The roots of maxillary molars—especially the mesiobuccal root of the second molar—are often close to or even penetrate the maxillary sinus floor. This proximity can increase the risk of complications such as oroantral communication, sinus infection, or difficulty during procedures such as extraction, implantation, or root canal treatment. Three-dimensional imaging such as Cone Beam Computed Tomography (CBCT) provides a more accurate depiction of root position relative to the maxillary sinus compared to two-dimensional radiographs such as panoramic images.
Reference Study and Panoramic Findings
A study conducted by Ni Luh Putu Sandrina Putri, an FKG UGM student, under the supervision of Dr. drg. Rini Widyaningrum, M.Biotech. and drg. Erdananda Haryosuwandito, Sp.BMM., evaluated the relationship between the mesiobuccal root of the maxillary second molar and the maxillary sinus floor using digital panoramic radiographs in 164 images (men and women aged 20–40 years).
Panoramic radiographs provide useful two-dimensional images for morphometric assessment of bone relationships and can serve as supportive examinations prior to treatment to identify anatomical relationships between posterior maxillary teeth roots and the maxillary sinus.
The results showed that the most common proximity type was Type 1 (root contacting the cortical border of the sinus floor), while Type 0 (no contact) was the least frequent. No significant association was found between gender or side (right/left) and the type of root proximity to the maxillary sinus.
Role of CBCT in Root Canal Evaluation
Although the study used panoramic radiography, many other studies indicate that CBCT offers the following advantages:
- Provides three-dimensional images showing root position more precisely, including proximity, penetration, and risk toward the maxillary sinus.
- Allows visualization in multiple planes (axial, coronal, sagittal) that cannot be obtained with two-dimensional panoramic images.
- Highly useful for implant planning, endodontic treatment, sinus lift surgery, and posterior molar extraction.
Clinical Implications
Using CBCT to evaluate maxillary molar roots can assist in:
- Risk assessment before extraction of second molars or other posterior teeth, including the possibility of sinus-oroantral communication.
- Endodontic planning: understanding how close the roots are to the sinus and the likelihood of perforation or penetration.
- Implant planning in the posterior maxilla by selecting implant location and orientation to avoid sinus complications.
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Although basic research using panoramic radiography shows that Type 1 proximity of the mesiobuccal root of the maxillary second molar is most common and that there are no differences based on gender or side, CBCT offers superior 3D visualization. For high-risk patients, major procedures, or complex anatomy, CBCT is strongly recommended as a pre-treatment evaluation tool. Thus, the use of CBCT in evaluating maxillary molar roots can improve clinical accuracy, patient safety, and align with SDG goals related to health, innovation, and sustainability.
References
MKGK, Ni Luh Putu Sandrina Putri, Dr. drg. Rini Widyaningrum, M.Biotech., drg. Erdananda Haryosuwandito, Sp.BMM., Hubungan akar gigi molar kedua maksila dengan dasar sinus maksila pada pria dan wanita: studi pada radiograf panoramik, https://jurnal.ugm.ac.id/mkgk/article/download/100565/40490
Author: Rizky B. Hendrawan | Photo: Freepik
