Radiographic assessment of maxillary sinus membrane and lateral wall thickness using cone-beam CT in different facial types in southwestern Saudi Arabia.

The anatomy of the edentulous posterior maxilla and maxillary sinus possess unique challenges in implant dentistry. The purpose of this study was to assess maxillary sinus membrane thickness (MT) and lateral wall thickness (LWT) in different facial index profiles and to describe the clinical implications. A retrospective image analysis of 75 CBCT scans was done, which yielded a total of 150 sinus images. The facial index was calculated as per the formula given in the text and grouped as euryprosopic, mesoprosopic and leptoprosopic. The images obtained were of 36 women (48%) and 39 men (52%), with maximum subjects in 30-39 years age group. MT and LWT were measured at three different points on the radiograph at every 3mm from the base of the sinus floor in premolar and molar regions of each image. Results showed females had significant differences from males in LWT in both premolar and molar regions (p = 0.018 and 0.032 respectively). Subjects in 40-49 years of age had significant differences (p = 0.021) in MT in premolar region only. Also, difference in MT in premolar and molar regions were also statistically significant. Lastly, the present study did not find any statistically significant difference in MT and LWT in all three facial indices groups. It can be concluded that different facial indices have no positive correlation with maxillary sinus membrane thickness and lateral wall thickness. Hence, surgical complications are avoidable with proper detailed knowledge and appropriate identification of the anatomic structures characteristic to the maxillary sinus.

Assessment of the osteogenic effect after maxillary sinus floor elevation and simultaneous implantation with or without bone grafts by analyzing trabecular bone parameters: a retrospective study.

OBJECTIVE: The aim of this population-based retrospective study was to compare the osteogenic effect of newly formed bone after maxillary sinus floor elevation (MSFE) and simultaneous implantation with or without bone grafts by quantitatively analyzing trabecular bone parameters. METHODOLOGY: A total of 100 patients with missing posterior maxillary teeth who required MSFE and implantation were included in this study. Patients were divided into two groups: the non-graft group (n=50) and the graft group (n=50). Radiographic parameters were measured using cone beam computed tomography (CBCT), and the quality of newly formed bone was analyzed by assessing trabecular bone parameters using CTAn (CTAnalyzer, SkyScan, Antwerp, Belgium) software. RESULTS: In the selected regions of interest, the non-graft group showed greater bone volume/total volume (BV/TV), bone surface/total volume (BS/TV), trabecular number (Tb. N), and trabecular thickness (Tb. Th) than the graft group (p<0.001). The non-graft group showed lower trabecular separation (Tb. Sp) than the graft group (p<0.001). The incidence of perforation and bleeding was higher in the graft group than in the non-graft group (p<0.001), but infection did not significantly differ between groups (p>0.05). Compared to the graft group, the non-graft group showed lower postoperative bone height, gained bone height and apical bone height (p<0.001). CONCLUSION: MSFE with and without bone grafts can significantly improve bone formation. In MSFE, the use of bone grafts hinders the formation of good quality bone, whereas the absence of bone grafts can generate good bone quality and limited bone mass.

Orthopantomography Versus Cone Beam Computed Tomography for the Assessment of the Proximity of Posterior Maxillary Apexes with the Maxillary Sinus: A Cross-sectional Study.

BACKGROUND: The lack of knowledge of the relation of the maxillary sinus with the apexes of maxillary posterior teeth can lead to important complications during common dental procedures. This can be avoided using different imaging techniques, such as orthopantomography (OPG) and cone beam computed tomography (CBCT). The present study aims to compare the performance of OPG with CBCT in measuring the vertical distance of the apexes of posterior-superior teeth to the maxillary sinus. METHODS: This study corresponded to a cross-sectional study. OPGs and CBCT scans were obtained from the same individuals, and the qualitative and quantitative vertical distance of the apexes in relation to the maxillary sinus was categorized and measured in mm. RESULTS: A total of 28 pairs of OPGs and CBCT scans from the same patients were obtained. About 381 roots were analysed, which included 89 upper first premolars, 51 upper second premolars, 115 upper first molars, and 126 upper second molars. Projection/protrusion was observed with more frequency in molars, specially 1º molars in both OPG (n= 75, 65.2%) and CBCT (n= 31, 27%); however, 106 more cases (27.9%) were classified as projected in the OPG compared to CBCT (p < 0.05). When comparing the performance of the OPG and CBTC for analysing all roots qualitatively, there was a 57.8% agreement between both techniques. This difference was statistically significant (p <0.0001). Statistically significant differences were also observed when comparing the millimetric differences. CONCLUSION: This study showed that OPG is not an accurate technique to observe the relationship between the maxillary sinus and the apexes of the upper posterior teeth. In those cases where precision is required when performing dental procedures in this area, CBCT should be used. When not available, the clinicians should be aware of the limitations of the OPG and add other complementary techniques.

Assessment of the intrasinusidal volume before and after maxillary sinus augmentation using mri - a pilot study of eight patients.

PURPOSE: The purpose of this study was to evaluate the suitability, accuracy, and reliability of a non-invasive 3-Tesla magnetic resonance imaging technique (3 T-MRI) for the visualization of maxillary sinus grafts in comparison to conventional, X-ray-based, established standard imaging techniques. METHODS: A total of eight patients with alveolar bone atrophy who required surgical sinus floor augmentation in the course of dental implantation were included in this pilot study. Alongside pre-operative cone-beam computed tomography (CBCT), 3 T-MRI was performed before and 6 months after sinus floor augmentation. Two investigators measured the maxillary sinus volume preoperatively and after bone augmentation. RESULTS: In all cases, MRI demonstrated accurately the volumes of the maxillary sinus grafts. Following surgery, the bony structures suitable for an implant placement increased at an average of 4.89 cm3, corresponding with the decrease of the intrasinusidal volumes. In general, interexaminer discrepancies were low and without statistical significance. CONCLUSION: In this preliminary study, we could demonstrate the feasibility of MRI bone volume measurement as a radiation-free alternative with comparable accuracy to CT/CBCT before procedures like sinus floor augmentation. Nevertheless, costs and artifacts, also present in MRI, have to be taken into account. Larger studies will be necessary to justify the practicability of MRI bone volume evaluation.

Computed tomography assessment of maxillary sinus hypoplasia and associated anatomical variations: a systematic review and meta-analysis of global evidence.

OBJECTIVE: To summarize the scientific evidence on the prevalence of maxillary sinus hypoplasia (MSH) and associated anatomical variations as assessed by computed tomography scans. STUDY DESIGN: This PROSPERO-registered systematic review followed the recommendations of the PRISMA guidelines. Search algorithms were constructed for each of the six databases and gray literature. After screening the references (Rayyan®), the extracted data were meta-analyzed according to a random-effects model. The joanna briggs critical appraisal tool assessed the methodological quality of the included studies. The GRADE approach was used to estimate the certainty of the evidence. RESULTS: From a total of 2781 studies screened, 22 were considered for four meta-analysis. The prevalence of MSH in 7358 patients was 5.65% (CI95% = 4.07-7.47%) with significant heterogeneity between studies (p < 0.001, I2 = 89.30%). MSH was identified in 295 patients, of whom 82.38% (CI95% = 75.82-88.09%) had unilateral hypoplasia and 17.62% (CI95% = 11.91-24.18%) bilateral hypoplasia with moderate heterogeneity between studies (p < 0.0503, I2 = 42.87%). The prevalence of MSH in 9998 maxillary sinuses was 3.77% (95% CI = 2.44-5.38%), with significant heterogeneity between studies (p < 0.001, I2 = 92.84%). Hypoplastic/aplastic uncinate process, concha bullosa and paradoxical concha were the most reported anatomical variations. The studies presented a low-moderate methodological quality. The certainty of the evidence was very low to moderate. CONCLUSION: The prevalence of maxillary sinus hypoplasia observed was 5.65%, with most cases being unilateral.

Assessment of maxillary sinus fluid volume for postmortem diagnosis of drowning.

INTRODUCTION: Drowning is a comprehensive and exclusive diagnosis at autopsy. Autopsy findings such as pleural effusion and waterlogged lungs contribute to the diagnosis. Herein, we aim to reveal the practical usefulness and postmortem changes of the maxillary sinus fluid volume to diagnose drowning. METHODS: We evaluated 52 drowning and 59 nondrowning cases. The maxillary sinus fluid volume was measured using a computed tomography (CT) scan, and pleural effusion volume and lung weight were manually measured at autopsy. The utility of these three indices for diagnosing drowning and its postmortem changes was evaluated. RESULTS: The maxillary sinus fluid volume was significantly higher in drowning cases than in other external causes and cardiovascular death cases. Receiver operating characteristic curve analysis revealed that a total maxillary sinus fluid volume >1.04 mL more usefully indicated drowning (odds ratio, 8.19) than a total pleural effusion volume >175 mL (odds ratio, 7.23) and a total lung weight >829 g (odds ratio, 2.29). The combination of maxillary sinus fluid volume and pleural effusion volume more effectively predicted drowning than one index alone. Moreover, the maxillary sinus fluid volume was less influenced by the postmortem interval than the other two indices up to a week after death. CONCLUSION: Maxillary sinus fluid volume can be more useful than pleural effusion volume and lung weight with higher sensitivity and odds ratio for diagnosing drowning. IMPLICATIONS FOR PRACTICE: Fluid accumulation in both the maxillary sinuses strongly predicts drowning in the postmortem imaging.

Serial assessment and long-term radiographic evaluation of the maxillary sinus after inferior maxillectomy and soft tissue free flap reconstruction in patients with oral cancer.

PURPOSE: This study evaluates serial radiographic changes in the maxillary sinus of patients with oral cancer after an inferior maxillectomy and a soft tissue free flap reconstruction. METHODS: Fifty-six patients were evaluated between Oct 2005 and Mar 2017 from an institutional database. Preoperative and surveillance imaging was reviewed at set time-points. Maxillary sinus scores were allotted based on a modification of the Lund-MacKay staging system. Patients were evaluated for change in sinus score. A univariate (UV) and multivariate (MV) analysis was performed. RESULTS: There were 53.5% T3/T4 category tumors and 68% received adjuvant treatment. Median follow-up was 24.4 months. Preoperative mean sinus score was 0.27 ± 0.44 and postoperative mean sinus score at 24 months was 1.2 ± 1.3 (p = <0.001). On UV analysis advanced T-stage at 12 months (OR 6.7, 95% CI 1.2-50.3, p = 0.01) and 24 months (OR 5.2, 95% CI 1.03-36.8, p = 0.04) was associated with significantly higher sinus score. On MV analysis, advanced T-stage continued to be associated with increased odds for higher sinus score (OR 4.9, 95% CI 1.1-26.8, p = 0.039). CONCLUSION: A mild increase in postoperative sinus score is seen in this cohort of patients. Advanced T-stage is associated with increased odds for higher sinus scores.

Assessment of the Naso-Maxilla and Related Dentoalveolar Region with Cone Beam Computed Tomography.

PURPOSE: To evaluate via CBCT the anatomical variations of the maxillary teeth and associated major anatomical cavities, the maxillary sinus and nasal fossa. MATERIAL AND METHODS: CBCT scans of 221 patients were used to examine maxillary sinus variations, the posterior superior alveolar artery (PSAA) course, nasal septum variations, middle and inferior concha-meatus variations, canalis sinuosus, infraorbital ethmoid cell, infraorbital canal, anterior nasal spina, and nasopalatine canal. RESULTS: The incidence of anatomical variations was 32.6% for maxillary sinus septa, 50.9% for PSAA, 23.1% for nasal septum deviation, 6.3% for nasal septum spur and pneumatization, 3.6% for paradoxical middle concha, 14.9% for middle concha hypertrophy, 39.6% for middle concha bullosa, 0.45% for bifid inferior concha, 0.9% for paradoxical inferior concha, 60.1% for inferior conch hypertrophy, 1.8% for inferior concha bullosa, and 40.3% for the infraorbital ethmoid cell. The study mainly observed group 2 anterior nasal spina with a rate of 35.7%, group 1 nasopalatine canal with a rate of 37.1%, and infraorbital duct type 2 with a rate of 70%. In 20.4% and 47% of cases, canalis sinuosus was located in the right and left sides of the maxilla, respectively. CONCLUSIONS: Maxillary sinus variations, PSAA prevalence and localization, nasal septum and concha variations, anterior nasal spina subgroups, nasopalatine canal subgroups, canalis sinuosus prevalence, and localization and infraorbital ethmoid cell prevalence were found to be consistent with the literature. Moreover, a rare case of the lower bifid concha was identified. The nasomaxillary complex and related dental structures, which are a multidisciplinary study area, should be carefully examined in the presence of pain of unknown origin and the planning of surgical procedures.

Assessment of the relationships between posterior root apices and the maxillary sinus floor: a comparison of panoramic radiography and cone beam computed tomography.

The aim of this study was to evaluate the relationships between the apices of posterior teeth and the maxillary sinus floor, comparing the results of assessments performed with panoramic radiography and cone beam computed tomography (CBCT). This retrospective cross-sectional study consisted of 96 participants with a total of 302 maxillary posterior teeth. On both panoramic radiographs and corresponding CBCT images, 735 roots were classified into 3 categories according to their topographic relationship with the maxillary sinus: class 1, clear, distinct distance between the root tips and the floor of the sinus; class 2, roots adjacent to the floor of the maxillary sinus; or class 3, roots protruding into the maxillary sinus cavity. Panoramic radiographic signs of root protrusion into the sinus (class 3) were categorized as projection, discontinuity, missing lamina dura, darkening, or kinking. The observed data were analyzed using statistical software, and the Cohen κ coefficient was calculated. The level of significance was set at P < 0.05. Multiple logistic regression was performed to identify the predictive radiographic signs of protrusion into the sinus. The overall correlations between panoramic radiography and CBCT classifications were 90.8%, 66.8%, and 47.1% for the class 1, class 2, and class 3 categories, respectively. The radiographic signs of projection and darkening were significant predictors of root protrusion (P < 0.05). Panoramic radiography is reliable for assessing root posi¬tions when there is a clear distance between the roots and the floor of the maxillary sinus. However, when the roots are in contact with or have protruded into the sinus on panoramic images, the results are not definitive, and CBCT should be performed.

Assessment of the prelacrimal recess in different maxillary sinus pneumatizations in relation to endoscopic prelacrimal recess approaches: a computed tomography study.

PURPOSE: To assist in planning before the endoscopic prelacrimal recess (PLR) approach, we aimed to investigate the relationship between morphometry and variations of PLR in maxillary sinus (MS) pneumatizations. METHODS: Retrospective analysis of the paranasal sinus computed tomography images of 150 patients was conducted to determine the pneumatization patterns of the MS, PLR variations, and the applicability of the PLR approach. The results were compared based on lateralization, gender, and age groups. RESULTS: The PLRwidth, the anteroposterior diameter of the nasolacrimal duct (NLD), the vertical and horizontal diameters of the MS were the highest in hyperplasic MS, and decreased significantly with increasing age (p = 0.005, p = 0.017, p = 0.000), respectively. Most of the morphometric measurements were higher in hyperplasic MS, while the medial wall thickness of PLR was higher in hypoplasic MS. The PLRwidth for feasibility of the PLR approach were Type I (48%) in hypoplasic MS and Type III (80%) in hyperplasic MS (p < 0.001), respectively. The PLR medial wall thickness was higher in Type I, while the piriform aperture angle (PAA), MS volume, length, and slope of the NLD were higher in Type III PLRwidth (p = 0.000), respectively. The highest anterior and separation-type variations of the PLR were observed in hyperplasic MS, whereas 31.0% of hypoplasic MS had no PLR (p < 0.001). CONCLUSION: This study revealed that PLRwidth and PAA were the highest in hyperplasic MS, which allows the endoscopic PLR approach to be performed more easily. For safer and uncomplicated surgery, surgeon should be aware of the PLR anatomy in different MS pneumatization patterns.

Preliminary Assessment of In Vivo Raman Spectroscopy Technique for Bone Quality Evaluation of Augmented Maxillary Sinus Floor.

(1) Background: In oral surgery, bone regeneration is achieved through various types of bone grafts or bone substitutes and its success is usually analyzed by micro-computed tomography and histomorphometry. The aim of this study was to evaluate the usefulness of Raman spectroscopy as an alternative to other techniques for bone quality evaluation during a standard oral surgery procedure. (2) Methods: The preliminary evaluation of bone augmentation during maxillary sinus floor elevation oral surgery was performed by Raman spectroscopy for several (five) patients during and after the surgery and the results were compared with postoperative data from histomorphometry, EDX and SEM analysis. (3) Results: After analyzing all the results for the bone samples according to the four methods (Raman, EDX, SEM and Histology) that were used in our study, the obtained result of the investigation provided a good augmentation process for three of the patients and partly successful augmentation process for two of the patients. The primary evaluation using Raman spectroscopy (in vivo and ex vivo investigation) was confirmed by histological results, thus having a first step for validation of Raman as a new method of imaging for dentistry. (4) Conclusions: Our results show that Raman spectroscopy could provide fast and reliable insight on bone condition during augmentation of the maxillary sinus floor. We emphasize the advantages and drawbacks of the proposed techniques as its accuracy could increase by performing larger size clinical trials. Using the Raman mapping, the method can serve as an alternative to histology.

Assessment of absorbable gelatin sponge for maxillary sinus floor elevation versus anorganic bovine bone minerals: a randomized clinical trial.

PURPOSE: The present study compared the absorbable gelatin sponge as a space-filling material versus anorganic bone bovine mineral (ABBM) in maxillary sinus augmentation with simultaneous endosseous dental implant placement. METHODS: Eighteen maxillary sinus floor elevation cases were randomly allocated into two groups. The first group received ABBM, while the second group received an absorbable gelatin sponge as a space-filling material. For both groups, CBCT scans were obtained immediately postoperatively and six months later to calculate the difference in sinus floor bone gain. Osstell readings were recorded both at the time of implant placement and implant exposure with a total of twenty-three dental implant placements in relation to the eighteen elevated sinus floors. RESULTS: The mean radiographic sinus floor gain in the ABBM group was 10.2 mm (± 2.5), while in the absorbable gelatin sponge group was 5.4 mm (± 2.0), with a mean difference of 4.8, which was statistically significant (p < 0.001). The mean implant stability for the ABBM was 77.3 (± 4.9), while in the absorbable gelatin sponge group was 74.2 (± 3.0), with a mean difference of 3.1, which was statistically insignificant (p = 0.1610). CONCLUSION: The ABBM showed superior results regarding the amount of radiographic sinus floor bone gain. However, the implant stability was invariable between both groups.

Cone-Beam Computed Tomographic Assessment of Maxillary Sinus Characteristics in Patients With Cleft Lip and Palate: A Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis was to evaluate the maxillary sinus characteristics of patients with cleft lip and palate (CLP).The study included manuscripts which met the following criteria: (1) study of individuals with CLP in any age group or gender and (2) study of individuals in whom assessment of maxillary sinus characteristics had been done by cone-beam computed tomography. Studies with (1) individuals having special health-care needs and (2) individuals with any syndrome affecting the development of the head and neck were excluded.In total, 11 articles were included in the review, based on the inclusion and exclusion criteria. Pooled maxillary sinus volume (MSV) on the cleft sides of patients with unilateral cleft lip and palate (UCLP) was found to be 9433.14 mm3 (95% CI, 7453.99-11 412.30), which was significantly smaller than that of controls. The meta-analyses also revealed significantly reduced MSV on the cleft sides of patients with UCLP. The differences between cleft and noncleft sides of the patients with UCLP were not found to be statistically significant. Strength-of-evidence was found to be moderate in 4 characteristics, along with 10 out of 11 articles showing low risk-of-bias.It was concluded that MSV was reduced and mucosal thickening was increased/present in patients with CLP as compared with controls. The differences between MSV of cleft and noncleft sides of the patients with UCLP could not be established. However, heterogeneity was found in terms of sample size, stratification of samples by age, and evaluation of some confounding factors.

Three-dimensional assessment of the favorability of maxillary posterior teeth intrusion in different skeletal classes limited by the vertical relationship with the maxillary sinus floor.

BACKGROUND: Understanding the anatomical relationship between the maxillary sinus floor (MSF) and the posterior maxillary teeth (PMT) is important when planning the orthodontic intrusion of the posterior teeth. This study aimed to determine the vertical relationship between posterior maxillary teeth and maxillary sinus floor in different skeletal classes in the Chinese adult population. METHODS: This is a retrospective cross-sectional study involved cone beam computed tomography images of 298 adult patients (145 males and 153 females) between 20 and 45 years old. The sample was categorized according to A point, Nasion, B point (ANB) angle into 102 Class I, 102 Class II, and 94 Class III malocclusion. Non-parametric Wilcoxon Mann-Whitney U and Kruskal-Wallis tests were used to compare the studied groups. The Intra-class Correlation Coefficient (ICC) was used to assess the intra- and inter-observer reliability analysis. RESULTS: Overall, there was a statistically significant difference in the mean distance between both genders (P < 0.001). The measured distance increased with age in all posterior tooth roots (P < 0.001). The root apex in the sagittal view appeared to be closer to the maxillary sinus than in the coronal view; 2.2 ± 4.3 and 3.1 ± 5.5 mm, respectively. The most frequent root scores were Type 1 and Type 2P. In both sagittal and coronal views, Class I demonstrated a higher Type 2P prevalence, whereas Class III showed a lower prevalence. The second molars' mesiobuccal root had the largest number of penetration in the three examined skeletal classes. CONCLUSIONS: Maxillary molars of Class I malocclusion with the majority of Type 2P root-sinus relationship have the highest possible risk of root resorption during molar intrusion due to cortical bone encroachment, while Class III malocclusion showed the least possible risk.

Clinical and radiographic assessment and restoration of maxillary sinus function in relation to oro-antral fistula closure: a systematic review.

BACKGROUND: The purpose of this study was to determine current practice in assessment of maxillary sinus health during oro-antral fistula closure. METHOD: A systematic review using specific MeSH headings between 1990 and September 2021 on Medline, Ovid, and PubMed was performed. The inclusion criterion was closure of oro-antral fistula in adult patients. Exclusion criteria were oro-antral fistula arising in children; or from trauma, malignancy, or developmental abnormality; or any osteonecrotic lesion of bone. Risk of bias for individual papers was not assessed. Oxford Centre for Evidence Based Medicine levels of evidence were recorded. RESULTS: 4309 papers were identified, and 119 were eligible for review. Nineteen were from otolaryngology (16%), 25 from combined ear, nose, and throat (ENT) and oral/oral and maxillofacial (OS/OMF) surgery (21%), and 75 from OS/OMF surgery (63%). Preoperative rhinoscopy and cross-sectional imaging were reported in 33 papers (28%), reflecting the role of ENT with or without OS/OMFS. Sixty-eight did not record any formal assessment of maxillary sinus health (57%), of which 60 were from OS/OMF surgery (50%). Use of computed tomography was reported in 58 papers (49%), and use of cone beam computed tomography was reported in 8 papers (7%) but did not correlate with assessment of sinus health. DISCUSSION: Most surgery for oro-antral fistual closure was undertaken without objective assessment of maxillary sinus health, pre- or postoperatively. The involvement of ENT was associated with formal assessment of maxillary sinus health.

Three-dimensional assessment of the favorability of maxillary posterior teeth intrusion in different facial patterns limited by the vertical relationship with the maxillary sinus floor.

OBJECTIVE: Posterior teeth intrusion is one of the best treatment options for treatment of skeletal open bite in adults; the surrounding anatomical landmarks are one of the restraining factors. This study aimed to assess the vertical relationship between the maxillary posterior teeth (MPT) and the maxillary sinus floor (MSF) in different facial growth patterns in the Chinese adult population. MATERIALS AND METHODS: Cone beam computed tomography images of 298 patients, 145 males and 153 females aged between 20 and 45 years, were analyzed. Based on Jarabak ratio and the mandibular plane inclination, the sample was categorized into 94 hyperdivergent, 102 hypodivergent, and 102 normodivergent facial patterns subjects. The vertical relationship between the root-apex distances were classified as favorable, indicating no contact (type 1), or unfavorable, indicating roots in contact (type 2) for the posterior teeth intrusion. The relationship in the unfavorable group was subdivided into three subgroups (T2C, T2LC, and T2P). Comparative statistical tests were done related to age, gender, tooth side, and type of multiplanar view (sagittal and coronal). The significant level was set to be P < 0.05. RESULTS: There was a statistically significant difference in the mean distance between both genders in the hyperdivergent group (P < 0.001). The measured distance increased with age in all tooth roots (P < 0.001). In both sagittal and coronal views, the most frequent root scores were type 1 and type 2p (54.2%, 27.5%) and (55.1%, 21.4%), respectively. The hyperdivergent group demonstrated a higher prevalence of type 2P (31.6% and 25.5%), whereas the hypodivergent group showed a lower prevalence (25.1% and 19.2%); furthermore, the second molar's mesiobuccal root in hyperdivergent patients showed the closest distance to the maxillary sinus in sagittal and coronal views, 0.3 ± 3.7 and 0.4 ± 3.1 mm, respectively. CONCLUSIONS: Maxillary molars of hyperdivergent patients have the highest possible risk of root resorption due to the possible risk of cortical bone encroachment, while hypodivergent patients have the least possible risk. CLINICAL RELEVANCE: Analysis of apex-sinus distances can be of great help for safe posterior teeth intrusion and providing correct and adequate treatment.

[Topographic assessment of the vascular anastomosis in the maxillary sinus wall using cone-beam computed tomography]. / Topografiya sosudistogo anastomoza v stenke verkhnechelyustnoi pazukhi po dannym konusno-luchevoi komp'yuternoi tomografii.

OBJECTIVE: The aim of the study was to establish the prevalence, diameter and topography of the intraosseous vascular canal of the maxillary sinus lateral wall. MATERIAL AND METHODS: The data of cone-beam computed tomography of 150 dental patients (294 maxillary sinuses) were analyzed. RESULTS: Intraosseus anastomosis of the branches of the posterior superior alveolar artery and infraorbital artery was detected in 87.8% of cases (258 of 294 sinuses). Anastomosis was found inside the wall of the sinus in every tooth location in 9.5% of sinuses; in other cases, the anastomosis was partially or fully embedded in the thickness of the lateral wall of the maxillary sinus in different tooth site. The mean diameter of the vascular anastomosis was 0.95±0.3 mm (range 0.3-2.18 mm). The average distance from the anastomosis to the sinus floor was 8.91±3.39 mm (range 1.68-21.83mm). In most cases, at locations of molars and premolars, the distance from the vascular anastomosis to the alveolar crest was greater than 15 mm (from 75.5% at the location of the first molar to 99.2% at the location of the first premolar). CONCLUSION: Detection of the topography of the vascular anastomosis by using cone-beam computed tomography is essential when planning the position of the antrostomy for the lateral sinus lift procedure in order to minimize iatrogenic complications.

Radiographic assessment of deproteinized bovine bone mineral (DBBM) and collagen-stabilized DBBM for transalveolar sinus floor elevation: A 2-year retrospective cohort study.

BACKGROUND: Theoretically, collagen-stabilized deproteinized bovine bone mineral (DBBM-C) has better operability compared with DBBM. DBBM-C avoids dispersing during the transalveolar sinus floor elevation (TSFE) because of its block shape. PURPOSE: To evaluate radiological changes of using DBBM-C in TSFE. MATERIALS AND METHODS: Patients who received TSFE using DBBM (Bio-Oss®) or DBBM-C (Bio-Oss® collagen) with simultaneous implantation were recruited. Graft bone height apically (aGH), endo-sinus bone gain (ESBG), and crest bone level (CBL) were assessed through panoramic radiograph and cone beam computed tomography (CBCT). RESULTS: A total of 138 patients (138 implants) were retrospectively enrolled. After 2 years of implantation, the incidence of postoperative complications was 4.2% (95% CI: 0.9%-11.7%) and 4.5% (95% CI: 0.9%-12.7%) for DBBM and DBBM-C groups, respectively. Measured in panoramic radiograph, ΔaGH of DBBM-C (1.8 mm, SD: 1.4, 95% CI: 1.2-2.4, P = 0.044) group was significantly higher than that of DBBM (1.2 mm, SD: 1.4, 95% CI: 0.7-1.7) after 24 months. No significant differences for ΔCBL were noted during the entire observation period. Measured through CBCT, ESBG was 5.0 (SD: 1.8, 95% CI: 4.1-5.8) mm in DBBM group and 4.6 (SD: 1.6, 95% CI: 3.9-5.3) mm in DBBM-C group 24 months after implantation. The aGH value of DBBM-C group was significantly higher compared with DBBM in CBCT (OR = 1.4, 95% CI: 1.1-1.9, P = 0.020). CONCLUSIONS: DBBM-C could achieve similar bone generation as DBBM in TSFE. Both materials could maintain aGH, ESBG, and CBL relatively stable 2 years after implantation.

Assessment of the necessity of frontal sinostomy in cases of frontal sinusitis associated with fungus ball of the maxillary sinus.

PURPOSE: This study was conducted to evaluate outcomes in patients presenting with fungus ball of the maxillary sinus (MSFB) and frontal sinusitis who were treated via middle meatal antrostomy alone. METHODS: This was a randomized, controlled study with a parallel group design. Patients with MSFB and frontal sinusitis were randomly assigned to the maxillary middle meatal antrostomy (MMMA) or control (MMMA + frontal sinusotomy) groups. Patient demographics, complaints, imaging findings were analyzed, and surgical outcomes were evaluated using the Lund-Kennedy endoscopic score (LKES) and the 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire. RESULTS: In total, 40 patients were separated into two groups, with similar symptoms including nasal obstruction, mucopurulent rhinorrhea, maxillary or frontal pain, blood stained nasal discharge, nasal cacosmia and orbital pain being observed in both groups. Total LKES and SNOT-22 scores were significantly improved in both groups at 6 months post-treatment, with no significant differences in these scores between groups within a mean 6.8-month follow-up. CONCLUSION: These results suggest that frontal sinusotomy is not required to resolve frontal sinusitis associated with MSFB. As such frontal sinusitis appears to be a reactive process caused by fungal ball obstruction, it regresses spontaneously following fungus ball removal, drainage of the maxillary sinus, and middle meatal antrostomy.

Assessment of the relationship between the maxillary sinus and the canine root tip using cone beam computed tomography.

BACKGROUND: The purpose of the present study is to investigate the relationship between the maxillary sinus and the canine root apices in cone beam computed tomographic images (CBCT) and to assess the amount of extension of the maxillary sinus to the anterior region of the jaw in different sexes and age groups. METHODS: CBCT of 300 individuals (154 males and 146 females) over 20 years (with a mean age of 35.12 ± 8.40 years) were evaluated. The subjects were categorized into three age groups (20-30, 30-40, and 40-50 years). When the maxillary sinus extended to the canine area, the vertical distance between them was measured, and their relationship was classified into three types: I (more than 2 mm distance), II (less than 2 mm distance or in-contact), and III (interlock). RESULTS: 413 out of 600 maxillary sinuses (68.8%) were extended into the canine area or beyond. Among them, 15 maxillary sinuses pneumatized into the incisor area (2.5%). The prevalence of the maxillary sinuses extended to the anterior region of the jaw was not significantly different between genders. However, it was significantly less frequent in the older age group and more frequent on the left side. In addition, the mean amount of anterior extension of the maxillary sinus (mm) was significantly lower in the older age group. Type I was the most frequent vertical relationship between the maxillary sinuses and canine apices with no significant difference in gender, side, and age groups. CONCLUSIONS: In most cases, the maxillary sinus extended to the canine area and sometimes reached the incisor region. This necessitates paying more attention to the maxillary anterior sextant during surgical procedures.