Distances of root apices to adjacent anatomical structures in the anterior maxilla: an analysis using cone beam computed tomography

  • Julien DucommunEmail author
  • Michael M. Bornstein
  • May Chun Mei Wong
  • Thomas von Arx
Original Article



The aim was to assess the anatomical relationship of anterior maxillary teeth to the nasal floor in patients referred for apical surgery.

Materials and methods

Cone beam computed tomographic images (CBCT) of 83 patients were analysed retrospectively to quantify the distances between the root apices of maxillary anterior teeth (canine to canine) to the nasal floor or maxillary sinus (whichever was closer). Secondary outcome variables were the distances of the periapical lesion to the nasal floor, distances of the apices to the labial and palatal bone plates as well as to the neighbouring teeth.


A total of 93 teeth (39 central, 35 lateral incisors and 19 canines) were analysed. The mean shortest distances of the apices to the nasal floor (or maxillary sinus) were 8.54 mm for central incisors, 9.49 mm for lateral incisors and 5.39 mm for the canines. The canines exhibited a significantly shorter distance to the nasal floor/maxillary sinus. In the presence of an osteolysis, the distance to the nasal floor was significantly shorter compared to the teeth without lesions. The lateral and central incisors showed significant proximity to each other at the level of the future surgical resection (3 mm from the apex).


A close proximity between apices and adjacent anatomical structures such as nasal floor, maxillary sinus or adjacent roots could be shown in some cases.

Clinical relevance

CBCT could be a valuable adjunctive imaging tool prior to apical surgery in the anterior maxilla to assess the risk for and decrease the incidence of damage to neighbouring anatomical structures such as the nasal floor, maxillary sinus or adjacent roots.


Cone beam computed tomography Apical surgery Nasal floor Maxillary sinus 



The authors thank Ines Badertscher, Medical Illustrator, School of Dental Medicine, University of Bern, Switzerland, for the schematic illustrations.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol has been approved by the standing ethics committee of the State of Bern (approval number KEK-BE 361/15). The study has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Julien Ducommun
    • 1
    Email author
  • Michael M. Bornstein
    • 2
  • May Chun Mei Wong
    • 3
  • Thomas von Arx
    • 1
  1. 1.Department of Oral Surgery and Stomatology, School of Dental MedicineUniversity of BernBernSwitzerland
  2. 2.Applied Oral Sciences, Faculty of Dentistry, Prince Philip Dental HospitalThe University of Hong KongHong KongChina
  3. 3.Dental Public Health, Faculty of Dentistry, Prince Philip Dental HospitalThe University of Hong KongHong KongChina

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