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Paper text:
the maxillary sinuses are the most important paranasal sinuses in dentistry and maxillofacial surgery due to their proximity to the roots of upper dentition ( 1 , 2 ) . the importance of the maxillary sinuses becomes clearer when it is understood that dental sources are responsible for 10 - 12% of maxillary sinusitis and that late diagnosis and treatment of this problem can lead to severe complications , including orbital cellulitis and cerebral abscesses ( 3 , 4 ) .
hence , accurate detection and immediate treatment of odontogenic maxillary sinusitis is an important issue in dentistry ( 5 ) . in addition
, the microbiology of odontogenic sinusitis differs from that of other maxillary sinusitis , necessitating treatment plans based on the source of infection ( 6 , 7 ) .
several investigations have proposed signs and symptoms of maxillary sinusitis that have dental sources ( 8 , 9 ) .
some studies have categorized the dental etiologic factors of sinusitis according to their frequency and importance ( 10 - 12 ) .
however , these studies did not suggest the same dental etiologic factors and proposed various methods of diagnosing sinusitis that had dental sources ( 11 - 13 ) .
in addition , the literature identifies no common treatment approach for odontogenic sinusitis ( 14 - 16 ) .
several literature reviews have addressed diagnosing and treating maxillary sinusitis with dental sources , but none are systematic or present adequate information about this issue ( 3 , 4 , 17 ) .
in fact , there is some bias in these article reviews ( 17 , 18 ) . publication bias and heterogeneity are found in nearly all of them .
publication bias is a limitation of meta - analysis , in which researchers are influenced to select articles with significant results ( 19 ) .
in addition , it is difficult to avoid heterogeneity in a meta - analysis because of the dissimilarity of the various studies . to reduce publication bias ,
this study used rosenthal s file drawer method to estimate it . because of the above - mentioned publication bias and heterogeneity , the existing literature lacks a systematic review of maxillary sinusitis with dental origin .
therefore , this study aims to present a systematic review of etiologies and treatment plans for odontogenic maxillary sinusitis and to provide better insight into various dental etiologic factors of this type of sinusitis .
the authors searched various electronic databases , including medline ( pubmed ) , embace , the science direct databases , and the cochrane library , for papers published between january 2001 and december 2014 .
odontogenic maxillary sinusitis  in combination with ( and )  treatment  or  diagnosis  .
in addition ,  maxillary sinusitis  in combination with ( and )  dental source  or  dental origin  or
all titles and abstracts returned by the search were appraised using the inclusion criteria , which were the following .
clinical trials ; papers investigating only maxillary sinusitis , not pan - sinusitis cases ; maxillary sinusitis with dental origin that was compared to other etiologies ; investigations assessing diagnosis , treatment , or microbiology of odontogenic sinusitis . excluded were animal studies , case reports , review articles , grey literatures ( conference lectures , posters , and technical reports ) , and investigations that did not compare odontogenic sinusitis with other etiologies ( figure 1 ) . to prevent possible reviewer bias during appraisal of the papers ,
all identifying information , such as authors names , journal names , and publishing dates , were ignored . to reduce the selection bias , each researcher in the present study checked the extracted data separately .
all data regarding the frequency of dental etiologies , microbiology , treatment methods , and success rate were extracted and organized in tables 1 - 4 .
the authors searched various electronic databases , including medline ( pubmed ) , embace , the science direct databases , and the cochrane library , for papers published between january 2001 and december 2014 .
odontogenic maxillary sinusitis  in combination with ( and )  treatment  or  diagnosis  .
in addition ,  maxillary sinusitis  in combination with ( and )  dental source  or  dental origin  or
all titles and abstracts returned by the search were appraised using the inclusion criteria , which were the following .
clinical trials ; papers investigating only maxillary sinusitis , not pan - sinusitis cases ; maxillary sinusitis with dental origin that was compared to other etiologies ; investigations assessing diagnosis , treatment , or microbiology of odontogenic sinusitis . excluded were animal studies , case reports , review articles , grey literatures ( conference lectures , posters , and technical reports ) , and investigations that did not compare odontogenic sinusitis with other etiologies ( figure 1 ) .
to prevent possible reviewer bias during appraisal of the papers , all identifying information , such as authors names , journal names , and publishing dates , were ignored . to reduce the selection bias , each researcher in the present study checked the extracted data separately . all data regarding the frequency of dental etiologies , microbiology , treatment methods , and success rate were extracted and organized in tables 1 - 4 .
after reading and evaluating the abstracts , the researchers discarded articles unrelated to the inclusion criteria . finally , 19 studies were included ( tables 1 and 2 ) .
of the 19 papers , 10 were related to diagnosis of odontogenic sinusitis , 4 were microbiological studies , and 9 were related to presenting a treatment method . as table 3 shows , 10 articles investigated various dental causes of odontogenic maxillary sinusitis .
oroantral fistula ( oaf ) was the most common cause of maxillary sinusitis that had dental origin .
these data suggest that anaerobic bacteriological flora is the most common cause of chronic odontogenic sinusitis , while the predominant flora are mixed in cases with acute sinusitis . in acute odontogenic maxillary sinusitis , gram - negative bacilli , peptostreptococcus , and fusobacterium spp are the predominant bacterial flora , although the literature indicates no certain flora for chronic cases .
the caldwell - luc approach is the most popular method for treating sinusitis caused by displaced teeth , roots , or dental materials .
endoscopic sinus surgery ( ess ) was the most common treatment plan for cleaning the antrum and the infected mucosa .
abbreviations : ess , endoscopic sinus surgery ; fess , functional endoscopic sinus surgery ; oaf , oroantral fistula ; rct , root canal therapy .
as table 3 shows , 10 articles investigated various dental causes of odontogenic maxillary sinusitis .
oroantral fistula ( oaf ) was the most common cause of maxillary sinusitis that had dental origin .
these data suggest that anaerobic bacteriological flora is the most common cause of chronic odontogenic sinusitis , while the predominant flora are mixed in cases with acute sinusitis . in acute odontogenic maxillary sinusitis ,
gram - negative bacilli , peptostreptococcus , and fusobacterium spp are the predominant bacterial flora , although the literature indicates no certain flora for chronic cases .
the caldwell - luc approach is the most popular method for treating sinusitis caused by displaced teeth , roots , or dental materials .
endoscopic sinus surgery ( ess ) was the most common treatment plan for cleaning the antrum and the infected mucosa .
abbreviations : ess , endoscopic sinus surgery ; fess , functional endoscopic sinus surgery ; oaf , oroantral fistula ; rct , root canal therapy .
the importance of maxillary sinusitis has been mentioned in the literature , although this issue is ignored by some dentists and maxillofacial surgeons ( 5 ) . the complications of maxillary sinusitis may be life threatening , and dental sources have been reported as responsible for 10 - 12% of these problems by some studies ( 3 , 4 ) and up to 40% by other studies ( 18 ) .
several investigators have studied the frequency of odontogenic maxillary sinusitis and have presented various treatment methods ( 15 , 22 ) .
the importance of this issue necessitates a systematic review in order to collect the information in various studies and propose a standard protocol for diagnosing and treating maxillary sinusitis that has dental sources .
the purpose of the current study was to provide a better understanding of this topic .
oaf was the most common cause of odontogenic maxillary sinusitis among all dental etiologies ( 12 , 20 - 22 ) all oafs led to chronic sinusitis , while other dental etiologies caused acute sinusitis .
it should be noted that oaf mostly led to odontogenic sinusitis , especially chronic cases , although the sinusitis may be silent at first , without any signs or symptoms ( 21 , 22 ) .
dentists and maxillofacial surgeons must be aware of oaf as a complication of tooth extraction and attempt to close the fistula as soon as possible to prevent maxillary sinusitis .
studies of the microbiology of odontogenic sinusitis have proved that anaerobic bacterial flora is the most important microbiologic factor in maxillary sinusitis that has dental origin ( 23 - 26 ) . in one study ,
mixed bacterial flora were more common in acute odontogenic sinusitis ( 25 ) . among aerobic flora ,
staphylococcus aureus was the common cause of acute and chronic odontogenic sinusitis in all studies ( 23 - 25 ) .
the second most predominant aerobic floras in acute and chronic maxillary sinusitis with dental sources were alpha - hemolytic and microaerophilic streptococci , which were common in all studies ( 24 , 25 ) except one ( 23 ) .
the predominant anaerobic flora was peptostreptococcus in all studies , while the anaerobic gram - negative bacilli were the second most common factor in most studies ( 23 - 25 ) .
furthermore , other studies showed that the most common causes of rhinosinusitis were staphylococcus aureus and pneumococcus ( 36 , 37 ) .
these findings suggest that the flora implicated in odontogenic sinusitis are very similar to the flora in the oral cavity .
alpha hemolytic streptococci are responsible for dental decay , so they may easily invade the inferior border of the maxillary sinuses and causes inflammation . after the aerobic flora initiate inflammation and use the oxygen , the anaerobic flora continue proliferating and inflaming the mucosal membranes . in most cases of sinusitis ,
the literature showed that although closure of the oaf may be necessary to treat chronic odontogenic sinusitis , ess may be the best method for cleaning the inflamed and proliferated membrane ( 14 , 22 , 27 ) .
studies of sinusitis due to displaced teeth or dental material showed that the caldwell - luc technique might be the best approach for treating these cases ( 15 , 28 , 29 ) . in such cases , this treatment plan may be the simplest and safest method , with minimal complication .
three studies assessed the effect of dental treatment in odontogenic sinusitis cases ( 15 , 16 , 31 ) , showing that dental treatments might be helpful in such cases but are not complete treatments by themselves
. longhini et al . suggested that dental infections may be the cause of ess failure in maxillary sinusitis .
they proved that ess might be an appropriate treatment approach after dental treatments ( 16 ) .
ess is a surgical treatment for various types of sinusitis , including chronic , recurrent acute , fungal , and bacterial . in this technique
, an endoscope is passed through the nose and inserted into the sinus to provide an internal view of the sinus so that the infected membrane , mucoceles , and other small objects blocking the sinus opening can be removed .
the problem with this technique is the proximity of anatomical structures such as the orbital nerve , internal carotid , and eyes .
any clinician using this technique must be expert in it . in addition , this treatment is not appropriate for removing large blocking objects . the present study aimed to present comprehensive data about odontogenic sinusitis .
selection bias is one of the most important issues that must be addressed in an article review . to address it ,
this review selected articles that both evaluated odontogenic sinusitis and compared it to other etiologies , because those studies that addressed only odontogenic sinusitis did not present appropriate treatment plan or accurately represent the prevalence of the problem .
in addition , the study used heterogeneity testing and rosenthal s file drawer method to avoid publication bias .
heterogeneity tests on the articles reviewed yielded results that were not significant ( p value > 0.05 ) .
the rosenthal number obtained was 58.6 , meaning that 58.6 articles with the opposite results would need to be published before the findings of the present study should be ignored .
one limitation of the present study was the inability to hand - search the literature .
dental etiologies are responsible for about 10 - 40% of maxillary sinusitis , and oaf may be the most common cause of all .
the literature contains several treatment plans that may be effective , depending on the dental etiology of the sinusitis .
dentists and maxillofacial surgeons must consider dental factors as important causes of maxillary sinusitis and must be aware of various treatment approaches .
context : maxillary sinusitis is an important issue in dentistry and maxillofacial surgery . 
 this study aims to present a systematic review of etiologies and treatments of odontogenic maxillary sinusitis.evidence acquisition : an electronic database search was performed based on related mesh keywords . 
 articles published between january 2001 and december 2014 was selected according to the inclusion criteria . 
 the information extracted from various studies was categorized in various tables.results:the study selected 19 studies . in most studies , oroantral fistula ( oaf ) 
 was the most common etiology of odontogenic sinusitis . 
 alpha - hemolytic streptococcus was the most common flora in sinusitis with dental origin . 
 the literature shows that the caldwell - luc approach may be the best method for treating sinusitis in cases of displaced teeth.conclusions:oaf is a common cause of odontogenic maxillary sinusitis and may easily be treated by endoscopy and fistula closure . 
 maxillofacial surgeons and dentists should consider this problem to avoid misdiagnosis and prevent complications .