Background and Aims: It is crucial to verify the relationship between root apices and maxillary sinus floor in some surgical procedures like extraction and implant placement or in orthodontic movements like intrusion. Protrusion of roots into the sinus increases the risk of post extraction pneumatization which in turn decreases the available bone at the implant or denture sites. The aim of this study was to determine the panoramic radiology accuracy for defining the relationship between posterior root apices and the maxillary sinus floor by Cone Beam CT (CBCT).

  Materials and Methods: Paired panoramic radiographs and CBCT images of 117 subjects were examined. 452 posterior maxillary roots including second premolar, first and second molar were classified by the means of the relationship with maxillary sinus floor. CBCT was used as Gold standard method, and the agreement of panoramic findings with CBCT was examined statistically. Data were analyzed using Chi-square and Multiple logistic regressions.

  Results: Agreement of the panoramic and CBCT results were seen in 57.7% of all cases. Roots which had no contacts with the sinus floor (class 0) showed a high agreement of 89.5% between two imaging techniques. Roots in contact with sinus floor (class 1) showed 58.8 % and cases with root protrusion into sinus cavity (class 3, 4) showed 50% of agreement (P<0.001). Also in 36% of cases with no protrusion into the sinus cavity (class 0, 1, 2), panoramic showed protrusion. The agreement for the premolar was higher than molars (P<0.001)

  Conclusion: The majority of roots which their images were projected on the sinus cavity had no vertical protrusion in CBCT cuts. Considering the results, in these cases CBCT can be recommended.