Association Between Periodontal Bone Defects and Tonsilloliths on Cone Beam Computed Tomography Imaging: A Retrospective Study

Objectives: Tonsilloliths are calcified structures commonly detected incidentally on radiographic examinations and are thought to be associated with chronic inflammatory and microbial processes. The aim of this study was to evaluate the relationship between tonsillolith characteristics and periodontal bone defects using cone-beam computed tomography (CBCT) imaging.Materials and Methods: This retrospective cross-sectional study included archived panoramic radiographs and CBCT images of 621 patients. Among them, 158 patients with tonsilloliths who met the inclusion criteria were included in the study. Tonsillolith characteristics, including number, size, localization, and Hounsfield Unit (HU)-based calcification degree, were evaluated using CBCT images. Periodontal bone loss and accompanying oral findings, including missing teeth, restored teeth, apical periodontitis, furcation involvement, and peri-implantitis, were also assessed radiographically. Statistical analyses were performed using non-parametric tests and Spearman correlation analysis.Results: The prevalence of tonsilloliths was 25.4%. The mean age of the study population was 48.9±17.5 years, and 58.9% of the patients were male. Tonsillolith size demonstrated statistically significant positive correlations with periodontal bone loss (r=0.270, p=0.001), missing teeth (r=0.264, p=0.001), apical periodontitis (r=0.301, p