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This study aimed to develop and internally validate a preliminary cumulative odontogenic score (COS) by integrating periodontal and endodontic parameters to characterize their combined association with maxillary sinus membrane thickening (SMT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cross-sectional study analyzed 1,056 dentate maxillary sinuses from 562 patients. Odontogenic variables, including PBL severity, endodontic treatment history, and periapical lesions, were assessed using cone-beam computed tomography (CBCT). Multivariable logistic regression using generalized estimating equations (GEE) was performed to identify independent factors associated with SMT (&gt;\u20092\u00a0mm). A COS (range 1\u20137) was derived from weighted \u03b2 regression coefficients. Classification performance was evaluated through ROC analysis, calibration plots, and bootstrapping (1,000 resamples).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      SMT was prevalent in 46.3% of sinuses. PBL, periapical lesions, and endodontic treatment were all independent contributors to SMT (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The COS demonstrated significantly superior classification performance compared to PBL alone (AUC 0.718 vs. 0.602;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and exhibited adequate calibration (slope\u2009=\u20091.00). Internal validation via bootstrapping confirmed the stability of the associations. Each one-point increase in the COS was associated with a 30% increase in the odds of SMT. Using a clinically relevant threshold of COS\u2009&gt;\u20093, the prevalence of SMT in the high-COS group was nearly double that of the low-COS group (59.9% vs. 30.5%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Integrating periodontal and endodontic conditions into a unified scoring framework provides a more adequate characterization of the dental-sinus association than individual parameters. The internally validated COS offers a structured approach for preoperative radiographic evaluation and can function as a preliminary cross-sectional risk categorization score to characterize interdisciplinary associations in the posterior maxilla.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12903-026-09030-x","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T01:53:51Z","timestamp":1782352431000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and internal validation of a preliminary cumulative odontogenic risk categorization score for identifying factors associated with maxillary sinus membrane thickening: a retrospective cross-sectional study"],"prefix":"10.1186","volume":"26","author":[{"given":"Yu-Ming","family":"Kuo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsin-Yi","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chieh-An","family":"Yi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Chun","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya-Chi","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4112-9444","authenticated-orcid":false,"given":"Hsuan-Hung","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"issue":"Suppl 1","key":"9030_CR1","first-page":"S173","volume":"89","author":"PN Papapanou","year":"2018","unstructured":"Papapanou PN, et al. 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The study protocol was reviewed and approved by the Institutional Review Board of Taipei Veterans General Hospital (IRB-TPEVGH No. 2022-02-015AC). The requirement for informed consent was formally waived by the Institutional Review Board of Taipei Veterans General Hospital due to the retrospective nature of the study and the use of de-identified, anonymized data.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1687"}}