CBCT-Based Differentiation of Odontogenic and Non-Odontogenic Maxillary Sinus Pathology: A Retrospective Imaging Study

Background: Maxillary sinus disease represents a common diagnostic challenge in clinical imaging, particularly when differentiating odontogenic from non-odontogenic etiologies. Odontogenic maxillary sinusitis (OMS) is frequently underrecognized despite its significant clinical implications, especially in cases of unilateral sinus involvement. Cone-beam computed tomography (CBCT) provides high-resolution three-dimensional imaging that enables detailed evaluation of the maxillary sinus and adjacent anatomical structures. Methods: This retrospective imaging study evaluated CBCT examinations from 2,006 patients. A total of 4,012 maxillary sinuses were initially identified; one sinus was excluded due to incomplete radiographic classification, resulting in 4,011 sinuses included in the final analysis. Based on predefined imaging criteria, sinuses were categorized as normal, odontogenic sinusitis, non-odontogenic sinusitis, or sinusitis of undetermined etiology. Odontogenic sources were systematically recorded, and descriptive statistical analyses were performed. Results: Among the evaluated sinuses, 44.7% were classified as normal. Odontogenic sinusitis was identified in 818 sinuses (20.4%), while 29.3% demonstrated non-odontogenic sinusitis and 5.6% were classified as sinusitis of undetermined etiology. OMS was detected in 571 patients (28.5%), with a clear predominance of unilateral involvement. Endodontic pathology was the most frequent odontogenic source (45.5%), followed by iatrogenic factors (25.8%) and periodontal disease (22.9%). Conclusion: Odontogenic pathology accounts for a substantial proportion of maxillary sinus disease. CBCT plays a critical role in the imaging-based differentiation of sinus disease etiology, particularly in unilateral cases, and provides essential information to support accurate diagnosis and interdisciplinary clinical management.