Diagnosing odontogenic sinusitis: An international multidisciplinary consensus statement.

BACKGROUND: Odontogenic sinusitis (ODS) is distinct from non-odontogenic rhinosinusitis, and often requires multidisciplinary collaboration between otolaryngologists and dental providers to make the diagnosis. The purpose of this study was to develop international multidisciplinary consensus on diagnosing ODS. METHODS: A modified Delphi method was used to assess for expert consensus on diagnosing bacterial ODS. A multidisciplinary panel of 17 authors with ODS expertise from 8 countries (8 otolaryngologists, 9 dental specialists) was assembled. Each author completed 2 of 3 surveys (2 specialty-specific, and 1 for all authors). Thirty-seven clinical statements were created, focusing on 4 important diagnostic components: suspecting ODS; confirming sinusitis in ODS; confirming different dental pathologies causing ODS; and multidisciplinary collaborative aspects of diagnosing ODS. Target audiences were all otolaryngologists and dental providers. RESULTS: Of the 37 clinical statements, 36 reached consensus or strong consensus, and 1 reached no consensus. Strong consensus was reached that certain clinical and microbiologic features should arouse suspicion for ODS, and that multidisciplinary collaboration between otolaryngologists and dental providers is generally required to diagnose ODS. To diagnose ODS, otolaryngologists should confirm sinusitis mainly based on nasal endoscopic findings of middle meatal purulence, edema, or polyps, and dental providers should confirm dental pathology based on clinical examination and dental imaging. CONCLUSION: Based on multidisciplinary international consensus, diagnosing ODS generally requires otolaryngologists to confirm sinusitis, and dental providers to confirm maxillary odontogenic pathology. Importantly, both dental providers and otolaryngologists should suspect ODS based on certain clinical features, and refer patients to appropriate providers for disease confirmation.

Diagnosing odontogenic sinusitis of endodontic origin: A multidisciplinary literature review.

PURPOSE: Endodontic disease is one of the most common causes of bacterial odontogenic sinusitis (ODS). Diagnosing ODS of endodontic origin involves otolaryngologists confirming sinusitis, and dental specialists confirming endodontic sources. The purpose of this study was to conduct a multidisciplinary literature review to highlight clinical and microbiological features of ODS, and the most optimal diagnostic modalities to confirm endodontic disease. METHODS: An extensive review of both medical and dental literature was performed by rhinologists, endodontists, and an infectious disease specialist. Frequencies of various clinical and microbiological features from ODS studies were collected, and averages were calculated. Different endodontic testing and imaging modalities were also evaluated on their abilities to confirm endodontic disease. RESULTS: ODS patients most often present with unilateral sinonasal symptoms for over 3 months, purulence on nasal endoscopy, and overt dental pathology on computed tomography (CT). Subjective foul smell, and maxillary sinus cultures demonstrating anaerobes and α-streptococci (viridans group) may be more specific to ODS. For endodontic evaluations, cold pulp testing and cone-beam CT imaging are most optimal for confirming pulpal and periapical disease. CONCLUSION: Diagnosing ODS requires collaboration between otolaryngologists and dental specialists. Clinicians should suspect ODS when patients present with unilateral sinonasal symptoms, especially foul smell. Patients will generally have purulent drainage on nasal endoscopy, and both sinus opacification and overt dental pathology on CT. However, some patients will have subtle or absent dental pathology on CT. For suspected endodontic disease, endodontists should be consulted for at least cold pulp testing, and ideally cone-beam CT.

A micro-computed tomography study of canal configuration of multiple-canalled mesiobuccal root of maxillary first molar.

OBJECTIVES: Detailed information of complex anatomical configuration of mesiobuccal (MB) root is essential for successful endodontic treatment in maxillary first molars. The aims of this study were to investigate the configuration types present in multiple-canalled MB roots of maxillary first molars using micro-computed tomography (µCT) and to evaluate whether further modification to current configuration classifications are needed for in-depth morphology study of MB root canal system. MATERIALS AND METHODS: One hundred and fifty-four extracted human maxillary first molar MB roots were scanned by µCT (Skyscan) and their canals were reconstructed by 3D modeling software. Root canal configurations were categorized according to the classifications proposed by Weine and Vertucci. Canal configurations that did not fit into both classifications were categorized as non-classifiable. RESULTS: One hundred and thirteen (73.4 %) MB roots had multiple canals. The most predominant canal configuration was Weine type III (two orifices and two foramens). Thirty-three (29.2 %) and 20 (17.7 %) MB roots had non-classifiable configuration types that could not be classified by the Weine and Vertucci classification, respectively. Three configurations (types 1-3, 2-3-2-3-2, and 2-3-4-3-2) were first reported in maxillary first molar MB roots. CONCLUSIONS: The present µCT study provided an in-depth analysis of canal configurations of the MB roots of maxillary first molar and suggests that additional modification of current configuration classifications may be needed to more accurately reflect the morphology configurations of MB roots. CLINICAL RELEVANCE: Clinicians should consider the complex canal configurations of the maxillary first molar MB roots during surgical or nonsurgical endodontic procedures.

Smear layer production of K3 and ProFile Ni-Ti rotary instruments in curved root canals: a comparative SEM study.

OBJECTIVE: The aim of this scanning electron microscopic study was to compare the quality and amounts of smear layer generated by 2 brands of nickel-titanium rotary instruments during canal preparation in the apical thirds of curved root canals. STUDY DESIGN: Forty mandibular mesial root canals with intact apex and mean curvature between 30 and 35 degrees were selected for this study. The root canals were randomly divided into 2 instrumentation groups of 15 each. Automated preparation was performed with ProFile (Dentsply Maillefer, Ballaigues, Switzerland; n = 15) and K3 (SybronEndo, Orange, Calif; n = 15) instrumentss using a crown-down technique. As a control group, barbed broaches (Mani; Matsutani Seisakusho, Takanezawa-Machi Tochibi-Ken, Japan; n = 10) were used to extirpate the necrotic pulp tissue from the root canals. All root canals were prepared to size #35. Glyde (File Prep, Dentsply Maillefer) was used as lubricant and 1% sodium hypochlorite solution as irrigant. At the conclusion of the experiments, all roots were split longitudinally and the root canal walls were examined at the apical third from 2 different perspectives using a scanning electron microscope. A 4-category scoring system for assessing the smear layer accumulation was used, and the resulting scores were statistically analyzed. RESULTS: Less smear layer was obtained in the K3 group at the selected apical third of curved root canals (P < .05). However, all instruments left a smear layer. The surface texture of the smear layer, in addition to the depth and the frequency of packed materials into the dentinal tubules, varied with instrument type. CONCLUSIONS: This finding may imply that, compared to ProFile, compression of the remaining smear layer is minimized when using the K3 rotary nickel-titanium system.