JOURNAL OF ENDODONTICS Printed in U.S.A.

Copyright © 2003 by The American Association of Endodontists VOL. 29, NO. 12, DECEMBER 2003

Prevalence of Odontogenic Sinus Tracts in Patients

Referred for Endodontic Therapy

Rahul Gupta, DDS, and Gunnar Hasselgren, DDS, PhD

The purpose of this study was to determine the divided into six categories depending on their preoperative status:
prevalence of odontogenic sinus tracts in patients vital teeth; nonvital teeth without radiolucency; previously end-
referred for endodontic therapy. Charts of 330 pa- odontically treated teeth without radiolucency; nonvital teeth with
tients (393 permanent teeth) endodontically radiolucency (periapical, juxtaradicular, furcation); previously
treated during a 10-month period were reviewed endodontically treated teeth with radiolucency; and vital teeth with
and data was collected. Among the 393 permanent periapical radiolucency. All sinus tracts had been traced with
teeth there were a total of 160 teeth with preoper- gutta-percha points and radiographs had been taken.
ative status of periradicular inflammation. Of 160
teeth with preoperative status of periradicular in-
flammation, 29 teeth (18.1%) had an odontogenic
sinus tract, which correlates to almost one in five
teeth with periradicular inflammation having a si- TABLE 1. No. of teeth and sinus tracts according to
preoperative status
nus tract.
No. of
No. of
Preoperative status Sinus
Teeth
Tracts
Vital teeth 199 0
When an acute periapical abscess forms, it will drain along a path Nonvital teeth without radiolucency 21 0
of least resistance. The odontogenic abscess may spread to deeper Previously endodontically treated teeth 13 0
tissues causing fascial space infection or it may establish an in- without radiolucency
traoral or external drainage in the form of a sinus tract. Whether Nonvital teeth with radiolucency
there is an intraoral or extraoral sinus-tract opening depends on the Periapical radiolucency 90 17
location of the perforation in the cortical plate by the inflammatory Juxtaradicular radiolucency 1 1
process and its relationship to facial-muscle attachments (1). Furcation radiolucency 1 1
Sometimes drainage to the maxillary sinus or nasal cavity may Previously endodontically treated teeth
occur (2, 3). with radiolucency
Periapical radiolucency 55 9
After formation of a sinus tract, the inflammation at the apex of
Furcation radiolucency 1 1
the root may persist for a long period of time. Because of the
Vital teeth with periapical radiolucency 12 0
drainage through the sinus tract, a chronic abscess can remain Total sinus tracts 29
asymptomatic for extended periods of time. If there is a closure of Total teeth 393
the sinus tract, then the chronic abscess may become symptomatic
(4).
Many texts have reported the presence of sinus tracts, but few
studies have dealt with their prevalence. The purpose of this study TABLE 2. Percentage of sinus tracts according to preoperative
was to find the prevalence of sinus tracts in patients referred for status
endodontic therapy.
No. of % of
No. of
Preoperative status Sinus Sinus
teeth
MATERIAL AND METHODS Tract Tract
Nonvital teeth with radiolucency 92 19 20.7%
Data were gathered from charts of 330 patients (393 permanent Previously endodontically treated 56 10 17.9%
teeth) referred for endodontic treatment at a postgraduate endodon- teeth with radiolucency
tic clinic, during a 10-month period. Patient age varied from 10 to Vital teeth with periapical 12 0 0.0%
83 yr. There were 107 male and 223 female patients. All charts radiolucency
Total 160 29 18.1%
were reviewed independently by two examiners. The teeth were

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Vol. 29, No. 12, December 2003 Odontogenic Sinus Tracts 799

TABLE 3. Distribution of treated teeth

Third Second First Second First Lateral Central Total

Canine
Molar Molar Molar Premolar Premolar Incisor Incisor (N ⫽ 393)
Maxilla 0 32 46 21 26 26 21 52 224
Mandible 2 27 74 26 14 9 10 7 169

TABLE 4. Location of 29 sinus tracts by tooth origin

Third Second First Second First Lateral Central

Canine Total
Molar Molar Molar Premolar Premolar Incisor Incisor
Maxilla 0 1 3 3 0 0 4 7 18
Mandible 0 2 6 0 2 1 0 0 11

RESULTS concur that sinus tracts heal after traditional root-canal treatment.
In this study 24 sinus tracts healed after endodontic therapy. The
Sinus tracts were found in 29 of 160 permanent teeth with remaining five teeth had vertical fractures and were extracted. It
periradicular radiolucencies. The number of teeth according to has been shown that the presence of a sinus tract will not influence
preoperative status and the number of sinus tracts are summarized the long-term outcome of endodontic treatment (13, 14).
in Table 1. Percentage of sinus tracts according to preoperative In this study all odontogenic sinus tracts had intraoral openings.
status is found in Table 2. The distribution of teeth treated is Cutaneous odontogenic sinus tracts are occasionally seen (15).
summarized in Table 3. However, none were found in this patient material. When dealing
In this study, 27 of 29 teeth with sinus tracts had labial/buccal with cutaneous sinus tracts, McWalter et al. (1) stated, “Dental
openings. One of 29 teeth with sinus tracts had a palatal opening pathosis should be the primary suspect in differential diagnosis.
and one had a sulcular opening. None of the teeth with sinus tracts Also to be considered are osteomyelitis of the facial bones, gran-
had lingual openings. Locations of odontogenic sinus tracts by ulomatous disorders, congenital fistulas, foreign bodies and basal
their tooth origin are summarized in Table 4. cell carcinoma.”
Of 29 teeth, five sinus tracts were caused by vertical fractures. In this study there was only one odontogenic sinus tract per
Three of these five teeth had been previously endodontically tooth. Odontogenic infections can result in multiple sinus tracts.
treated and had periapical radiolucencies. Two teeth showed fur- This is usually caused by advanced infections such as osteomyeli-
cation radiolucencies. One of these was necrotic and one was tis, fractures acting as avenues for infection, or similar infections
previously endodontically treated. The remaining 24 teeth with involving substantial amounts of microorganisms (16, 17).
sinus tracts were treated endodontically and all tracts closed. The The majority of the odontogenic sinus tracts (27 of 29) had
vital teeth with periapical radiolucency were multirooted, or mul- labial/buccal openings. A reason for this could be that palatal and
ticanaled, and had tested vital to diagnostic tests but had one root, lingual alveolar bone is generally more compact than labial/buccal
or canal, with periapical radiolucency. bone. It is conceivable that there may have been unnoticed sinus
tracts draining into the maxillary sinus or nasal cavity. The dis-
tance from maxillary tooth apices to these areas is often short and
DISCUSSION it is not uncommon with drainage into these cavities (2, 3). Of the
teeth with periradicular inflammations, basically one in five had a
Periapical inflammation is caused by infection (5, 6). Of 160 sinus tract. This may at least partly explain why so many teeth with
infected teeth in this study 29 had sinus tracts (18.1%). Only a few periradicular inflammations are free from symptoms.
studies have dealt with prevalence of sinus tracts. Mortensen et al.
(7) investigated 1600 teeth with periapical lesions; 136 (9.0%) Drs. Gupta and Hasselgren are affiliated with the School of Dental and Oral
teeth had sinus tracts. They found that the size of the radiolucency Surgery, Columbia University, New York, NY.
seemed to matter, because teeth with periapical lesions smaller Address requests for reprints to Dr. Gunnar Hasselgren, Director, Division
than 5 mm had sinus tracts in 5% of cases, whereas teeth with of Endodontics, School of Dental and Oral Surgery, Columbia University, 630
West 168th Street, PH 7 E117, New York, NY 10032.
periapical lesions greater than or equal to 5 mm had sinus tracts in
19%.
When examining patients with odontogenic sinus tract, it is
important to trace the tract to its origin by taking a gutta-percha References
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