Clinical context and challenges of OMES

The close anatomical proximity between the maxillary sinus floor and the apices of the posterior teeth constitutes a natural pathway through which pulpal and periapical pathologies can extend into the sinus. Although apex involvement is recognized, maxillary sinusitis of endodontic origin (MSEO) remains a clinical entity with blurred contours, frequently underestimated or misdiagnosed by the various specialties of dental surgery, otorhinolaryngology, and radiology. Practitioners are faced with significant terminological heterogeneity and radiographic diagnostic criteria, particularly via CBCT, whose thresholds are still subject to debate.

Research objectives and questions

Cette étude, réalisée sous la forme d'une scoping review suivant la méthodologie JBI, vise à cartographier l'état des connaissances sur la MSEO pour clarifier sa définition, son diagnostic et sa prise en charge. L'objectif est d'analyser comment la pathologie est définie à travers la littérature, d'identifier les méthodes diagnostiques prévalentes — telles que l'épaississement muqueux, l'ostéopériostite périapicale (PAO) ou la mucosite périapicale (PAM) — et d'évaluer les stratégies thérapeutiques employées. La revue cherche également à documenter les taux de guérison et les modalités de suivi afin de mettre en lumière les lacunes dans les preuves actuelles et d'orienter les futures pratiques multidisciplinaires.

Study design and eligibility criteria

This protocol describes a scoping review based on the JBI "Population–Concept–Context" (PCC) framework. The study targets human populations presenting with maxillary sinus pathologies attributed to an endodontic origin (pulp necrosis, apical periodontitis). Included are primary studies (controlled trials, cohorts, case reports) and grey literature (theses, conference abstracts) written in English, with no date restriction.

Search strategy and sources

The authors apply a three-step search strategy:

• Step 1: A limited initial search on MEDLINE (via PubMed) and Embase to identify relevant keywords and indexing terms.
• Step 2: An exhaustive search extended to MEDLINE, Scopus, Embase and Cochrane Central (CENTRAL).
• Step 3: Reviewing the reference lists of all included sources.

Grey literature is explored via the first 200 results of Google Scholar, OpenGrey (until 2020) and clinicaltrials.gov.

Analysis and data management

To limit bias, the researchers responsible for data coding and interpretation will work in a blinded manner regarding the assigned treatments. The analysis is based on descriptive numerical summaries (frequencies, medians) and a qualitative thematic mapping structured around four domains: definitions, diagnosis, treatments, and clinical outcomes.

A protocol to lift the veil on MSFA

Maxillary sinusitis of endodontic origin (MSEO) is a daily diagnostic challenge. Between vague definitions and divergent therapeutic approaches, this scoping review protocol relies on the JBI methodology to map current knowledge. The stakes are high: distinguishing pure endodontic origin from other odontogenic causes (implants, extractions, grafts) to refine clinical management.

Five key questions for your practice

The authors have structured their analysis around five fundamental research areas for the practitioner:

• Terminology: How is MSEO defined in relation to global "odontogenic sinusitis"?
• Diagnosis: Which radiographic signs (mucosal thickening, periapical osteoperiostitis - PAO, periapical mucositis - PAM) and which thresholds (e.g., > 2 mm) are consensual?
• Management: What is the role of non-surgical endodontic treatment compared to microsurgery or extraction?
• Outcomes: How to measure healing (resolution of symptoms vs radiographic healing)?
• Gaps: What are the grey areas where scientific evidence is still lacking?

The search strategy is particularly exhaustive. It combines two blocks of concepts (maxillary sinus/sinusitis and endodontic/periapical diseases) through major databases such as MEDLINE, Embase, Scopus, and CENTRAL. A notable point for the study's rigor: the first 200 results from Google Scholar and grey literature (theses, abstracts) are also screened to avoid any publication bias.

The strength of this design? A qualitative thematic mapping divided into four areas (definitions, diagnosis, treatment, results). The authors take a clear position: excluding all non-endodontic pathology to provide a precise answer on the real impact of the tooth on the sinus. A tool that promises to be indispensable for ending the diagnostic uncertainty often observed between the dental surgery and the ENT department.

Analysis and perspectives of the review on MOES

This scoping review protocol targets a major issue: the terminological and diagnostic ambiguity surrounding endodontic-related maxillary sinusitis (ERMS). By isolating pulpal and periapical pathology from other odontogenic causes (implants, periodontitis, oro-antral communications), the authors seek to stabilize a clinical definition that remains, according to preliminary data, extremely heterogeneous across dental, radiological, and ENT specialties.

The clinical interest lies in mapping radiographic signs on CBCT, particularly periapical osteoperiostitis (PAO) and periapical mucositis (PAM). The study highlights that diagnosis often relies on mucosal swelling thresholds, the definition of which varies considerably from one study to another. This variability directly impacts therapeutic choices, oscillating between conventional endodontic treatment, endodontic microsurgery, extractions, or endoscopic sinus surgery (ESS).

The limitations of this work stem from its very nature as a review protocol: it does not provide new experimental results but organizes existing literature. The synthesis highlights a lack of consensus on the sequencing of care and on the systematic involvement of a multidisciplinary approach.

Protocol summary

This scoping review protocol aims to harmonize the definitions and diagnostic criteria for Maxillary Sinusitis of Endodontic Origin (MSEO), currently characterized by major heterogeneity between dental surgery and ENT. The authors report that diagnosis relies on identifying specific CBCT signs, such as periapical osteoperiostitis (PAO) and periapical mucositis (PAM), for which mucosal thickening thresholds remain to be stabilized to validate standardized management.

In concrete terms, for the practitioner:

• Refine your CBCT reading: Do not limit yourself to observing a mucosal thickening of more than 2 mm; actively look for signs of osteoperiostitis (PAO) to confirm the involvement of a pulpal or periapical pathology.
• Clarify the origin before operating: Rigorously distinguish MSOD from other odontogenic causes (implants, grafts, periodontitis) to avoid treatment failures related to an unresolved infectious source.
• Interdisciplinary coordination: Faced with persistent unilateral sinusitis, endodontic expertise must be systematically integrated into the care pathway before considering endoscopic sinus surgery, in order to treat the primary root cause.

Technical lexicon of the study

Maxillary Sinusitis of Endodontic Origin (MSEO): Term referring to maxillary sinusitis resulting specifically from endodontic pathology (pulpal necrosis, periapical pathology, or root canal treatment failure) of the maxillary posterior teeth, distinct from other odontogenic causes.

Periapical Osteoperiostitis (PAO): Radiographic sign observed on CBCT/CT characterized by an osteo-periosteal reaction at the level of the sinus floor, following periapical inflammation of endodontic origin.

Periapical Mucositis (PAM): Localised inflammation of the sinus mucosa located directly above the apex of a tooth with endodontic involvement, identified by sectional imaging.

Mucosal Thickening: Thickening of the maxillary sinus mucosa. It is a key radiographic sign for the diagnosis of MSOP, although the millimetric thresholds defining the pathology are subject to debate in the literature.

CBCT (Cone-Beam Computed Tomography): Preferred three-dimensional imaging modality for evaluating the relationship between dental apices and the maxillary sinus, allowing for the detection of opacification or mucosal thickening.

Endoscopic sinus surgery: Otorhinolaryngological surgical intervention reported in the management of MSEO, sometimes integrated into a multidisciplinary care protocol alongside endodontic treatments.

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