Detection of maxillary sinusitis of endodontic origin in cone-beam CT images using deep learning algorithms

Document Type

Research Project

Publication Date

Spring 5-26-2026

Abstract

sinusitis, with or without the extension to other paranasal sinuses secondary to either adjacent infectious dental pathology or iatrogenic injury from dental procedures1. Studies have shown that it accounts for 25–40% of all chronic maxillary sinusitis2 and 45–75% of unilateral maxillary sinus opacification on computed tomography (CT)3. Despite its relatively high prevalence, MSDO has received significantly little attention and has been often overlooked in sinusitis guidelines or position papers4. Maxillary sinusitis of endodontic origin (MSEO) is a newer term suggested to distinguish between different odontogenic sources for sinusitis and recognize endodontic infections or apical periodontitis (AP) as an important, yet overlooked, etiologic factor due to either lack of dental symptoms or atypical radiographic presentation5. MSEO can be a sequalae to untreated pulpal inflammation and necrosis or can present as post treatment disease following inadequate root canal treatment or inadequate coronal restoration of maxillary posterior teeth6. The integrity of the sinus mucosa may be affected by endodontic infections with or without perforation of the cortical bone of the sinus floor7. The clinical presentation of AP may be symptomatic or asymptomatic. Radiographically, AP has variable presentations according to the disease course, ranging from a slight widening of the periodontal ligament space to well-defined radiolucent lesions around a tooth apex. Subtle radiographic changes are not always detectable on medical CT images which may be more familiar to radiologists and physicians8 and can be also discounted in two-dimensional (2D) radiographs due to the superimposition of anatomical structures9. Minor periapical changes may only be evident using small field of view cone beam computed tomography (CBCT) examination that allows visualizing both bone and soft tissue changes in multiple plans with a thin slice thickness10

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