Sinus floor elevation or referral for further diagnosis and therapy: A comparison of maxillary sinus assessment by ENT specialists and dentists using cone beam computed tomography

Janner, Simone F. M.; Dubach, Patrick; Suter, Valérie G. A.; Caversaccio, Marco D.; Buser, Daniel; Bornstein, Michael M. (2020). Sinus floor elevation or referral for further diagnosis and therapy: A comparison of maxillary sinus assessment by ENT specialists and dentists using cone beam computed tomography. Clinical oral implants research, 31(5), pp. 463-475. Wiley-Blackwell 10.1111/clr.13582

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Abstract
Objectives: To compare ear, nose, and throat (ENT) specialists and dentists assessing
health or pathology of maxillary sinuses using cone beam computed tomography
(CBCT).
Material and methods: Two ENT specialists and two oral surgeons assessed 100
CBCT datasets of healthy patients referred for dental implant placement in the posterior
maxilla and decided on the possibility of sinus floor elevation or the necessity
for further diagnostic examinations based solely on radiographic findings. Inter-rater
agreements within the same specialty were calculated with Cohen's kappa and overall
agreements with Fleiss kappa, and factors influencing the decisions taken were
evaluated using regression analyses.
Results: The correlation between all four raters was generally fair to moderate. The
intra-specialty comparison showed a lower correlation between dentists than between
ENT specialists. Absence of membrane thickening and total or subtotal sinus
opacification showed the highest predictive value for a consensus in favor of sinus
floor elevation and ENT referral, respectively. Flat membrane thickening with an irregular
surface morphology was associated with disagreement between the examiners.
Dome-shaped membrane thickenings were often considered as to be referred by
dentists but not by ENTs.
Conclusion: The assessment of maxillary sinuses using CBCT imaging exhibited
unsatisfactory agreement between ENT specialists and oral surgeons. Referral
guidelines based on accidental CBCT findings that aim to diagnose relevant sinus
pathologies early and avoid unnecessary diagnostics and/or therapies are needed,
and an initial proposal for such recommendations is provided. Further research on
correct interpretation of sinus findings and a validation of the present recommendations
are required.
K E Y W O R D S
cone beam computed tomography, dental implants, ear, nose, and throat, maxillary sinus,
sinus floor elevation

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