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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Comparison of cone-beam computed tomography and panoramic radiographs in detecting maxillary sinus septa</title><author><name sortKey="Toraman Alkurt, Meryem" sort="Toraman Alkurt, Meryem" uniqKey="Toraman Alkurt M" first="Meryem" last="Toraman Alkurt">Meryem Toraman Alkurt</name><affiliation><nlm:aff id="aff1">Department of Dentomaxillofacial Radiology Faculty of Dentistry Gazi University<country>Turkey</country></nlm:aff></affiliation></author><author><name sortKey="Peker, Ilkay" sort="Peker, Ilkay" uniqKey="Peker I" first="Ilkay" last="Peker">Ilkay Peker</name><affiliation><nlm:aff id="aff1">Department of Dentomaxillofacial Radiology Faculty of Dentistry Gazi University<country>Turkey</country></nlm:aff></affiliation></author><author><name sortKey="Degerli, Serife" sort="Degerli, Serife" uniqKey="Degerli S" first="Serife" last="Degerli">Serife Degerli</name><affiliation><nlm:aff id="aff1">Department of Dentomaxillofacial Radiology Faculty of Dentistry Gazi University<country>Turkey</country></nlm:aff></affiliation></author><author><name sortKey="Cebeci, Ali R Za Lker" sort="Cebeci, Ali R Za Lker" uniqKey="Cebeci A" first="Ali R Za Lker" last="Cebeci">Ali R Za Lker Cebeci</name><affiliation><nlm:aff id="aff2">Private Practice<country>Turkey</country></nlm:aff></affiliation></author><author><name sortKey="Sadik, Elif" sort="Sadik, Elif" uniqKey="Sadik E" first="Elif" last="Sadik">Elif Sadik</name><affiliation><nlm:aff id="aff3">Department of Dentomaxillofacial Radiology Faculty of Dentistry Ordu University<country>Turkey</country></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28955570</idno><idno type="pmc">5573509</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573509</idno><idno type="RBID">PMC:5573509</idno><idno type="doi">10.17096/jiufd.84476</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">003212</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">003212</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Comparison of cone-beam computed tomography and panoramic radiographs in detecting maxillary sinus septa</title><author><name sortKey="Toraman Alkurt, Meryem" sort="Toraman Alkurt, Meryem" uniqKey="Toraman Alkurt M" first="Meryem" last="Toraman Alkurt">Meryem Toraman Alkurt</name><affiliation><nlm:aff id="aff1">Department of Dentomaxillofacial Radiology Faculty of Dentistry Gazi University<country>Turkey</country></nlm:aff></affiliation></author><author><name sortKey="Peker, Ilkay" sort="Peker, Ilkay" uniqKey="Peker I" first="Ilkay" last="Peker">Ilkay Peker</name><affiliation><nlm:aff id="aff1">Department of Dentomaxillofacial Radiology Faculty of Dentistry Gazi University<country>Turkey</country></nlm:aff></affiliation></author><author><name sortKey="Degerli, Serife" sort="Degerli, Serife" uniqKey="Degerli S" first="Serife" last="Degerli">Serife Degerli</name><affiliation><nlm:aff id="aff1">Department of Dentomaxillofacial Radiology Faculty of Dentistry Gazi University<country>Turkey</country></nlm:aff></affiliation></author><author><name sortKey="Cebeci, Ali R Za Lker" sort="Cebeci, Ali R Za Lker" uniqKey="Cebeci A" first="Ali R Za Lker" last="Cebeci">Ali R Za Lker Cebeci</name><affiliation><nlm:aff id="aff2">Private Practice<country>Turkey</country></nlm:aff></affiliation></author><author><name sortKey="Sadik, Elif" sort="Sadik, Elif" uniqKey="Sadik E" first="Elif" last="Sadik">Elif Sadik</name><affiliation><nlm:aff id="aff3">Department of Dentomaxillofacial Radiology Faculty of Dentistry Ordu University<country>Turkey</country></nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Istanbul University Faculty of Dentistry</title><idno type="ISSN">2149-2352</idno><idno type="eISSN">2149-4592</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Purpose:</title><p>The purpose of this retrospective study was to compare the performance of cone-beam computed tomography (CBCT) and panoramic radiography
in detecting the presence and location of maxillary sinus septa.</p></sec><sec><title>Materials and Methods:</title><p>This study included radiographic examination of 104 maxillary sinuses of 52 individuals (26 females, 50% and 26 males, 50%)
whose panoramic radiographs and CBCT images were obtained for several dental causes which were examined by the consensus of four dentomaxillofacial radiologists.
The posterior maxillary segments in proximity of maxillary sinus were classified as edentulous and dentate maxillary segments. The location of maxillary sinus septa
was classified as primary septa and secondary septa according to the presence of maxillary tooth at the affected site. The maxillary sinus septa were divided into
three categories (anterior, middle and posterior) according to its relation with posterior maxillary teeth. Data were statistically analyzed with chi-square and
Fisher’s exact tests.</p></sec><sec><title>Results:</title><p>The septa were found in 23.1% and 29.8% of the maxillary sinuses on panoramic radiography and CBCT images, respectively. The majority of
maxillary sinus septa were observed in dentate posterior maxillary segments on both panoramic (45.8%) radiography and CBCT (64.5%) images. Statistically significant
differences (p<0.001) were found between panoramic radiography and CBCT images for presence, location and neighborhood with the posterior maxillary teeth of
maxillary sinus septa.</p></sec><sec><title>Conclusion:</title><p>The results of this study demonstrated the low reliability of panoramic radiography images in the detection of maxillary sinus septa.
CBCT images can provide valuable information to the clinicians about the presence and location of maxillary sinus septa.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Mc Growan, Da" uniqKey="Mc Growan D">DA Mc Growan</name></author><author><name sortKey="Baxter, Pw" uniqKey="Baxter P">PW Baxter</name></author><author><name sortKey="James, J" uniqKey="James J">J James</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Williams, Pl" uniqKey="Williams P">PL Williams</name></author><author><name sortKey="Bannister, Lh" uniqKey="Bannister L">LH Bannister</name></author><author><name sortKey="Berry, Mm" uniqKey="Berry M">MM Berry</name></author><author><name sortKey="Collins, P" uniqKey="Collins P">P Collins</name></author><author><name sortKey="Dyson, M" uniqKey="Dyson M">M Dyson</name></author><author><name sortKey="Dussek, Je" uniqKey="Dussek J">JE Dussek</name></author><author><name 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Istanb Univ Fac Dent</journal-id><journal-id journal-id-type="iso-abbrev">J Istanb Univ Fac Dent</journal-id><journal-id journal-id-type="publisher-id">J. Istanbul Univ. Fac. Dent.</journal-id><journal-id journal-id-type="hwp">jiufd</journal-id><journal-id journal-id-type="pmc">jiufd</journal-id><journal-id journal-id-type="publisher-id">IUFD</journal-id><journal-title-group><journal-title>Journal of Istanbul University Faculty of Dentistry</journal-title></journal-title-group><issn pub-type="ppub">2149-2352</issn><issn pub-type="epub">2149-4592</issn><issn-l>2149-2352</issn-l><publisher><publisher-name>Istanbul University Faculty of Dentisty</publisher-name><publisher-loc>Istanbul, Turkey</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28955570</article-id><article-id pub-id-type="pmc">5573509</article-id><article-id pub-id-type="doi">10.17096/jiufd.84476</article-id><article-id pub-id-type="publisher-id">jiufd-50-3-399</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject><subj-group subj-group-type="heading"><subject>Biological Sciences</subject><subj-group subj-group-type="heading"><subject>Dentistry</subject></subj-group></subj-group></subj-group></article-categories><title-group><article-title>Comparison of cone-beam computed tomography and panoramic radiographs in detecting maxillary sinus septa</article-title><alt-title alt-title-type="short">Detection of maxillary sinus septa</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Toraman Alkurt</surname><given-names>Meryem</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref rid="cor" ref-type="corresp"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Peker</surname><given-names>Ilkay</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Degerli</surname><given-names>Serife</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Cebeci</surname><given-names>Ali Rıza İlker</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sadik</surname><given-names>Elif</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><aff id="aff1"><label>1</label>Department of Dentomaxillofacial Radiology Faculty of Dentistry Gazi University<country>Turkey</country></aff><aff id="aff2"><label>2</label>Private Practice<country>Turkey</country></aff><aff id="aff3"><label>3</label>Department of Dentomaxillofacial Radiology Faculty of Dentistry Ordu University<country>Turkey</country></aff></contrib-group><author-notes><corresp id="cor"><label>*</label>To whom correspondence should be addressed: Dr. Meryem Toraman Alkurt <institution content-type="edu">Department of Dentomaxillofacial Radiology
Faculty of Dentistry Gazi University </institution> 06510 Emek Ankara <country>Turkey</country> Phone: +90 312 203 41 52 <email>mtalkurt@gmail.com</email></corresp></author-notes><pub-date pub-type="collection"><year>2016</year></pub-date><pub-date pub-type="epub"><day>01</day><month>10</month><year>2016</year></pub-date><volume>50</volume><issue>3</issue><fpage>8</fpage><lpage>14</lpage><history><date date-type="received"><day>08</day><month>1</month><year>2016</year></date><date date-type="accepted"><day>19</day><month>4</month><year>2016</year></date></history><permissions><copyright-statement>Copyright © 2016 Journal of Istanbul University Faculty of Dentistry</copyright-statement><copyright-year>2016</copyright-year><copyright-holder>Journal of Istanbul University Faculty of Dentistry</copyright-holder><license license-type="open-access"><license-p>This article is licensed under Creative Commons License Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license (<ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by-nc-nd/4.0/" xlink:show="new"></ext-link>). Users must give appropriate credit, provide a link to the license, and indicate if changes were made. Users may do so in any reasonable manner, but not in any way that suggests the journal endorses its use. The material cannot be used for commercial purposes. If the user remixes, transforms, or builds upon the material, he/she may not distribute the modified material. No warranties are given. The license may not give the user all of the permissions necessary for his/her intended use. For example, other rights such as publicity, privacy, or moral rights may limit how the material can be used.</license-p></license></permissions><abstract abstract-type="section"><sec><title>Purpose:</title><p>The purpose of this retrospective study was to compare the performance of cone-beam computed tomography (CBCT) and panoramic radiography
in detecting the presence and location of maxillary sinus septa.</p></sec><sec><title>Materials and Methods:</title><p>This study included radiographic examination of 104 maxillary sinuses of 52 individuals (26 females, 50% and 26 males, 50%)
whose panoramic radiographs and CBCT images were obtained for several dental causes which were examined by the consensus of four dentomaxillofacial radiologists.
The posterior maxillary segments in proximity of maxillary sinus were classified as edentulous and dentate maxillary segments. The location of maxillary sinus septa
was classified as primary septa and secondary septa according to the presence of maxillary tooth at the affected site. The maxillary sinus septa were divided into
three categories (anterior, middle and posterior) according to its relation with posterior maxillary teeth. Data were statistically analyzed with chi-square and
Fisher’s exact tests.</p></sec><sec><title>Results:</title><p>The septa were found in 23.1% and 29.8% of the maxillary sinuses on panoramic radiography and CBCT images, respectively. The majority of
maxillary sinus septa were observed in dentate posterior maxillary segments on both panoramic (45.8%) radiography and CBCT (64.5%) images. Statistically significant
differences (p<0.001) were found between panoramic radiography and CBCT images for presence, location and neighborhood with the posterior maxillary teeth of
maxillary sinus septa.</p></sec><sec><title>Conclusion:</title><p>The results of this study demonstrated the low reliability of panoramic radiography images in the detection of maxillary sinus septa.
CBCT images can provide valuable information to the clinicians about the presence and location of maxillary sinus septa.</p></sec></abstract><kwd-group><kwd>Maxillary sinus septa</kwd><kwd>panoramic radiography</kwd><kwd>cone-beam computed tomography</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="s1"><title>Introduction</title><p>The maxillary sinuses, which occupy the body of the maxilla generally as large pyramidal cavities, have variable morphologies and sizes. They are the
largest of the paranasal sinuses (<xref rid="b1" ref-type="bibr">1</xref>, <xref rid="b2" ref-type="bibr">2</xref>). Maxillary sinus is in close proximity to the orbit,
alveolar ridge and maxillary posterior teeth, thus, this anatomical region may sustain injuries during dental procedures. The maxillary sinus elevation technique is
one of the most commonly used strategies for dental implant rehabilitation in atrophic posterior maxilla (<xref rid="b3" ref-type="bibr">3</xref>,
<xref rid="b4" ref-type="bibr">4</xref>, <xref rid="b5" ref-type="bibr">5</xref>). Since the maxillary alveolar process forms the maxillary sinus floor, assessment of
possible alterations in maxillary sinuses is essential especially in the preoperative implant planning in the maxillary posterior region
(<xref rid="b6" ref-type="bibr">6</xref>). In the images of the maxillary sinuses, one or multiple transvers radiopaque lines, which are named ‘septa’ can be observed.
They were originally described in 1910 by Underwood (<xref rid="b7" ref-type="bibr">7</xref>). They can divide maxillary sinus into two or more cavities. As Zijderveld
et al. (<xref rid="b5" ref-type="bibr">5</xref>) and Boyne and James (<xref rid="b3" ref-type="bibr">3</xref>) stated the presence, location, shape, number and size of
septa in the maxillary sinus, especially the inferior wall, increase the risk of sinus membrane perforation during sinus floor elevation procedures
(<xref rid="b8" ref-type="bibr">8</xref>, <xref rid="b9" ref-type="bibr">9</xref>, <xref rid="b10" ref-type="bibr">10</xref>, <xref rid="b11" ref-type="bibr">11</xref>,
<xref rid="b12" ref-type="bibr">12</xref>). There are several hypotheses suggested by different authors concerning the presence of antral septa
(<xref rid="b10" ref-type="bibr">10</xref>, <xref rid="b13" ref-type="bibr">13</xref>, <xref rid="b14" ref-type="bibr">14</xref>,
<xref rid="b15" ref-type="bibr">15</xref>, <xref rid="b16" ref-type="bibr">16</xref>). Krennmair et al. (<xref rid="b14" ref-type="bibr">14</xref>) have classifed the
septa into primary and secondary septa. Primary septa is thought to arise during maxillary development whereas secondary septa arises from the irregular pneumatization
of the sinus floor following tooth loss. In previous studies the septae were accepted as the wall of the cortical bone at least 2.5 mm in height within the maxillary
sinus (<xref rid="b9" ref-type="bibr">9</xref>, <xref rid="b13" ref-type="bibr">13</xref>, <xref rid="b17" ref-type="bibr">17</xref>).</p><p>Accurate radiographic identification of these structures is necessary to obtain detailed information regarding maxillary sinus anatomy during maxillofacial surgery.
Dental panoramic radiography, computed tomography (CT) and conebeam computed tomography (CBCT) have been used to identify the maxillary sinus septa
(<xref rid="b9" ref-type="bibr">9</xref>, <xref rid="b10" ref-type="bibr">10</xref>, <xref rid="b18" ref-type="bibr">18</xref>). CBCT is recommended as an excellent,
low cost technique for the evaluation of maxillary sinus septa with only slightly more ionizing radiation dose than panoramic radiography and far less than CT
(<xref rid="b19" ref-type="bibr">19</xref>, <xref rid="b20" ref-type="bibr">20</xref>, <xref rid="b21" ref-type="bibr">21</xref>,
<xref rid="b22" ref-type="bibr">22</xref>, <xref rid="b23" ref-type="bibr">23</xref>). Although various studies compared panoramic radiography and CT for detection of
maxillary sinus septa, no study was conducted regarding the comparison of panoramic radiography and CBCT (<xref rid="b6" ref-type="bibr">6</xref>,
<xref rid="b22" ref-type="bibr">22</xref>, <xref rid="b24" ref-type="bibr">24</xref>).</p><p>The purpose of this retrospective study was to compare the performance of CBCT and panoramic radiography in determining the presence and location of maxillary sinus
septa.</p></sec><sec sec-type="materials|methods" id="s2"><title>Materials and Methods</title><sec id="s2a"><title>Sample characteristics and imaging protocols</title><p>This study included panoramic radiographs and CBCT scans of 104 maxillary sinuses in 52 individuals (26 females, 26 males), obtained for several dental causes which
were available in the database of a private imaging center. Before any radigraphic images were obtained, the patients were asked to sign informed consents for
radiography and clinical examinations according to the principles of the Helsinki Declaration. Only researchers had access the acquired data. Panoramic images used in
the study had been obtained using Planmeca Proline XC (Planmeca, Helsinki, Finland) unit, a charge coupling device (CCD) based digital panoramic unit operating at 60-80
kVp and 4-12 mA, with a 0.5 mm focal spot and an exposure time of 16 seconds. CBCT images were acquired with Iluma Ultra Cone-beam CT Scanner (3M Imtec, Ardmore, OK,
USA) with a 24.4×19.5 cm amorphous silicon flat-panel image detector and a cylindrical volume of reconstruction up to 21.2×14.2 cm. CBCT images were obtained at 120 kVp,
1-3.8 mA with 0.2 mm voxel size, an exposure time of 7.8 seconds and a field of view of 8 cm.</p></sec><sec id="s2b"><title>Study variables</title><p>The posterior maxillary segments in proximity of maxillary sinus were classified as edentulous (partial, complete and atrophic edentulous) and dentate maxillary
segments (<xref rid="b14" ref-type="bibr">14</xref>). The location of maxillary sinus septa was classified as primary septa if it was located from a maxillary tooth
root; and secondary septa located superior to an edentulous ridge (<xref rid="b3" ref-type="bibr">3</xref>, <xref rid="b10" ref-type="bibr">10</xref>,
<xref rid="b14" ref-type="bibr">14</xref>, <xref rid="b22" ref-type="bibr">22</xref>). The maxillary sinus septa according to neighborhood with the posterior maxillary
teeth was divided into three categories: anterior region, between the mesial and distal aspects of the second premolar root; middle between distal aspects of second
premolar and second molar; and posterior, distal aspect of the root of the second molar (<xref rid="b6" ref-type="bibr">6</xref>,
<xref rid="b9" ref-type="bibr">9</xref>, <xref rid="b17" ref-type="bibr">17</xref>). In this study, septa of at least 2.5 mm in height were evaluated in accordance
with previous studies (<xref rid="b9" ref-type="bibr">9</xref>, <xref rid="b13" ref-type="bibr">13</xref>, <xref rid="b17" ref-type="bibr">17</xref>).</p></sec><sec id="s2c"><title>Radiographic examination protocol</title><p>The examinations were carried out by the agreement of four dentomaxillofacial radiologists (M.A, I.P, I.C and E.S) with at least five years of experience on panoramic
images and axial, coronal and sagittal sections for CBCT examinations, on the computer monitor (21 inch LCD monitor with 1280 × 1024 resolution) in a quiet room with
subdued ambient lighting. Totally 11 sessions were arranged in a period of two weeks and 10 maxillary sinuses were evaluated in each session, eventually the examinations
were completed in 22 weeks. The examples of maxillary sinus septa were presented in <xref ref-type="fig" rid="fig1">Figure 1</xref> and
<xref ref-type="fig" rid="fig2">Figure 2</xref>.</p><fig id="fig1" orientation="portrait" position="float"><label>Figure 1.</label><caption><p>An example of maxillary sinus septa on panoramic (A) and CBCT (B,C and D) images.</p></caption><graphic xlink:href="jiufd-050-008-e001"></graphic></fig><fig id="fig2" orientation="portrait" position="float"><label>Figure 2.</label><caption><p>An example of maxillary sinus septa on panoramic (A) and CBCT (B,C and D) images.</p></caption><graphic xlink:href="jiufd-050-008-e002"></graphic></fig></sec><sec id="s2d"><title>Statistical analysis</title><p>Data were statistically analyzed by using SPSS-15.0 version (SPSS Inc, Chicago, IL, USA) for Windows with descriptive statistics, chi-square and Fisher’s exact
tests. Confidence interval was set to 95% and p-values less than 0.05 were considered statistically significant.</p></sec></sec><sec sec-type="results" id="s3"><title>Results</title><p>In total, 104 maxillary sinuses of 52 individuals between 16 and 75 years of age (mean±standard deviation (SD): 46.8±15.9 years) were examined in this study.
There were two age groups; 26 subjects’ ages were under 50. Regarding the posterior maxillary segments in proximity of maxillary sinus; the most common posterior
maxillary segments were partial edentulous (n=22, 42%), followed by dentate (n=15, 29%), atrophic edentulous (n=11, 21%) and complete edentulous jaws (n=4, 8%) in the
right quadrants, respectively. In the left quadrants, dentate posterior maxillary segments (n=20, 38%) were mostly observed, followed by partial edentulous (n=15, 29%),
atrophic edentulous (n=12, 23%) and complete edentulous jaws (n=5, 10%). The prevalence of maxillary sinus septa was found to be 23.1% (n=24) and 29.8% (n=31) on
panoramic and on CBCT images, respectively. 24 maxillary sinus septa were observed in 21 patients on panoramic images and 31 maxillary sinus septa were observed in 20
patients on CBCT images whose mean age±SD was 39.05±16.6 years. Most of the septa was observed in subjects under age 50. Thus, bilateral maxillary sinus septa was
determined in 3 (5.8%) patients on panoramic images and in 8 (15.4%) patients on CBCT images and also double unilateral septa was observed in 3 (5.8%) patients on CBCT
images. The majority of maxillary sinus septa was observed in dentate posterior maxillary segments which was followed by partial edentulous, atrophic edentulous and
complete edentulous jaws on both panoramic and CBCT images (<xref ref-type="table" rid="table1">Table 1</xref>).</p><p>Regarding the location of maxillary sinus septa; the frequencies of primary septa was 58.3% (n=14) and 58.1% (n=18) on panoramic and CBCT images, respectively. The
frequencies of secondary septa were found to be 41.7% (n=10) and 41.9% (n=13) on panoramic and CBCT images, respectively. Statistically significant difference
(p<0.001) was observed between panoramic radiography and CBCT scans for the location of maxillary sinus septa (<xref ref-type="table" rid="table2">Table 2</xref>).
Regarding presence of the maxillary sinus septa and its neighborhood with the posterior maxillary teeth; the majority of maxillary sinus septa were observed at the
anterior region on panoramic images (<xref ref-type="table" rid="table3">Table 3</xref>). However, the maxillary sinus septa was mostly observed at the middle region on
CBCT images. Statistically significant differences (p<0.001) were found between panoramic radiography and CBCT scans for the presence and neighborhood with the
posterior maxillary teeth of the maxillary sinus septa (<xref ref-type="table" rid="table3">Table 3</xref>).</p><table-wrap id="table1" orientation="portrait" position="float"><label>Table 1.</label><caption><p>The distribution of maxillary sinus septa according to the adjacent posterior maxillary segments (CBCT:Cone beam computed tomography).</p></caption><table frame="hsides" rules="groups" style="border-collapse:collapse; border-bottom: 3px solid; border-top: 3px solid" cellpadding="20px"><tbody><tr><th rowspan="1" colspan="1"></th><th colspan="2" rowspan="1">Presence of maxillary sinus septa</th></tr><tr><td rowspan="1" colspan="1"></td><th rowspan="1" colspan="1">Panoramic images</th><th rowspan="1" colspan="1">CBCT images</th></tr><tr><th rowspan="1" colspan="1">Posterior maxillary segments</th><th align="left" rowspan="1" colspan="1">n (%)</th><th align="left" rowspan="1" colspan="1">n (%)</th></tr><tr><td rowspan="1" colspan="1">Partial edentulous</td><td rowspan="1" colspan="1">8 (33.4)</td><td rowspan="1" colspan="1">6 (19.4)</td></tr><tr><td rowspan="1" colspan="1">Complete edentulous</td><td rowspan="1" colspan="1">2 (8.3)</td><td rowspan="1" colspan="1">2 (6.4)</td></tr><tr><td rowspan="1" colspan="1">Atrophic edentulous</td><td rowspan="1" colspan="1">3 (12.5)</td><td rowspan="1" colspan="1">3 (9.7)</td></tr><tr><td rowspan="1" colspan="1">Dentate</td><td rowspan="1" colspan="1">11 (45.8)</td><td rowspan="1" colspan="1">20 (64.5)</td></tr><tr><td rowspan="1" colspan="1">Total</td><td rowspan="1" colspan="1">24 (100)</td><td rowspan="1" colspan="1">31 (100)</td></tr></tbody></table></table-wrap><table-wrap id="table2" orientation="portrait" position="float"><label>Table 2.</label><caption><p>The results of statistical analysis for the location of maxillary sinus septa (CBCT:Cone beam computed tomography).</p></caption><table frame="hsides" rules="groups" style="border-collapse:collapse; border-bottom: 3px solid; border-top: 3px solid" cellpadding="20px"><tbody><tr><th rowspan="1" colspan="1">Location of maxillary sinus septa</th><th rowspan="1" colspan="1">Panoramic images n (%)</th><th rowspan="1" colspan="1">CBCT images n (%)</th><th rowspan="1" colspan="1">p value</th></tr><tr><td rowspan="1" colspan="1">Primary </td><td rowspan="1" colspan="1">14 (58)</td><td rowspan="1" colspan="1">18 (58)</td><td rowspan="3" colspan="1">p<0.001*</td></tr><tr><td rowspan="1" colspan="1">Secondary</td><td rowspan="1" colspan="1">10 (42)</td><td rowspan="1" colspan="1">13 (42)</td></tr><tr><td rowspan="1" colspan="1">Total</td><td rowspan="1" colspan="1">24 (100)</td><td rowspan="1" colspan="1">31 (100)</td></tr></tbody></table><table-wrap-foot><fn id="foot2"><p>*Fisher's Exact test</p></fn></table-wrap-foot></table-wrap><table-wrap id="table3" orientation="portrait" position="float"><label>Table 3.</label><caption><p>The distribution and statistical analysis for the presence and neighborhood with the posterior maxillary teeth of the
maxillary sinus septa (CBCT:Cone beam computed tomography).</p></caption><table frame="hsides" rules="groups" style="border-collapse:collapse; border-bottom: 3px solid; border-top: 3px solid" cellpadding="5px"><tbody><tr><th colspan="2" rowspan="2">Presence and neighborhood of septa with posterior maxillary teeth</th><th colspan="6" rowspan="1">Panoramic radiography findings</th><th rowspan="1" colspan="1"></th></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Absent</td><td rowspan="1" colspan="1">Anterior region</td><td rowspan="1" colspan="1">Middle region</td><td rowspan="1" colspan="1">Posterior region</td><td rowspan="1" colspan="1">Total</td><td rowspan="1" colspan="1">p value</td></tr><tr><th rowspan="7" colspan="1">CBCT findings</th><td rowspan="1" colspan="1">Anterior region</td><td rowspan="1" colspan="1">n</td><td rowspan="1" colspan="1">1</td><td rowspan="1" colspan="1">1</td><td rowspan="1" colspan="1">0</td><td rowspan="1" colspan="1">0</td><td rowspan="1" colspan="1">2</td><td rowspan="7" colspan="1">p<0.001*</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">%</td><td rowspan="1" colspan="1">3.25</td><td rowspan="1" colspan="1">3.25</td><td rowspan="1" colspan="1">0</td><td rowspan="1" colspan="1">0</td><td rowspan="1" colspan="1">6.5</td></tr><tr><td rowspan="1" colspan="1">Middle region</td><td rowspan="1" colspan="1">n</td><td rowspan="1" colspan="1">8</td><td rowspan="1" colspan="1">9</td><td rowspan="1" colspan="1">6</td><td rowspan="1" colspan="1">0</td><td rowspan="1" colspan="1">23</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">%</td><td rowspan="1" colspan="1">25.85</td><td rowspan="1" colspan="1">29</td><td rowspan="1" colspan="1">19.35</td><td rowspan="1" colspan="1">0</td><td rowspan="1" colspan="1">74.2</td></tr><tr><td rowspan="1" colspan="1">Posterior region</td><td rowspan="1" colspan="1">n</td><td rowspan="1" colspan="1">5</td><td rowspan="1" colspan="1">0</td><td rowspan="1" colspan="1">0</td><td rowspan="1" colspan="1">1</td><td rowspan="1" colspan="1">6</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">%</td><td rowspan="1" colspan="1">16.1</td><td rowspan="1" colspan="1">0</td><td rowspan="1" colspan="1">0</td><td rowspan="1" colspan="1">3.25</td><td rowspan="1" colspan="1">19.35</td></tr><tr><td rowspan="1" colspan="1">Total</td><td rowspan="1" colspan="1">n</td><td rowspan="1" colspan="1">14</td><td rowspan="1" colspan="1">10</td><td rowspan="1" colspan="1">6</td><td rowspan="1" colspan="1">1</td><td rowspan="1" colspan="1">31</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">%</td><td rowspan="1" colspan="1">45.2</td><td rowspan="1" colspan="1">32.25</td><td rowspan="1" colspan="1">19.35</td><td rowspan="1" colspan="1">3.25</td><td rowspan="1" colspan="1">100</td></tr></tbody></table><table-wrap-foot><fn id="foot3"><p>*Fisher's Exact test</p></fn></table-wrap-foot></table-wrap></sec><sec sec-type="discussion" id="s4"><title>Discussion</title><p>Accurate diagnosis of maxillary sinus septa is possible with radiographic identification. Panoramic radiography, CT and CBCT have been used to identify
the maxillary sinus septa. However, exact and definitive assessment can be achieved by CT and CBCT scans. CBCT is recommended as an excellent, low cost technique for
the evaluation of maxillary sinus septa with only slightly more radiation dose than panoramic radiography and far less than CT
(<xref rid="b22" ref-type="bibr">22</xref>, <xref rid="b25" ref-type="bibr">25</xref>). Although various studies compared panoramic radiography with CT for the detection
of maxillary sinus septa, according to our knowledge, no study was conducted regarding the comparison of panoramic radiography and CBCT
(<xref rid="b6" ref-type="bibr">6</xref>, <xref rid="b25" ref-type="bibr">25</xref>, <xref rid="b26" ref-type="bibr">26</xref>).</p><p>Different observation methods have been used by several authors. Underwood (<xref rid="b7" ref-type="bibr">7</xref>) examined 45 dried skulls, Ulm et al.
(<xref rid="b17" ref-type="bibr">17</xref>) observed maxillary sinuses during sinus lift procedures, Lugmayr et al. (<xref rid="b15" ref-type="bibr">15</xref>) observed
sinus septa on CT images. Krennmair et al. (<xref rid="b14" ref-type="bibr">14</xref>) assessed prevalence of septa on CT images and 24.5% of the sinuses were also
observed during sinus lifting. Kasabah et al. (<xref rid="b13" ref-type="bibr">13</xref>) compared panoramic radiography by CT images. Velasquez-Plata et al.
(<xref rid="b27" ref-type="bibr">27</xref>) and Kim et al. (<xref rid="b9" ref-type="bibr">9</xref>) used software analyses for septa detection. Several studies
detected septa using panoramic images (<xref rid="b25" ref-type="bibr">25</xref>, <xref rid="b26" ref-type="bibr">26</xref>, <xref rid="b27" ref-type="bibr">27</xref>,
<xref rid="b28" ref-type="bibr">28</xref>). Our study represents the first performance for comparison of the CBCT and panoramic radiography findings in detecting the
presence, number and location of maxillary sinus septa. We examined 104 maxillary sinuses of 52 individuals on both digital panoramic and CBCT images. The prevalence of
maxillary sinus septa has been reported as 20.6% and 58% by CBCT in previous studies performed in different countries (<xref rid="b29" ref-type="bibr">29</xref>,
<xref rid="b30" ref-type="bibr">30</xref>, <xref rid="b31" ref-type="bibr">31</xref>, <xref rid="b32" ref-type="bibr">32</xref>,
<xref rid="b33" ref-type="bibr">33</xref>, <xref rid="b34" ref-type="bibr">34</xref>). However, it was reported that the prevalence of maxillary sinus septa
ranged between 14.3% and 33.3 % in a systematic review in French population (<xref rid="b30" ref-type="bibr">30</xref>). Jang et al.
(<xref rid="b31" ref-type="bibr">31</xref>) examined 151 patients and reported its prevalence of 26% in Korean population. Li et al.
(<xref rid="b32" ref-type="bibr">32</xref>) analyzed 424 patients in Han population and observed the maxillary sinus septa in 44.8% of the patients. Dobele et al.
(<xref rid="b33" ref-type="bibr">33</xref>) determined the maxillary sinus septa in 20.6% of the Latvian patients. Lana et al.
(<xref rid="b34" ref-type="bibr">34</xref>) reported the prevalence of maxillary sinus septa as 44.4% in Brazilian patients. The prevalence of maxillary sinus septa has
been reported as 58% in Turkish patients by Orhan et al. (<xref rid="b23" ref-type="bibr">23</xref>). In the current study, prevalence of maxillary sinus septa was
found to be 23.1% and 29.8% on panoramic and on CBCT images. Although, this result was lower than the previous study performed in Turkish population, it was in
accordance with some previous reports. Orhan et al. (<xref rid="b23" ref-type="bibr">23</xref>) reported that unilateral septa has been determined in majority of cases
with mixed dentition (3.2%) and bilateral septa has been determined in majority of cases with dentition (23%). Unilateral and bilateral two septa were found in 1.08%
and 0.2% of the cases, respectively. Also, unilateral and bilateral three septa were found in 0.4% of the cases by the same authors. In the present study, the frequency
of unilateral maxillary sinus septa was higher (40.4%) than bilateral septa (5.8%) and also unilateral double septa was observed in 5.8% of the patients on CBCT images.
This result is different from Orhan et al.’s (<xref rid="b23" ref-type="bibr">23</xref>) results. Some authors (<xref rid="b23" ref-type="bibr">23</xref>,
<xref rid="b35" ref-type="bibr">35</xref>) observed higher prevalence of septa in partially edentulous maxilla than in totally edentulous ones and reported no
statistically significant differences between the different types of edentulism. However, other authors (<xref rid="b9" ref-type="bibr">9</xref>,
<xref rid="b14" ref-type="bibr">14</xref>, <xref rid="b36" ref-type="bibr">36</xref>, <xref rid="b37" ref-type="bibr">37</xref>) reported a higher prevalence of septa
in completely edentulous patients than in partially edentulous patients. In the present study, the majority of maxillary sinus septa was observed in dentate posterior
maxillary segments which was followed by partial edentulous, atrophic edentulous and complete edentulous jaws on both panoramic and CBCT images, which is different
from previous studies. Location of the maxillary sinus septa was determined by different authors. Underwood (<xref rid="b7" ref-type="bibr">7</xref>) reported most of
the septa has been found in the posterior region over third molar roots;Ulm et al. (<xref rid="b17" ref-type="bibr">17</xref>) reported a greater frequency of septa in
the anterior region, as did Krennmair et al. (<xref rid="b14" ref-type="bibr">14</xref>) (70% of septa in the premolar region); and Velásquez-Plata et al.
(<xref rid="b27" ref-type="bibr">27</xref>), Kim et al. (<xref rid="b9" ref-type="bibr">9</xref>), González-Santana et al. (<xref rid="b25" ref-type="bibr">25</xref>),
Orhan et al. (<xref rid="b23" ref-type="bibr">23</xref>) found the highest frequency in the middle region, as 41%, 50.8%, 65% and 69.1%, respectively. However, Jang et
al. (<xref rid="b30" ref-type="bibr">30</xref>) reported the highest frequency they have observed was in the middle and anterior regions for edentulous and dentate
patients, respectively. In the present study, the highest prevalence was found in the anterior region as 32.2% on panoramic images and 74.2% were observed in the middle
region on CBCT images which is in accordance with previous reports. Krennmair et al (<xref rid="b14" ref-type="bibr">14</xref>) reported the rate of false diagnosis on
panoramic radiographs as 21.3% while Kasabah et al. (<xref rid="b13" ref-type="bibr">13</xref>) reported as 44.1% and Gonzalez-Santana et al.
(<xref rid="b25" ref-type="bibr">25</xref>) as 11.8%. We also found statistically significant differences between panoramic radiography and CBCT scans for the
detection of septa presence, location and distribution of primary/secondary septa in accordance with previous studies.</p></sec><sec sec-type="conclusion" id="s5"><title>Conclusion</title><p>The results of this study demonstrated that there are significant differences between panoramic radiographs and CBCT images in the detection of presence, number
and location of maxillary sinus septa. 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