Vol. 9, No. 6, November-December 2020
19
ODONTOGENIC CAUSES. REVIEW
2* , Maria-Alexandra Martu
1
1 UMPh ”Grigore T. Popa” Iasi, Faculty of Medical Dentistry, Department of Oral Pathology.
2 UMPh ”Grigore T. Popa” Iasi, Faculty of Medicine, Department of ENT
3 UMPh ”Grigore T. Popa” Iasi, Faculty of Medical Dentistry, Department of Periodontology
4 UMPh ”Grigore T. Popa” Iasi, Faculty of Medical Dentistry, Department of Dento-alveolar Surgery
5 Phd Student ”Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania.
*Corresponding authors: Martu Cristian: cristimartu@gmail.com # All authors had equal contributions with the first author.
Abstract: Maxillary sinusitis is a frequent pathology encountered in both otolaryngology but also in oro-maxillo-facial and
dento-alveolar surgery. When it is of odontogen origin it can originate in a maxillary tooth infection, and/or
endodontic treatment, periodontal bone loss and dental implants. Odontogenic maxillary sinusitis accounts for
approximately 10%–41% cases of maxillary sinusitis and a routine radiologic examination can reveal its dental
origin.
The purpose of this review was to assess the association and influence between the various odontogenic conditions
(endodontic periapical pathology, periodontal disease, bone loss, dental trauma, missing teeth, etc.) and the presence
of maxillary sinus mucosal thickening reported in the literature. The thickness of the alveolar cortical plate and the
roots of maxillary molars affect the spread of odontogenic infection, which, in turn, is the basis of treatment
planning.
during treatment the odontogenic cause is often overlooked, leading to persistent symptoms in patients and an
incomplete and a failure of sinusitis treatment. A collaborative approach to the diagnosis and treatment of suspected
odontogenic maxillary sinusitis between otolaryngologists and dental practitioners may be an effective patient-
centered strategy. The interdisciplinary management of sinusitis and the dental origin of the condition is essential in
these cases.
Introduction:
cavities, usually with a pyramidal shape
with the tip extending into the zygomatic
bone and the base of the pyramid being
composed of the lateral nasal wall. The floor
of the maxillary sinuses consists of
maxillary alveolar bone and partly by the
hard palate. In approximately 50% of the
population, by forming alveolar recesses, it
may expand into the alveolar process. In this
clinical variant, the maxillary sinuses are
located close to the roots of the molar and
premolar teeth, especially the second
premolar, first, and second permanent molar
teeth [1]. Maxillary sinuses are pneumatic
cavities within maxillary bone that
communicate with the nasal cavity by
ostium.
pseudostratified ciliated columnar
which is the unique lining of the nasal cavity
and paranasal sinuses, is derived from
ectoderm, unlike the endoderm-derived
Vol. 9, No. 6, November-December 2020
20
periosteum and is about 1 mm thick. The
normal sinus mucosa is not imagined on a
radiograph [2]. Although, when the mucosa
comes to be irritated from either an
infectious or allergic process, it may
increase and may be seen on radiograph.
Mucosal thickness (MT) greater than 3 mm
is most likely pathological. The radiographic
image of thickened mucosa is as a non-
corticated radiopaque band, paralleling the
bony wall of the sinus [3].
Inflammation of this epithelium may
be caused by several predisposing factors,
including asthma, upper respiratory tract
infections, inhalation of foreign bodies, and
irritants, immunodeficiency, all of which
increase the risk of maxillary sinusitis
development [4]. Maxillary sinusitis (MS) is
a globally prevalent disease that has
important health implications. Moreover, as
the maxillary sinuses are anatomically close
to the root apex of the teeth, dental diseases
are also a potential source of maxillary
sinusitis [5].
account for approximately 10 to 12% of all
maxillary sinusitis cases [6]. Previous
studies are suggesting an increase in the
occurrence of odontogenic sinusitis [7].
Although there is no consensus in the
literature regarding the definition of
odontogenic maxillary sinusitis, diagnosis is
strongly based on clinical and radiologic
symptoms.
forms of maxillary sinusitis, a precise
diagnosis of odontogenic origin of maxillary
sinusitis plays a decisive role in the success
of the treatment. If the underlying dental
condition is not diagnosed, treatment for
odontogenic maxillary sinusitis will not be
successful [8]. Rarely, there can be serious
complications, such as subdural empyema
and cerebral abscess, related to odontogenic
sinusitis [9].
odontogenic conditions may be related to
sinus alterations including periapical
surgical procedures [7]. However, there are
also some controversies about the
appearance of the Schneiderian membrane
and its association with odontogenic
conditions. Melen et al. in their extensive
study assesed the relationship between
odontogenic conditions and maxillary sinus
pathologies. They stated that there is still no
agreement as to the ratio between sinusitis
of dental and rhinogenous origin and also
still no evidence as to whether nasal
polyposis is a cause or an effect of chronic
sinusitis [10].
of the Schneiderian membrane, the current
evidence provides inconclusive information
describing this association with healthy,
treated, and/or missing teeth.
assess the association and influence between
the various odontogenic conditions
trauma, missing teeth, etc.) and the presence
of maxillary sinus mucosal thickening
reported in the literature.
A number of studies have reported
the varying prevalence rates of sinus
mucosal thickening between 37 and 62%
[12, 13, 14]. This discrepancy between
studies may be attributable to using different
diagnostic criteria (> 1, > 2, > 3 mm) for
assessing the pathological radiographic
difference in the indication of CBCT scans,
which were included in the study and ethnic
differences among studied populations.
Vol. 9, No. 6, November-December 2020
21
throughout the literature. Conventional
apical periodontitis include Xray
radiography, magnetic resonance, computed
tomography scanning, and conventional
Images 1, 2 and 3 highlight that even on an
orthopantomography we can sometimes
membrane due to pathological processes of
teeth and the dental units that are the cause
of this pathology
Fig. 1. Ortopanthomography of a patient with right odontogenic maxillary sinusitis caused by 1.6
and 1.7.
Fig. 2. Ortopanthomography of a patient with bilateral odontogenic maxillary sinusitis caused by
6.5 and 2.4. We can also observe on the radiograph the anodontia of all four second premolars.
Romanian Journal of Medical and Dental Education
Vol. 9, No. 6, November-December 2020
22
Fig. 3. Ortopanthomography of a patient with bilateral odontogenic maxillary sinusitis caused by
1.7 and root fragments of 2.6, 2.7.
Unfortunately 2-dimensional
data on the etiology, location, and size of
periapical lesions, especially in maxillary
molars, because of the superimposition of
adjacent structures such as the palatal root or
the zygomatic bone. Cone-beam
computed tomographic (CBCT) imaging,
relationship between the tooth morphology
and the adjacent anatomic structures, is a
valuable technique for the evaluation of
periapical lesions [13].
Although ‘‘mild’’ mucosal
thickening >2 mm is reported to indicate
sinus pathology [12, 15]. When taking into
account age and sex various authors noted
that a thicker mucosae were twice as
frequent in males and older patients (>40
years) reports [16, 17, 18]. The overall mean
mucosal thickness of samples was 3.38 and
6.60 mm in sinuses with mucosal thickening
> 2 mm. A majority of the sinuses with
thickened mucosae presented with a ‘‘flat’’
type of thickening (73.5%), whereas
‘‘polypoid’’ thickening was observed less
frequently (26.5%) [17]. These findings are
consistent with recent reports in which
mucosal thickening in CBCT scans was
classified as ‘‘flat’’ and ‘‘polypoidal’’,
‘‘mucocele-like’’, or ‘‘mucosal cysts’’ [19,
20, 21]. The categorization of mucosal
thickening is reported to be appropriate
given the differences in etiology and nature
of the findings.
as dome-shaped radiopaque thickenings of
the sinus mucosa [19]. Asymptomatic
retention cysts are reported to either regress
spontaneously or show no significant
dimensional changes over the long-term and
therefore may not always necessitate
removal [22]. However, in the presence of
symptoms (eg, headache, facial pain, nasal
obstruction, and so on), an ear, nose, and
throat consultation may be warranted.
Recent diagnostic criteria have described
odontogenic MS as a localized thickening
(>2 mm) of the sinus membrane associated
with a carious or heavily restored tooth with
a periapical lesion based on a retrospective
analysis of CBCT scans of patients
diagnosed with MS [23].
tissues; it occurs as a sequence of various
infectious or physical insults to the dental
pulp or the damaging effects of root canal
filling materials. Microorganisms from the
infected root canals produce a sufficient
amount of endotoxins, which enter in high
concentrations into the periapical area. The
microbial factors and host defense destroy
much of the periapical tissue, resulting in a
formation of various kinds of lesions, such
as reactive granulomas and cysts [24].
Moreover, a close anatomical proximity of
the maxillary posterior lateral teeth to the
maxillary sinuses renders them vulnerable to
this periodontal inflammation [25]. Infection
from periapical lesion can affect the
maxillary sinus mucosa via bone marrow,
blood vessels and lymphatic vessels. The
upper posterior roots and the floor of the
maxillary sinus are separated by a thin
cortical bone and, sometimes, solely by the
sinus mucosa, which facilitates the spread of
infection into sinus [26].
Anatomic information regarding the
relationships with the posterior teeth are of
Romanian Journal of Medical and Dental Education
Vol. 9, No. 6, November-December 2020
23
may occur in both MSs and periapical
regions. Apical periodontitis (AP) in teeth in
which the root apices are close to the MS
may reveal inflammatory changes in the
MS. In cases in which the periapical bone is
thin (where the molar teeth are close to the
MS), perforation of the MSs may also occur
[27].
(3D) imaging modality that could be of
clinical value not only during screening but
also in planning treatments. CBCT scanning
is a technological innovation developed in
recent years and could be used in oral
surgery, orthodontic evaluation, implant
treatment planning, apical periodontitis
[12]. One of the benefits of applying CBCT
scanning for imaging of the paranasal
sinuses, including the maxillary sinus, is the
lower radiation dose when compared with
computed tomography imaging. Moreover,
accuracy of CBCT scanning parallels that of
computed tomography scanning and
helpful in elucidating the etiology and extent
of the relationship between the dental
pathology and the involved sinus. It was also
helpful in evaluating the preoperative and
postoperative conditions of the maxillary
sinuses [28]. Currently, CBCT systems can
be classified into 2 categories: limited
(dental and regional) and full (ortho or
facial).
apical lesions can infiltrate the maxillary
sinuses directly or via the numerous vascular
anastomoses, porous alveolar bone marrow,
and lymphatics, thereby infecting the sinus
mucosa. An increase in the quantity of
bacteria and toxins results in an increase in
the severity of apical periodontitis and thus
increases the likelihood of maxillary sinus
mucosal thickening [12].
likely to be found in odontogenic maxillary
sinusitis, normal antibiotics used to treat
routine sinusitis are less effective in the
treatment of odontogenic sinusitis.
treatment.
Periodontal disease is one of the
most prevalent infectious disease in humans
and it can considerably impact systemic
health. Periodontitis is a chronic oral
infection generated and sustained by a
polymicrobial biofilm in the mouth. The
resultant immuno-inflammatory response
connective tissue elements, stimulating net
resorption of alveolar bone. Maxillary
sinusitis, which can arise from bacterial,
fungal or viral infections, is often attributed
to periodontal disease [29, 30].
Limited previous researchers studied
thickening [16, 27, 29, 31]. Studies on this
topic published in the literature did not show
a significant association with the appearance
of the mucosal thickening and radiographic
parameters such as periodontal bone loss
and/or furcation involvement nor clinical
parameters [17, 32, 33, 34]. However, in a
study by Phothikhun et al. showed a
significant positive correlation with mucosal
thickening and severe periodontal bone loss
while no such association existed for
moderate periodontal bone loss [18].
The prevalence of maxillary sinus
mucosal thickening in several studies was
reported as 14.5%, 29.5% and 87.9% in
Romanian Journal of Medical and Dental Education
Vol. 9, No. 6, November-December 2020
24
loss values recorded were similarly
somewhat higher in patients with mucosal
thickening than in those with normal mucosa
[29]. Periodontitis is marked by
inflammation of the tooth-supporting tissues
caused by bacterial infection, thus probing
depth increases as the fibres of the
desmodontium are progressively destroyed,
Higher values for these clinical indexes
reflect a more severe periodontal condition.
The maxillary sinuses can also
become inflamed as a result of bacterial
infection, possibly arising in adjacent
periodontitis. A study suggested that the
bony floor of the maxillary sinus is not
continuous but rather is perforated by a
number of vessels, allowing for close
approximation of the maxillary sinus
mucosa and periodontal ligament in the
endosteal bony space adjacent to the
maxillary molar teeth [35].
the dental and periodontal structures: the
intra-alveolar branches of the anterior and
posterior superior alveolar arteries.
with vessels of the basilar maxillary sinus,
forming an intricate vascular network [3].
Finally, the roots of the maxillary premolar
and molar teeth are normally separated from
the sinus floor by dense cortical bone of
variable thickness, but this separation
consists only of mucoperiosteum in some
individuals. The latter circumstance is
believed to encourage the spread of
inflammation to the Schneiderian membrane
[2]. Indeed, there has been abundant
evidence to support the notion that
inflammation of the maxillary sinus
develops from adjacent periodontitis.
a significant association between mucosal
thickening in sinusitis of periodontal origin
and furcation lesions (OR = 2.76) and
vertical infrabony pockets (OR = 13.58)
[29]. These results were comparable to
another study, in which furcation lesions
(OR = 4.4) and vertical infrabony pockets
(OR = 6.3) corresponded with a significantly
higher risk of MT, relative to edentulous
subjects [37]. Given that furcation lesions
and vertical infrabony pockets are
characteristic of severe periodontitis, the
inherently higher levels of pathogenic
bacteria, bacterial products and
this heightened risk [37].
the posterior maxilla to the maxillary sinuses
renders the maxilla vulnerable to periodontal
inflammation. Furcation lesions and vertical
infrabony pockets of the posterior teeth are
also common accompaniments of
periodontitis, especially severe periodontitis
controversial for such correlation. Moreover,
there have been no reports associating the
number of missing teeth with maxillary
sinus mucosal thickening.
the number of missing teeth. It is highly
possible that the patient had periapical
diseases before extraction that provokes
maxillary sinus mucositis. A study by Block
and Dastoury observed that the removal of
unhealthy teeth decreased, but did not
completely resolve sinus membrane
causes of high prevalence observed in
edentulous maxilla. Apart from the
odontogenic factors, there are many causes
predisposing to sinus membrane
infection, allergy, asthma, smoking, diabetes
mellitus, previous history of trauma, some
Romanian Journal of Medical and Dental Education
Vol. 9, No. 6, November-December 2020
25
the number of the missing teeth increases
with age, the possibility of being various
factors that cause sinusitis also increases. A
further study with more focus on missing
teeth, carrying out with the group of patients
whose age is close to each other, is therefore
suggested [38].
and close relationship maxillary teeth and
sinus, may have a precursor effect on the
occurrence of mucosal thickening in the
maxillary sinus. Periodontal status and its
role as a risk factor in triggering maxillary
sinus infections should also be considered
by not only dental professionals but also the
medical professionals to plan for the
treatment of maxillary sinus lesions.
Conclusion:
prevalence and through its position entails
the collaboration of numerous medical
specialists. Among these otolaryngologists
maxilary sinusitis; however, during
overlooked, leading to persistent symptoms
in patients and an incomplete and a failure
of sinusitis treatment. A collaborative
approach to the diagnosis and treatment of
suspected odontogenic maxillary sinusitis
between otolaryngologists and dental
centered strategy. The interdisciplinary
origin of the condition is essential in these
cases.
References:
1. Berkovitz BK, Holland GR, Moxham BJ. Oral Anatomy, Histology and Embryology E-Book.
Elsevier Health Sciences; 2017 Jul 11.
2. Azgn , Kar M, Prokopakis EP. Histology and Embryology of the Nose and Paranasal Sinuses. InAll
Around the Nose 2020 (pp. 33-38). Springer, Cham.
3. Von Arx T, Lozanoff S. Maxillary Sinus. In Clinical Oral Anatomy 2017 (pp.163-197). Springer,
Cham.
4. Turfe Z, Ahmad A, Peterson EI, Craig JR. Odontogenic sinusitis is a common cause of unilateral
sinus disease with maxillary sinus opacification. In International Forum of Allergy & Rhinology 2019
Dec (Vol. 9, No. 12, pp. 1515-1520).
5. Whyte A, Boeddinghaus R. Imaging of odontogenic sinusitis. Clinical radiology. 2019 Jul
1;74(7):503-16.
6. Kim SM. Definition and management of odontogenic maxillary sinusitis. Maxillofacial plastic and
reconstructive surgery. 2019 Dec;41(1):1-1.
7. Vidal F, Coutinho TM, Carvalho Ferreira DD, Souza RC, Gonçalves LS. Odontogenic sinusitis: a
comprehensive review. Acta Odontol. Scandinavica. 2017 Nov 17;75(8):623-33.
8. Psillas G, Papaioannou D, Petsali S, Dimas GG, Constantinidis J. Odontogenic maxillary sinusitis: A
comprehensive review. Journal of Dental Sciences. 2020 Aug 22.
9. Shukairy MK, Burmeister C, Ko AB, Craig JR. Recognizing odontogenic sinusitis: A national survey
of otolaryngology chief residents. American Journal of Otolaryngology. 2020 Nov 1;41(6):102635.
10. Melén I, Lindahl L, Andréasson L, Rundcrantz H. Chronic maxillary sinusitis: definition, diagnosis
and relation to dental infections and nasal polyposis. Acta Oto-laryngologica. 1986 Jan 1;101(3-
4):320-7.
Vol. 9, No. 6, November-December 2020
26
beam computed tomography. A systematic review and meta-analysis. Medicina Oral, Patologia Oral y
Cirugia Bucal. 2020 Jan;25(1):e34.
12. Lu Y, Liu Z, Zhang L, Zhou X, Zheng Q, Duan X, Zheng G, Wang H, Huang D. Associations
between maxillary sinus mucosal thickening and apical periodontitis using cone-beam computed
tomography scanning: a retrospective study. Journal of Endodontics. 2012 Aug 1;38(8):1069-74.
13. Cayo-Rojas CF, Begazo-Jiménez LA, Romero-Solorzano LB, Nicho-Valladares MK, Gaviria-
Martínez A, Cervantes-Ganoza LA. Periapical Lesions and Their Relationship to Schneider’s
Membrane in Cone-Beam Computed Tomography. Int J Dentistry. 2020, 9;2020.
14. Van Den Munckhof T, Patel S, Koller G, Berkhout E, Mannocci F, Foschi F. Schneiderian membrane
thickness variation following endodontic procedures: a retrospective cone beam computed
tomography study. BMC Oral Health. 2020 Dec;20:1-8.
15. Hsiao YJ, Yang J, Resnik RR, Suzuki JB. Prevalence of maxillary sinus pathology based on cone-
beam computed tomography evaluation of multiethnicity dental school population. Implant Dntistry.
2019 Aug 1;28(4):356-66.
16. Brüllmann DD, Schmidtmann I, Hornstein S, Schulze RK. Correlation of cone beam computed
tomography (CBCT) findings in the maxillary sinus with dental diagnoses: a retrospective cross-
sectional study. Clinical Oral Investigations. 2012 Aug 1;16(4):1023-9.
17. Shanbhag S, Karnik P, Shirke P, Shanbhag V. Association between periapical lesions and maxillary
sinus mucosal thickening: a retrospective cone-beam computed tomographic study. Journal of
Endodontics. 2013 Jul 1;39(7):853-7.
18. Phothikhun S, Suphanantachat S, Chuenchompoonut V, Nisapakultorn K. Conebeam computed
tomographic evidence of the association between periodontal bone loss and mucosal thickening of the
maxillary sinus. J of Periodontology. 2012 May;83(5):557-64.
19. Pelinsari Lana J, Moura Rodrigues Carneiro P, de Carvalho Machado V, Eduardo Alencar de Souza
P, Ricardo Manzi F, Campolina Rebello Horta M. Anatomic variations and lesions of the maxillary
sinus detected in cone beam computed tomography for dental implants. Clinical Oral Implants
Research. 2012 Dec;23(12):1398-403.
20. Nascimento EH, Pontual ML, Pontual AA, Freitas DQ, Perez DE, Ramos-Perez FM. Association
between odontogenic conditions and maxillary sinus disease: a study using cone-beam computed
tomography. Journal of Endodontics. 2016 Oct 1;42(10):1509-15.
21. Ritter L, Lutz J, Neugebauer J, Scheer M, Dreiseidler T, Zinser MJ, Rothamel D, Mischkowski RA.
Prevalence of pathologic findings in the maxillary sinus in cone-beam computerized tomography.
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2011 May
1;111(5):634-40.
22. Amine K, Slaoui S, Kanice FZ, Kissa J. Evaluation of maxillary sinus anatomical variations and
lesions: A retrospective analysis using cone beam computed tomography. Journal of Stomatology,
Oral and Maxillofacial Surgery. 2020 Jan 10.
23. Bajoria AA, Sarkar S, Sinha P. Evaluation of odontogenic maxillary sinusitis with cone beam
computed tomography: A retrospective study with review of literature. Journal of International
Society of Preventive & Community Dentistry. 2019 Mar;9(2):194.
Romanian Journal of Medical and Dental Education
Vol. 9, No. 6, November-December 2020
27
24. Sakir M, Yalcinkaya SE. Associations between periapical health of maxillary molars and mucosal
thickening of maxillary sinuses in cone-beam computed tomographic images: a retrospective study.
Journal of Endodontics. 2020 Mar 1;46(3):397-403.
25. Simuntis R, Tušas P, Kubilius R, Leketas M, Šiupšinskien N, Vaitkus S. Association between
maxillary posterior teeth periapical odontogenic lesions and maxillary sinus mucosal thickening: a 3D
volumetric computed tomography analysis. Sinusitis. 2020 Dec;4(1):8-20.
26. Gürhan C, ener E, Mert A, en GB. Evaluation of factors affecting the association between
thickening of sinus mucosa and the presence of periapical lesions using cone beam CT. International
Endodontic Journal. 2020 Oct;53(10):1339-47.
27. Goller-Bulut D, Sekerci AE, Köse E, Sisman Y. Cone beam computed tomographic analysis of
maxillary premolars and molars to detect the relationship between periapical and marginal bone loss
and mucosal thickness of maxillary sinus. Medicina Oral, Patologia Oral y Cirugia Bucal. 2015
Sep;20(5):e572.
28. Premoli Maciel A, Albano Lopes I, Adami Tucunduva RM, Simpione G, da Silva Santos PS,
Damante JH, Alvares Capelozza AL. Contribution of the CBCT in the diagnosis and treatment plan of
odontogenic maxillary sinusitis: Cases Reports. Revista Estomatológica Herediana. 2020
Jan;30(1):47-52.
29. Ren S, Zhao H, Liu J, Wang Q, Pan Y. Significance of maxillary sinus mucosal thickening in patients
with periodontal disease. International Dental Journal. 2015 Dec;65(6):303-10.
30. Zhang B, Wei Y, Cao J, Xu T, Zhen M, Yang G, Chung KH, Hu W. Association between the
dimensions of the maxillary sinus membrane and molar periodontal status: A retrospective CBCT
study. Journal of Periodontology. 2020 Mar 7.
31. Sheikhi M, Pozve NJ, Khorrami L. Using cone beam computed tomography to detect the relationship
between the periodontal bone loss and mucosal thickening of the maxillary sinus. Dental Research
Journal. 2014 Jul;11(4):495.
32. Dagassan-Berndt DC, Zitzmann NU, Lambrecht JT, Weiger R, Walter C. Is the Schneiderian
membrane thickness affected by periodontal disease? A cone beam computed tomography-based
extended case series. J of the Int Academy of Periodontology. 2013 Jul 1;15(3):75-82.
33. Acharya A, Hao J, Mattheos N, Chau A, Shirke P, Lang NP. Residual ridge dimensions at edentulous
maxillary first molar sites and periodontal bone loss among two ethnic cohorts seeking tooth
replacement. Clinical Oral Implants Research. 2014 Dec;25(12):1386-94.
34. Block MS, Dastoury K. Prevalence of sinus membrane thickening and association with unhealthy
teeth: a retrospective review of 831 consecutive patients with 1,662 cone-beam scans. Journal of Oral
and Maxillofacial Surgery. 2014 Dec 1;72(12):2454-60.
35. Hauman CH, Chandler NP, Tong DC. Endodontic implications of the maxillary sinus: a review.
International Endodontic Journal. 2002 Feb;35(2):127-41.
36. Vallo J, Suominen-Taipale L, Huumonen S, Soikkonen K, Norblad A. Prevalence of mucosal
abnormalities of the maxillary sinus and their relationship to dental disease in panoramic radiography:
results from the Health 2000 Health Examination Survey. Oral Surgery, Oral Medicine, Oral
Pathology, Oral Radiology, and Endodontology. 2010 Mar 1;109(3):e80-7.
37. Bartold PM, Van Dyke TE. An appraisal of the role of specific bacteria in the initial pathogenesis of
periodontitis. Journal Of Clinical Periodontology. 2019 Jan;46(1):6-11.
38. Aksoy U, Orhan K. Association between odontogenic conditions and maxillary sinus mucosal
thickening:a retrospective CBCT study. Cl. Oral Investig. 2019, 29;23(1):123-31.