0.0)	3 (15.0)	6 (30.0)	5 (25.0)	1 (5.0)	0 (0.0)	20
AP + distant relation root-sinus floor	6 (31.6)	2 (10.5)	2 (10.5)	1 (5.3)	5 (26.3)	3 (15.8)	0 (0.0)	19
AP + touching/protruding relation AP-sinus floor + fully corticated sinus floor	6 (27.3)	3 (13.6)	2 (9.1)	6 (27.3)	4 (18.2)	0 (0.0)	1 (4.5)	22
AP + touching/protruding relation AP-sinus floor + partly demineralized sinus floor	1 (6.2)	1 (6.2)	1 (6.2)	9 (56.2)	4 (25.0)	0 (0.0)	0 (0.0)	16
Total	115	27	33	25	27	27	4	258

	Root sign
Description of the periapical pathology	Absent	Present	N	P
Root infection	4.3 (2.0 - 8.9)	45.5 (34.7 - 56.7)	98	<0.0001
Root infection and touching/protruding relation root-sinus floor	12.1 (8.2 - 17.7)	61.3 (43.2 - 76.8)	40	<0.0001
AP	10.6 (6.8 - 16.1)	52.1 (37.0 - 66.8)	57	<0.0001
AP and touching/protruding relation AP-sinus floor	12.3 (8.3 - 17.9)	62.1 (43.7 - 77.6)	38	<0.0001
AP and partial demineralization sinus floor	15.3 (10.9 - 21.0)	82.5 (54.5 - 94.9)	16	<0.0001

	Tooth root
Frequency Percent	Without AP	With AP	Total
Odontogenic thickening %	10 33.3	16 53.3	26 86.7
Non-odontogenic thickening %	0 0.0	4 13.3	4 13.3
Total %	10 33.3	20 66.7	30 100.0

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[1] Correspondence: Nicolly Oliveira-Santos OMFS IMPATH RESEARCH GROUP, KU Leuven, UZ campus St Rafael. Kapucijnenvoer 7, 3000 Leuven, Belgium, tel. +32 16 33 24 52