{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T04:20:14Z","timestamp":1787545214511,"version":"build-2736575974"},"reference-count":40,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Objectives: This study aimed to evaluate the association of anatomical proximity between posterior maxillary tooth roots and the sinus floor with the presence and severity of maxillary sinus mucosal thickening (MT) using cone-beam computed tomography (CBCT). Materials and Methods: A retrospective CBCT-based analysis was performed on 300 patients (175 females, 125 males; mean age: 27.55 \u00b1 8.74 years). Root\u2013sinus anatomical relationships were classified into three proximity types based on increasing root\u2013sinus closeness. Maxillary sinus mucosal thickness was measured in millimeters, and mucosal thickening was defined using both a binary threshold (&gt;2 mm vs. \u22642 mm) and an ordinal severity classification (\u22642 mm, 2\u201310 mm, &gt;10 mm). Multivariable binary logistic regression models evaluated the presence of MT after adjustment for age, sex, diabetes, cardiovascular disease, and smoking. As the proportional odds assumption was not satisfied, MT severity was evaluated using multinomial logistic regression models adjusted for age and sex. Results: Mucosal thickening (&gt;2 mm) was observed in 34.7% of patients on the right side and 34.7% on the left side, with bilateral involvement in 19.7%. Proximity type was significantly associated with mucosal thickening on the right and left sides (p &lt; 0.01). In multivariable binary logistic regression, each one-unit increase in proximity type was associated with a 2.58-fold increase in the odds of mucosal thickening on the right side (OR = 2.58; 95% CI: 1.61\u20134.12; p &lt; 0.001) and a 1.93-fold increase on the left side (OR = 1.93; 95% CI: 1.23\u20133.03; p = 0.004). In age- and sex-adjusted multinomial logistic regression, each one-unit increase in proximity type was associated with moderate mucosal thickening on both the right (OR = 2.60; 95% CI: 1.56\u20134.32; p &lt; 0.001) and left sides (OR = 1.74; 95% CI: 1.06\u20132.87; p = 0.030), relative to normal mucosal thickness. Proximity type was also associated with severe mucosal thickening on the right (OR = 2.75; 95% CI: 1.26\u20136.04; p = 0.012) and left sides (OR = 2.79; 95% CI: 1.34\u20135.84; p = 0.006). Age showed a modest independent association in the binary models, whereas systemic factors, including diabetes, cardiovascular disease, and smoking, were not significantly associated with mucosal thickening. Sensitivity analyses using an alternative severity classification supported the association between proximity type and severe mucosal thickening on both sides, although the association with moderate left-side mucosal thickening was threshold-dependent. Conclusions: Anatomical proximity between posterior maxillary tooth roots and the sinus floor was independently associated with MT presence after adjustment for demographic and systemic factors and with MT severity after adjustment for age and sex. These findings support considering root\u2013sinus proximity alongside odontogenic and sinonasal factors during CBCT-based assessment and treatment planning in the posterior maxilla.<\/jats:p>","DOI":"10.3390\/diagnostics16162675","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T14:20:36Z","timestamp":1787322036000},"page":"2675","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Anatomical Proximity of Posterior Maxillary Tooth Roots as an Independent Predictor of Maxillary Sinus Mucosal Thickening: A CBCT-Based Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0571-1824","authenticated-orcid":false,"given":"Cemile Nur","family":"Y\u0131ld\u0131r\u0131m","sequence":"first","affiliation":[{"name":"Dentomaxillofacial Radiology, Faculty of Dentistry, \u0130stanbul Ayd\u0131n University, Istanbul 34295, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8549-5193","authenticated-orcid":false,"given":"Ali","family":"Alt\u0131nda\u011f","sequence":"additional","affiliation":[{"name":"Dentomaxillofacial Radiology, Faculty of Dentistry, Necmettin Erbakan University, Konya 42090, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"15529","DOI":"10.1038\/s41598-024-66527-7","article-title":"Retrospective analysis of pathological changes in the maxillary sinus with CBCT","volume":"14","author":"Dogan","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_2","first-page":"605","article-title":"Location, size, and prevalence of the maxillary sinus septa: Comparison of panoramic radiography and cone-beam computed tomography","volume":"3","author":"Altindag","year":"2020","journal-title":"Harran Univ. Fac. Dent. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s00784-018-2418-x","article-title":"Association between odontogenic conditions and maxillary sinus mucosal thickening: A retrospective CBCT study","volume":"23","author":"Aksoy","year":"2019","journal-title":"Clin. Oral Investig."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1016\/j.joen.2012.04.027","article-title":"Associations between maxillary sinus mucosal thickening and apical periodontitis using cone-beam computed tomography scanning: A retrospective study","volume":"38","author":"Lu","year":"2012","journal-title":"J. Endod."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"0300060520926896","DOI":"10.1177\/0300060520926896","article-title":"Relationship between maxillary posterior molar roots and the maxillary sinus floor: Cone-beam computed tomography analysis of a western Chinese population","volume":"48","author":"Pei","year":"2020","journal-title":"J. Int. Med. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1007\/s00276-019-02308-6","article-title":"Frequency, location, and morphology of accessory maxillary sinus ostia: A retrospective study using cone beam computed tomography","volume":"42","author":"Hung","year":"2020","journal-title":"Surg. Radiol. Anat."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1111\/iej.13362","article-title":"Evaluation of factors affecting the association between thickening of sinus mucosa and the presence of periapical lesions using cone beam CT","volume":"53","author":"Gurhan","year":"2020","journal-title":"Int. Endod. J."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Ahmed, J., Gupta, A., Shenoy, N., Sujir, N., and Muralidharan, A. (2023). Prevalence of incidental maxillary sinus anomalies on CBCT scans: A radiographic study. Diagnostics, 13.","DOI":"10.20944\/preprints202308.1342.v1"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Kim, J.-H., Min, E.J., Ko, Y., Kim, D.H., and Park, J.-B. (2023). Change in maxillary sinus mucosal thickness in patients with preoperative maxillary sinus mucosal thickening as assessed by otolaryngologists: A retrospective study. Medicina, 59.","DOI":"10.3390\/medicina59101750"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Rege, I.C.C., Sousa, T.O., Leles, C.R., and Mendonca, E.F. (2012). Occurrence of maxillary sinus abnormalities detected by cone beam CT in asymptomatic patients. BMC Oral Health, 12.","DOI":"10.1186\/1472-6831-12-30"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1111\/cid.12807","article-title":"Effects of clinical local factors on thickness and morphology of Schneiderian membrane: A retrospective clinical study","volume":"21","author":"Ramanauskaite","year":"2019","journal-title":"Clin. Implant Dent. Relat. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"53","DOI":"10.15644\/asc59\/1\/6","article-title":"Anatomical and pathological assessment of the maxillary sinus using CBCT imaging: A retrospective descriptive study","volume":"59","author":"Hadziabdic","year":"2025","journal-title":"Acta Stomatol. Croat."},{"key":"ref_13","first-page":"474","article-title":"Odontogenic maxillary sinusitis: A comprehensive review","volume":"50","author":"Psillas","year":"2021","journal-title":"J. Otolaryngol. Head Neck Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"166","DOI":"10.15171\/joddd.2018.026","article-title":"Effect of periodontal therapy on maxillary sinus mucous membrane thickening in chronic periodontitis: A split-mouth study","volume":"12","author":"Lathiya","year":"2018","journal-title":"J. Dent. Res. Dent. Clin. Dent. Prospect."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/S0030-6665(03)00171-3","article-title":"Maxillary sinus disease of odontogenic origin","volume":"37","author":"Mehra","year":"2004","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Alghofaily, M., Alsufyani, N., Althumairy, R.I., AlSuhaibani, A., Alfawzan, F., and AlSadhan, L. (2023). Odontogenic factors associated with maxillary sinus Schneiderian membrane thickness and their relationship to chronic sinonasal symptoms: An ambispective cohort study. Diagnostics, 13.","DOI":"10.3390\/diagnostics13162710"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.joen.2023.01.010","article-title":"Global prevalence of maxillary sinusitis of odontogenic origin and associated factors: A systematic review and meta-analysis","volume":"49","author":"Vitali","year":"2023","journal-title":"J. Endod."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1007\/s11282-022-00666-3","article-title":"Proximity of healthy posterior teeth to the maxillary sinus floor in relation to mucosal thickening: A CBCT study","volume":"39","author":"Aguori","year":"2023","journal-title":"Oral Radiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"19","DOI":"10.5624\/isd.20210145","article-title":"Relationship of the maxillary posterior teeth and maxillary sinus floor in different skeletal growth patterns: A cone-beam computed tomographic study of 1600 roots","volume":"52","author":"Shrestha","year":"2022","journal-title":"Imaging Sci. Dent."},{"key":"ref_20","first-page":"e1","article-title":"Relationship of maxillary posterior roots to the maxillary sinus and cortical bone: A cone beam computed tomographic study","volume":"68","author":"Makris","year":"2020","journal-title":"Gen. Dent."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Constantino, T.M., Marceliano-Alves, M.F.V., Ronquete, V., da Silva Limoeiro, A.G., Amoroso-Silva, P.A., Pedano, M.S., Boukpessi, T., Vidal, F., and de Carvalho Coutinho, T.M. (2025). The effect of age and gender on the distance between the maxillary sinus cortical bone and maxillary molars: A cone-beam tomography analysis. Sinusitis, 9.","DOI":"10.3390\/sinusitis9010009"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Madi, M., Alsaad, S.S., AlAssiry, N., Attia, D., AlAssiry, M., and Zakaria, O. (2024). Multilevel modeling analysis of odontogenic risk factors and nasal septum deviation associated with maxillary sinus mucosal thickening: A cone-beam computed tomography study. Dent. J., 12.","DOI":"10.3390\/dj12030074"},{"key":"ref_23","first-page":"e34","article-title":"Association between maxillary sinus pathology and odontogenic lesions in patients evaluated by cone beam computed tomography: A systematic review and meta-analysis","volume":"25","year":"2019","journal-title":"Med. Oral Patol. Oral Cir. Bucal"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Kuligowski, P., Jaron, A., Preuss, O., Gabrysz-Trybek, E., Bladowska, J., and Trybek, G. (2021). Association between odontogenic and maxillary sinus conditions: A retrospective cone-beam computed tomographic study. J. Clin. Med., 10.","DOI":"10.3390\/jcm10132849"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"437","DOI":"10.2340\/aos.v84.43779","article-title":"Associations between odontogenic and sinus pathologies: A low-dose CBCT study","volume":"84","author":"Riekki","year":"2025","journal-title":"Acta Odontol. Scand."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"163","DOI":"10.34172\/joddd.2021.028","article-title":"Evaluation of the effect of periapical lesions and other odontogenic conditions on maxillary sinus mucosal thickness characteristics and mucosal appearance: A CBCT study","volume":"15","author":"Yusufoglu","year":"2021","journal-title":"J. Dent. Res. Dent. Clin. Dent. Prospect."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1111\/j.1601-6343.2010.01502.x","article-title":"Incidental maxillary sinus findings in orthodontic patients: A radiographic analysis using cone-beam computed tomography","volume":"14","author":"Pazera","year":"2011","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"871532","DOI":"10.1155\/2012\/871532","article-title":"Incidental findings on cone beam computed tomography images","volume":"2012","author":"Allareddy","year":"2012","journal-title":"Int. J. Dent."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1097\/ID.0000000000000902","article-title":"Prevalence of maxillary sinus pathology based on cone-beam computed tomography evaluation of multiethnicity dental school population","volume":"28","author":"Hsiao","year":"2019","journal-title":"Implant Dent."},{"key":"ref_30","first-page":"699","article-title":"Evaluation of health or pathology of bilateral maxillary sinuses in patients referred for cone beam computed tomography using a low-dose protocol","volume":"38","author":"Bornstein","year":"2018","journal-title":"Int. J. Periodont. Rest. Dent."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Gu, Y., Sun, C., Wu, D., Zhu, Q., Leng, D., and Zhou, Y. (2018). Evaluation of the relationship between maxillary posterior teeth and the maxillary sinus floor using cone-beam computed tomography. BMC Oral Health, 18.","DOI":"10.1186\/s12903-018-0626-z"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"327","DOI":"10.4103\/aam.aam_74_22","article-title":"Prevalence and pattern of proximity of maxillary posterior teeth to maxillary sinus with mucosal thickening: A cone beam computed tomography based retrospective study","volume":"22","author":"Nair","year":"2023","journal-title":"Ann. Afr. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1007\/s00276-014-1317-3","article-title":"Evaluation of the relationship between the maxillary posterior teeth and the sinus floor using cone-beam computed tomography","volume":"36","author":"Ok","year":"2014","journal-title":"Surg. Radiol. Anat."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1016\/j.joen.2013.04.010","article-title":"Association between periapical lesions and maxillary sinus mucosal thickening: A retrospective cone-beam computed tomographic study","volume":"39","author":"Shanbhag","year":"2013","journal-title":"J. Endod."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Huang, X., Xu, J., Hou, B., and Wang, Y. (2025). Proximity of maxillary molar palatal roots to adjacent structures for endodontic microsurgery: A cone-beam computed tomography study. BMC Oral Health, 25.","DOI":"10.1186\/s12903-024-05396-y"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Jouhar, R., Alkhames, H.M., Ahmed, M.A., Almadeh, N.M., Faheemuddin, M., and Umer, M.F. (2023). CBCT evaluation of periapical pathologies in maxillary posterior teeth and their relationship with maxillary sinus mucosal thickening. Healthcare, 11.","DOI":"10.3390\/healthcare11060787"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1055\/s-0043-1777013","article-title":"Evaluation of association between maxillary posterior teeth periapical pathologies and maxillary sinus mucosal changes: A cone-beam computed tomography study","volume":"34","author":"Kaimal","year":"2024","journal-title":"Indian J. Radiol. Imaging"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1111\/j.1600-0501.2010.02140.x","article-title":"Characteristics and dimensions of the Schneiderian membrane: A radiographic analysis using cone beam computed tomography in patients referred for dental implant surgery in the posterior maxilla","volume":"22","author":"Janner","year":"2011","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"115","DOI":"10.5624\/isd.2019.49.2.115","article-title":"Comparison of cone-beam computed tomography and panoramic radiography in the evaluation of maxillary sinus pathology related to maxillary posterior teeth","volume":"49","author":"Terlemez","year":"2019","journal-title":"Imaging Sci. Dent."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1007\/s00784-011-0620-1","article-title":"Correlation of cone beam computed tomography findings in the maxillary sinus with dental diagnoses: A retrospective cross-sectional study","volume":"16","author":"Brullmann","year":"2012","journal-title":"Clin. Oral Investig."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/16\/2675\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T04:13:18Z","timestamp":1787544798000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/16\/2675"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,21]]},"references-count":40,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["diagnostics16162675"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16162675","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,21]]}}}