Maxillary Sinusitis of Odontogenic Origin: Global Prevalence, Risk Factors, Diagnosis, and Management: A Review

Abstract

Maxillary sinusitis of odontogenic origin (MSOO) is a distinct clinical entity and is frequently misdiagnosed, where sinus inflammation is directly caused by dental pathology or iatrogenic dental procedures rather than infection of the respiratory system. Historical estimates suggested a low prevalence; the widespread use of three-dimensional imaging (CBCT) has revealed a significantly higher incidence of disease. This study aims to critically review and compare the results from major international research published between 2023 and 2026 in high-impact journals, to provide a current global perspective on the prevalence of MSOO, determine the relative role of the risk factors, and use this information to create practical evidence-based recommendations. We conducted a comprehensive search in PubMed, Scopus, and Web of Science. The search terms included "Odontogenic Sinusitis," "Prevalence," "Risk Factors," and "Maxillary Sinus Pathology." The search focused on peer-reviewed articles published between January 2023 and March 2026 that utilized of three-dimensional imaging (CT/CBCT). The selected literature was reviewed and data were synthesized narratively with direct analysis of study findings, methodologies, and populations. The percentages and odds ratios presented in this analysis were deduced through a cross-synthesis of contemporary three-dimensional (CBCT) literature, rather than relying on isolated prevalence values. The updated analysis confirms a pooled global prevalence of MSOO ranging from 40.2% to 51% of maxillary sinus pathology, with MSOO cases accounting for an average of 45.6% overall and rising to 79.63% in patients with unilateral maxillary sinusitis associated with ipsilateral dental lesions. Periapical lesions significantly increase the likelihood of sinus mucosal thickening, conferring an odds ratio (OR) ranging from 2.43 to 3, the primary risk factor (OR 2.43-3). Furthermore, oro-antral communication (OAC) represents a major determinant, elevating the odds of sinusitis by 3.8 times and dramatically increasing the odds of mucosal thickening by 16,8 times. The anatomical proximity, specifically a distance of less than 3.32 mm between the sinus floor and dental lesions, further increases the severity of sinus involvement, with the maxillary first molar representing the most frequently involved tooth in endodontic-related maxillary sinusitis. In addition, the past decade has witnessed a remarkable increase in implant-related maxillary sinusitis. Regarding diagnosis, three-dimensional CBCT imaging is essential for detecting subtle osseous and endodontic defects that remain undetected on conventional radiographs. Regarding management, prioritizing the elimination of the dental source prior to or simultaneously with functional endoscopic sinus surgery (FESS) yields a combined success rate approaching 97%, underscoring the necessity of standardized interdisciplinary co-management protocols between dental and ENT clinicians.