Influence of the height of the alveolar bone in the distal parts of the upper jaw on the odontogenic inflammatory processes in the maxillary sinus

Abstract

Aim: To determine whether the height of the alveolar bone affects the transmission of inflammation from the periapex of the tooth to the maxillary sinus.
Background: The maxillary sinus is the largest of all paranasal cavities and is located in the body of the upper jaw. The inflammatory process in the teeth can often ascend to the maxillary sinuses and thus can cause odontogenic maxillary sinusitis. Untreated periapical inflammatory processes of the teeth in the distal parts of the upper jaw are the most common cause of odontogenic sinusitis. Data in the literature show that there is a correlation between the thickness of the mucosa of the maxillary sinus and the proximity of some anatomical structures, such as the height of the alveolar bone between the distal teeth of the upper jaw and the floor of the maxillary sinus.
Methods: To accomplish the task, we analyzed 109 CBCT images of patients with odontogenic cysts of the upper jaw, located in the area below the floor of the maxillary sinus. In 61 of them the residual alveolar bone was less than 3 mm. For the other 48 it was over 5 mm. The group of teeth, included in the study, consisted of premolars and molars. Above each tooth with an odontogenic cyst, the thickness of the mucosa of the maxillary cavity was measured. For normal mucosa we considered thickness of 0 – 2 mm, and for pathological – thickness of over 2 mm.
Group I – In this group we included odontogenic cysts in which the measured distance between the cystic cavity and the floor of the maxillary sinus was less than 3 mm.
Group II – In this group we included odontogenic cysts in which the measured distance between the cystic cavity and the floor of the maxillary sinus was over 5 mm.
Results: The following results were obtained in group I. Of the 61 cases with an odontogenic cyst present and alveolar bone height below 3 mm, the mean measured value in mm of sinus membrane thickness was 5.7 mm. The maximum value was 13 mm and the minimum was 2 mm. In group II we obtained the following results: we had 47 cases of radicular cysts of the distal teeth of the upper jaw, and the height of the bone to the floor of the maxillary sinus was 5 mm and more. The average thickness of the maxillary sinus mucosa was 2.21 mm. For comparison, up to 2 mm in the scientific literature is considered a healthy clinical mucosa. The minimum measured value was 1 mm and the maximum value was 8 mm.
Conclusions: Based on the results obtained, we can conclude that there is a clear relationship between the thickening of the maxillary sinus membrane and the present periapical pathology of the maxillary distal teeth when they are close to or in contact with the floor of the maxillary sinus. This dependence increases with decreasing the volume of the residual alveolar bone.