In dentistry, PAN is a widely available, useful, and important diagnostic tool for diagnosis and general preoperative planning [32] with less radiation exposure then CBCT [21]. While most dentists have used it routinely successful for years and gained significant experience in doing so [33], there are certain limitations in dependence of the region to be examined [10]. The high number of “not visible” ratings of the area of interest in the study at hand underlines this conclusion. Nevertheless, PAN showed several additional incidental findings showing its important value being a basic diagnostic tool, also in preventive dentistry [32, 33]. It is noticeable that most of these incidental findings were described by senior surgeons. This demonstrates the impact of clinical experience of evaluation of PAN [12, 34]. A lack of experience in 2D imaging might even result in unnecessary additional 3D diagnostics (such as additional CBCTs) [12].

For the diagnosis of symptomatic pathologies in the maxillary sinus, PAN alone is not sufficient. Benefits (in dependence of clinical and radiological experience) offered from additional sFOV-CBCT imaging were proven in the presented study. The high number of “therapy affecting” ratings when adding CBCT supports such statement. Wolf et al. reported the general demand for three-dimensional imaging of maxillary sinus in order to minimize intra- and postoperative complications and to localize any foreign body in relation to other anatomical structures [35]. Similarly, various studies reported an average of one or more CT scans prior proceeding with sinus surgery [15]. Sharma et al. recommended CT scans prior sinus surgery in order to guide the surgeon [36]. Other researcher found the same diagnostic accuracy of CBCT scans of maxillary sinus pathologies when compared to sinus endoscopy [37] which underlines the importance of CBCT within this field. As shown by others as well [2, 38–43], a better evaluation of anatomical structures was found when using CBCT. CBCT scans offer an extremely valuable diagnostic and clinical tool for maxillary sinus pathologies in general [36, 44, 45] for vital findings like posterior superior alveolar arteries in the lateral sinus wall [46] as well as for anatomical variations [47]. Especially in cases with symptomatic maxillary sinus pathologies, three-dimensional diagnostic is helpful [13, 36, 48] and a sFOV-CBCT offers limited radiation exposure as well.