Assessment of neurovascular channels in lateral maxillary sinus wall using cone-beam computed tomography: An imperative clinicians guide for implant placements.

Background: The aim of this study is to evaluate the location and radio morphometric features of the posterior superior alveolar artery (PSAA) in patients undergoing rehabilitation of posterior maxilla and other sinus augmentation surgical procedures by cone-beam computed tomography (CBCT). Materials and Methods: A total of 816 CBCT scans were included. Various radio morphometric measurements were done to assess the PSAA location, diameter, and distances to the sinus floor and alveolar crest. Results: The PSAA was mostly intraosseous in the maximum in the age group 31-51 years (56%), in males (53.4%), and in dentate patients (57.4%). The artery tends to be wider in older patients. Distances to the sinus floor or the alveolar crest tend to be shorter in women. Conclusions: This study suggests that CBCT is a valuable pre-surgical tool and the evaluation of the PSAA on CBCT images could reduce the likelihood of excess bleeding during surgery in the maxillary posterior region.

Anatomy of Maxillary Sinus: Focus on Vascularization and Underwood Septa via 3D Imaging.

The study of the maxillary sinus anatomy should consider the presence of two features of clinical importance. The arterial supply course and the presence of the so-called Underwood septa are two important factors to consider when planning surgical treatment to reduce the risk of surgical complications such as excessive bleeding and Schneiderian membrane perforations. This study aimed to investigate the above-mentioned anatomical structures to improve the management of eventual vascular and surgical complications in this area. This study included a total of 200 cone-beam computed topographies (CBCTs) divided into two groups of 100 CBCTs to evaluate the arterial supply (AAa) course through the lateral sinus wall and Underwood's septa, respectively. The main parameters considered on 3D imaging were the presence of the AAa in the antral wall, the length of the arterial pathway, the height of the maxillary bone crest, the branch sizes of the artery in the first group, and the position of the septa, the length of the septa, and their gender associations in the second group. The CBCT analysis showed the presence of the arterial supply through the bone wall in 100% of the examined patients, with an average size of 1.07 mm. With regard to the septa, 19% of patients presented variations, and no gender difference was found to be statistically significant. The findings add to the current understanding of the clinical structure of the maxillary sinus, equipping medical professionals with vital details for surgical preparation and prevention of possible complications.

Alveolar antral artery: cone beam computed tomography study and clinical context.

Purpose: Anastomosis between posterior superior alveolar artery and infraorbital artery can go through bony canal in the lateral wall of the maxilla. This artery is called alveolar antral artery. It can complicate lateral sinus lift procedure by bleeding and hemosinus formation or bone graft wash out. The artery can also go in soft tissues where is not visible on cone beam computed tomography. In previous studies, the relation of this artery to sinus floor or alveolar process was measured. These structures are highly unstable during lifetime and after tooth loss. The aim of this study is to study presence and relations of bony canal in the lateral maxillary wall, to characterize the group of patients which is more likely to have bone canal in the lateral maxilla. The aim and the novelty of this study is the describing of the relationship of the bony canal to the more stable structure of hard palate and describing the relation of presence of bony canal on width of maxillary sinus, and to facilitate the prediction of presence of the alveolar antral artery. Materials: The cone beam computed tomography scans of the patients (251 in number) of the university hospital were examined for presence of alveolar antral artery (148 was fulfilled inclusion criteria), patient were characterized by gender, age, and sinus type (wide, average, narrow). The diameter of the bony canal and its relation to the level of sinus floor and hard palate were measured. Results: The cone beam computed tomography scans of 148 patients, out of it 55 man (37,2%) and 93 women (62,8%). Bony canal containing alveolar anastomosis was found in 69 cases (57,0%). Presence of the bony canal in the lateral wall of maxillae showed statistical probability depending on age with p = 0, 064 according to Mann-Whitney test. The older patients have more likely the bony canal. The presence of the alveolar antral artery was found more likely in the wide sinuses. The hard palate level can serve as a prediction point of alveolar antral artery only in first molar and second premolar region. In accordance with previous studies the width of bony canal is significantly higher in group of man (p = 0, 015). There was found a correlation between smaller distance of bony canal from sinus floor in the presence of teeth (p = 0, 067). After tooth loss the distance between sinus floor and bony canal increases, but the distance of bony canal to hard palate level stays constant. This can be explained hypothetically so that periodontal ligaments and root surface acts as a barrier for sinus pneumatization. Conclusion: Lateral sinus lifting in some cases can be unenviable, the knowledge about alveolar antral artery anatomy can reduce the risk of arterial bleeding. The cone-beam computed tomography is a routine examination prior to augmentation surgery and therefore the data obtained from it has an impact on clinical practice.

Anatomical Evaluation of the Alveolar Antral Artery in the Turkish Population: A Cone-Beam Computed Tomography Study.

Background Injury to the alveolar antral artery (AAA) is one of the most common complications in oral surgical procedures. This study aimed to determine the diameter and anatomical position of the AAA, establish reference values for the Turkish population, and contribute to the literature. Methodology The diameter of the AAA at the level of the first molar tooth, its distance from the sinus floor, its vertical distance to the alveolar crest, its oblique distance to the sinus floor, the width of the maxillary sinus, the thickness of the lateral sinus wall, the residual alveolar protrusion height, the residual alveolar protrusion width at the basal level, and the distance from the sinus lateral wall to the sinus floor were all measured using cone-beam computed tomography. Age, gender, and oral health were used to evaluate the collected data. Results The average age of the participants in the study was 42.63 ± 16.07 years. The average AAA diameter was 1.1 ± 0.25 mm, the average height of the residual alveolar protrusion was 0.44 ± 0.13 cm, the average width of the residual alveolar protrusion at the basal level was 0.79 ± 0.12 cm, and the average width of the residual alveolar ridge at the crest level was 0.55 ± 0.11 cm. No significant differences were observed in these parameters based on gender and dental status (p > 0.05). The average AAA distance to the sinus floor was 1.02 ± 0.26 cm, the average vertical distance to the alveolar crest was 1.21 ± 0.25 cm, the average oblique distance to the sinus floor was 1.38 ± 0.25 cm, the average maxillary sinus width was 1.63 ± 0.28 cm, the average thickness of the lateral sinus wall was 0.12 ± 0.06 cm, and the average distance from the sinus lateral wall to the sinus floor was 1.28 ± 0.22 cm. Significant differences based on gender were observed in all these parameters (p < 0.05). A significant difference was observed in the vertical distance from AAA to the alveolar crest and the oblique distance to the sinus floor based on dental status (p < 0.05), with shorter distances in dentate individuals. Only the AAA diameter showed a weak negative correlation with age (p < 0.05, 0.2 < r < 0.04). Conclusions The results obtained were within a reliable range for oral surgery. Detailed reference findings for the proximity and location of structures can be established for the Turkish population during dental surgery. It is recommended that physicians performing surgical interventions in the maxillary region carefully consider these reference values preoperatively.

Comparative diagnosis of the alveolar antral artery canal in the lateral maxillary sinus wall in corresponding panoramic radiography and cone-beam computed tomography.

PURPOSE: Sinus lift operations are a tried and tested means of providing adequate implant prosthetics to patients with compromised jawbones. Knowledge of the arterial supply of the maxillary sinus region is essential for surgical treatment in this area. The aim of the present comparative study was to determine whether alveolar antral artery (AAA) canal can be diagnosed both in corresponding panoramic radiography (PR) and cone-beam computed tomography (CBCT). METHODS: A total of 335 patients with 635 sites and corresponding maxillary sinus in both PR and CBCT were selected and examined for AAA canal visibility. RESULTS: The visibility of the AAA canal was significantly higher in CBCT than in PR. A total of 154 (46.0%) AAA canals could be identified in the maxillary sinus on the right. However, only four (1.2%) of these were also visible in PR. The detected values of the AAA canals in the maxillary sinus on the left in the PR and CBCT images were similar to those of the right. While 164 AAA canals (49%) were observed in CBCT images, only 1 (0.3%) was identifiable in PR. CONCLUSIONS: The results show that CBCT can be recommended for visualising the AAA canal when surgically planning sinus augmentation procedures.

The Radiological Evaluation of the Anatomy of the Alveolar Antral Artery and the Lateral Wall Thickness Using Cone-Beam Computed Tomography: A Retrospective Study.

The objectives study aims to assess the position and route of the alveolar antral artery and the lateral wall thickness of the maxillary sinus using cone-beam computed tomography (CBCT), reducing the risk of complications and improving the success rate of surgery. MATERIALS AND METHODS: This study included CBCT scans from 238 patients. The detection diameter of AAA and distance of the lower border of AAA to the maxillary sinus floor at the first premolar, second premolar, first molar, and second molar locations were evaluated. The route of AAA was observed with novel classification. Furthermore, the distance from the maxillary sinus floor to the alveolar crest at four posterior tooth locations was measured respectively. Moreover, the lateral wall thickness at four locations was assessed. Data were subjected to statistical analysis. RESULTS: AAA was observed in 62.18% of all sinuses. The mean diameter was 0.99±0.21 mm, with significant differences within gender. Half of the route of AAA was intrasinus intraosseous type. The mean distance between the maxillary sinus floor and AAA was 8.00±2.68 mm, with a significant difference between dentate and edentulous status at the first molar location. Distance from the sinus floor to the alveolar ridge crest in edentulous status negatively correlated with the distance from the sinus floor to AAA at the first molar location. The mean thickness of the lateral wall was 2.03±0.91 mm, and the difference in thickness between males and females at the four locations was statistically significant. CONCLUSION: intrasinus-intraosseous type, is the most common route. Special care should be taken at the first molar location during a lateral window sinus floor elevation. CBCT is highly recommended to before lateral wall maxillary sinus floor elevation.

Evaluation of alveolar antral anastomosis in south Indian population using cone beam computed tomography: a prospective study.

OBJECTIVES: The posterior superior alveolar artery (PSAA) and the infraorbital artery (IOA), both of which are ultimate branches of the maxillary artery, are connected by a horizontal anastomosis. PSAA anastomoses intraosseously and extraosseously with IOA. Profuse bleeding from the lateral wall while performing the direct sinus augmentation is a significant intraoperative complication.Thus the present study focused to assess the location of an alveolar antral anastomosis (AAA) in relation to the crest of the alveolar bone using cone beam computed tomography (CBCT). METHODS: A total of 200 CBCT scans of patients who were indicated for implant surgery were chosen and assessed. Group 1 includes 100 dentate patients and Group 2 includes 100 partially edentulous patients. The location of anastomosis along the lateral wall of the maxillary sinus was evaluated in association with alveolar bone height with respect to three posterior maxillary teeth: first premolar, second premolar, and first molar. RESULTS: The mean distance for P1, P2, and M1 was 21.94 ± 1.02 mm, 19.41 ± 0.40 mm, and 17.36 ± 0.51 mm, respectively, in the dentate group, whereas in the edentulous group, it was 20.07 ± 0.46 mm, 18.95 ± 0.32 mm, and 16.08 ± 0.16 mm. In 80% of participants, the distance of an AAA from the alveolar crest was between 16 and 23 mm, whereas in 12% of the participants the distance of an AAA from the alveolar crest was less than 16 mm. CONCLUSION: The present study concludes that the first premolar region is safe for preparing the lateral window but for the second premolar and first molar additional care should be taken prior to surgery.

Prevalence of the Alveolar Antral Artery and Its Accessory Arteries in Cone-Beam Computed Tomography Scans.

Alveolar antral artery (AAA) damage can cause perioperative hemorrhage during osteotomy. The aim of this study was to assess the prevalence of AAA presence and evaluate its characteristics using cone-beam computerized tomography (CBCT). One hundred maxillary sinuses were evaluated from 70 CBCT scans. The anteroposterior dimension of each sinus was divided into four equal quarters, and the main artery presence was noted for each section. Arterial diameter as well as distance to sinus floor and to alveolar ridge were measured, and the position of the main artery according to its location relative to the lateral sinus wall was determined. In cases where additional arteries were detected, their diameter and position were also determined. Artery prevalence was 87.0%. In 42% and 8% of the cases respectively, a second and third artery were visualized. No significant association was found between the prevalence of the arteries and age of participants. However, the prevalence of a secondary artery among men (56.4%) was significantly higher than in women (32.8%) (P = .02). Moreover, the main artery diameter was significantly different between sections (P = .014), as was its position. AAA was radiographically detectable in the majority of studied sinuses. In 2 cases, 3 arteries were visible. Arteries with a diameter ≥ 2 mm were not frequent. However, arteries exceeding this diameter must be factored in when choosing surgical techniques. The findings of this study suggest there might be accessory arteries associated with AAA. Therefore, preoperative radiological CBCT examination is necessary prior to any sinus floor elevation surgery.

Anastomosis between the posterior superior alveolar artery and the infra-orbital artery: a review of current terminology / Anastomosis entre la arteria alveolar superior posterior y la arteria infra-orbital: una revisión de la terminología actual

SUMMARY: The posterior superior alveolar artery (PSAA) and the infra-orbital artery (IOA) present intraosseous and extraosseous rami which form an anastomosis in the lateral wall of the maxillary sinus. This anastomosis is always present, however it has not yet been included in anatomical terminology (AT), and different terms are used in scientific communication to refer to it. The aim of this study was to carry out a review of the different terms used to name this vascular structure. A literature review was carried out on the terms used to name the anastomosis between the PSAA and IOA in imaging studies and human cadavers that assessed the presence/frequency of this anatomical structure. The search was carried out in the Medline, EMBASE and LILACS databases, in Portuguese, Spanish and English, with no date restrictions. Qualitative analysis was applied to the studies selected, analysing the terminology used to refer to the anastomosis between the PSAA and IOA. Of the 2108 original articles found, 60 were selected as potentially relevant and 54 studies were finally included for qualitative analysis. Sixteen terms were found to refer to the anastomosis between the PSAA and IOA, the most frequent being Posterior Superior Alveolar Artery (PSAA), followed by Alveolar Antral Artery (AAA). Many terms are used in the medical literature to designate the anastomosis between the PSAA and IOA, the most frequent being PSAA and AAA. There is a need to unify the terms used to designate this vascular structure, and to incorporate the selected term into anatomical terminology, in order to avoid confusion in scientific communication.

RESUMEN: La arteria alveolar superior posterior (AASP) y la arteria infra-orbital (AIO) tienen ramas intra y extra óseas que forman una anastomosis en la pared lateral del seno maxilar. Esta anastomosis está siempre presente, sin embargo, aún no ha sido incluida en la terminología anatómica (TA), por lo que en la comunicación científica se utilizan diferentes términos para referirse a ella. El objetivo de este estudio fue realizar una revisión sobre los diferentes términos utilizados para nombrar esta estructura vascular. Se realizó una revisión de la literatura sobre los términos utilizados para nombrar la anastomosis entre AASP y AIO en estudios imagenológicos y en cadáveres humanos que evaluaron la presencia/frecuencia de esta estructura anatómica. La búsqueda fue realizada en las bases de datosMedline, EMBASE y LILACS, en los idiomas portugués, español e inglés, sin restricción de fecha. Los estudios seleccionados fueron evaluados de forma cualitativa, analizando la terminología empleada para referirse a la anastomosis entre AASP y AIO. Fueron encontrados 2108 artículos originales, siendo seleccionados 60 artículos potencialmente relevantes y finalmente fueron incluidos 54 estudios para análisis cualitativo. Fueron encontrados 16 términos para referirse a la anastomosis entre AASP y AIO, siendo AASP el más frecuente seguido de arteria alveolo-antral (AAA). Son muchos los términos utilizados en la literatura médica para designar la anastomosis entre AASP y AIO, siendo AASP y AAA los más usados. La unificación de los términos utilizados para designar esta estructura vascular y su incorporación en la Terminología Anatómica contribuiría a evitar equívocos en la comunicación científica.

Association of location and diameter of alveolar antral artery to crest of alveolar bone in dentate and partially edentulous patients - A cone-beam computed tomography study.

BACKGROUND: One of the most challenging anatomical conditions to manage during sinus augmentation using lateral window approach is the alveolar antral artery (AAA) when it is unusually wide in diameter and passes through the area of the osteotomy with a complete intraosseous course. The purpose of this study was to investigate the association of location and diameter of AAA to the crest of alveolar bone in dentate and partially edentulous patients using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Totally 100 CBCT scans of patients (50 dentate and 50 edentulous) were selected and analyzed. The location and diameter of AAA in the lateral wall of the maxillary sinus were evaluated in association with alveolar bone height with respect to three posterior maxillary teeth: first premolar (P1), second premolar (P2), and first molar (M1). RESULTS: The diameter of AAA in dentate patients was higher in M1 region (1.32 ± 0.34 mm) than P1 (0.91 ± 0.20 mm) and P2 (1.07 ± 0.24 mm) regions as compared to edentulous patients. It was found that the location of AAA for P1 in the dentate group (22.35 ± 4.17 mm) was significantly higher than that of the edentulous group (20.37 ± 2.48 mm). A negative relationship has been found between age and the distance between the AAA canal and crest of the alveolar ridge in both dentate (P = 0.001) and edentulous (P = 0.003). CONCLUSION: A significantly negative relationship existed between age, diameter, and location of AAA in both the dentate and edentulous groups.

Alveolar antral artery in edentulous patients and their visualization through cone beam computed tomography.

OBJECTIVE OF THE STUDY: The aim of this study was to assess the anatomical features of the alveolar antral artery (AAA) in edentulous patients using cone beam computed tomography (CBCT). PATIENTS: The sample consisted of 191 CBCT scans of maxillary sinuses (n=382) of male (n=59) and female (n=132) edentulous patients (age: 38-89 years). MATERIAL AND METHODS: The images were analyzed in Dolphin™ 11.9 software. Visualization, location, and diameter of the AAA was registered. RESULTS: AAA was present in 88.5% of the assessed maxillary sinuses. Bilateral visualization was predominant 77% (P<0.0001). The mean vertical distance from the most anterior part of the AAA to the sinus floor was 7.9±6mm in female patients (both sides) and 12±7.22mm on the right side and 10.9±6.86mm on the left side in males. The mean diameter of the AAA was 1.2±0.7mm on both sides in females. In males, the diameter was significantly (P<0.05) larger: 1.5±0.62mm on the right side and 1.4±0.69 on the left side in females. CONCLUSION: The AAA had a higher visualization rate, better visualization, and larger diameter when it was present bilaterally in male and female patients.

Prevalence and morphometric analysis of the alveolar antral artery in a group of Thai population by cone beam computed tomography.

OBJECTIVE: To investigate the prevalence, diameter, and position of the alveolar antral artery (AAA) canals and measure the distances from the canal to the maxillary sinus floor and to the edentulous alveolar crest in each posterior maxillary tooth locations by cone beam computed tomography (CBCT). METHODS: CBCT images of the posterior maxillary region from 280 patients were investigated. The prevalence and diameter of the AAA canal were evaluated. The perpendicular distances from the canal to the maxillary sinus floor and to the edentulous alveolar crest of each tooth locations were measured. The mediolateral positions and routes of the canals were observed with novel classification. Statistical analyses were carried out to determine any significant differences in mean distances between the tooth locations along with mean distances of tooth location by age, gender, and dentate status. RESULTS: The AAA canal was found in 94.6% with a mean diameter ± SD of 1.05 ± 0.34 mm. The mean ± SD perpendicular distance from AAA canal to the edentulous alveolar crest at the first (16.02 ± 3.94 mm) and the second molars (16.74 ± 3.51 mm) were significantly shorter than the second premolar region. The intrasinus mediolateral position of the canal (72.5%) was the most common in concordance with the all-in type mediolateral route (50.9%). CONCLUSION: The intrasinus mediolateral position of the AAA canal is a common structure in the lateral wall of maxillary sinus, which could be detected with CBCT images. The all-in type is the most prevalent mediolateral route among a novel 7-type classification system of AAA routes. Owing to the short distance between the AAA canal and the alveolar crest in the first and second molar locations, CBCT images should be taken to investigate the AAA position and route before sinus lift procedure to prevent the risk of hemorrhage.

Analysis of the presence, location and morphometry of the «alveolar antral artery¼ by cone-beam computed tomography in Chilean adults / Análisis de la presencia, ubicación y morfometría de la arteria alvéolo-antral por tomografía computarizada de haz cónico en adultos chilenos

SUMMARY: The posterior superior alveolar artery is responsible for the vascularisation of the mucous which covers the posterior wall of the maxillary sinus, pulp and the periodontal tissues of upper molars. The collateral rami of the infraorbital artery irrigate the mucous of the anterior and lateral walls of the maxillary sinus, as well as the pulp and periodontal tissue of the upper anterior teeth and upper premolars. Both these arteries present intraosseous and extraosseous rami which form an anastomosis in the anterior and lateral walls of the maxillary sinus, called the alveolar antral artery (AAA). The aim of this study was to analyse the presence, location and morphometry of the AAA in a Chilean population, considering sex, side and age, using Cone-Beam computed tomography (CBCT). Forty-two CBCT examinations of Chilean adults were evaluated to analyse the presence, location (extraosseous, intraosseous or subperiosteal) and diameter (<1mm, 1-2 mm, 2-3 mm, >3 mm) of the AAA and the distance from the AAA to the amelocemental limit of the upper second premolar (2PM), permanent upper first molar (1M) and permanent upper second molar (2M) by sex and age range. Pearson's chi-squared test, Student's t-test, ANOVA and Pearson's correlation coefficient were applied, using a significance threshold of 5 %. AAA was found in 75 sides (89.3 %), 38 on the right side (90.5 %) and 37 on the left (88.09 %); extraosseous location was most common. More than 80 % of the arteries presented a diameter between 1 and 2 mm, with no important differences between sexes or age ranges. In younger individuals, the artery was located closer to the vestibular amelocemental limit than in older individuals. Carrying out a proper treatment plan which includes imagenological analysis before surgical procedures is essential to avoid possible haemorrhagic events in the region.

RESUMEN: Arteria alveolar superior posterior es responsable de la vascularización de la mucosa que recubre la pared posterior del seno maxilar, la pulpa y el tejido peridontal en el que se insertan los molares superiores. Las ramas colaterales de la arteria infraorbitaria irrigan la mucosa de las paredes anterior y lateral del seno maxilar, así como la pulpa y el periodonto de los dientes anteriores superiores y los premolares superiores. Ambas arterias presentan ramas intraóseas y extraóseas que forman una anastomosis en las paredes anterior y lateral del seno maxilar, denominada arteria alvéolo antral (AAA). El objetivo de este estudio fue analizar la presencia, localización y morfometría del AAA en una población chilena, considerando sexo, lado y edad, mediante tomografía computarizada Cone-Beam (CBCT). Se evaluaron 42 exámenes CBCT de adultos chilenos para analizar la presencia, ubicación (extraósea, intraósea o subperióstica) y diámetro (<1 mm, 1-2 mm, 2-3 mm,> 3 mm) del AAA. y la distancia del AAA al límite amelocemental del segundo premolar superior (2PM), primer molar superior permanente (1M) y segundo molar superior permanente (2M) por sexo y rango de edad. Se aplicaron la prueba de chi-cuadrado de Pearson, la prueba t de Student, ANOVA y el coeficiente de correlación de Pearson, utilizando un umbral de significancia del 5 %. Se encontró AAA en 75 lados (89,3 %), 38 del lado derecho (90,5 %) y 37 del lado izquierdo (88,09 %); la localización extraósea fue la más común. Más del 80 % de las arterias presentaban un diámetro entre 1 y 2 mm, sin diferencias importantes entre sexos ni rangos de edad. En individuos más jóvenes, la arteria se ubicó más cerca del límite amelocemental vestibular que en individuos mayores. La realización de un adecuado plan de tratamiento que incluya análisis imagenológico antes de los procedimientos quirúrgicos es fundamental para evitar posibles eventos hemorrágicos en la región.

[The alveolar antral artery prevalence and topography according to literature review]. / Analiz vstrechaemosti i topograficheskikh dannykh al'veolo-antral'noi arterii na osnove obzora literatury.

INTRODUCTION: The lack of the available bone in the posterior maxilla is determined by the range of anatomical and topographical factors. Lateral sinus floor elevation is the procedure for vertical augmentation in this region. Several complications may occur while performing a lateral sinus lift and bleeding due to alveolar antral artery (AAA) damage is one of them.The aim of the study is to analysis the different literature on AAA topographical features on cadaver species and on radiographic methods. MATERIALS AND METHODS: A search of the English language literature was performed by three independent readers in the PubMed electronic database. Articles published between 2013 and 2018 on cadaver and radiographic studies were included. RESULTS: The analysis included 9 articles. AAA prevalence in cadavers was 100% but AAA bone signs in CBCT studies varied between 32% and 93%. The diameter varied from 0.91 mm to 3.6 mm, and the distances from AAA to the sinus floor and to the alveolar ridge crest were 7.38-9.97 and 14.6-18.66 mm respectively. CONCLUSION: Our literature analysis showed the difference between AAA prevalence in cadavers and in CBCT scans. The results show that even proper pre-operative planning of the lateral sinus lift with CBCT cannot guarantee avoiding AAA damage while performing the surgery.

Evaluación de la arteria alveolo-antral mediante tomografía volumétrica en población mexicana y su relación con levantamiento del piso del seno maxilar / CBCT evaluation of the alveolar antral artery in a mexican cohort and its relationship to maxillary sinus floor lifting

Introducción: El conocimiento de la anatomía de la región maxilar debe ser esencial para el cirujano antes de realizar levantamiento del seno maxilar para evitar complicaciones. La arteria alveolo antral forma una anastomosis intraósea con la arteria infraorbitaria a nivel de la pared antero lateral del seno maxilar, aproximadamente a una distancia de entre 18.9 y 19.6 mm desde el reborde alveolar maxilar. La arteria alveolo antral es la encargada de dar vascularidad a la membrana mucosa del seno maxilar, pared antero lateral del seno y tejido perióstico subyacente.Objetivo: Describir y establecer la frecuencia, diámetro y localización dela anastomosis entre la arteria infraorbitaria y la arteria alveolar posterior superior, llamada arteria alveolo antral y su relación con la cresta ósea alveolar en una población mexicana. Material y métodos: Se realizaun protocolo de estudio observacional, descriptivo y transversal en una población de 1,116 pacientes derecho habientes del Instituto de Seguridad Social y Servicios para los Trabajadores del Estado (ISSSTE), en el oriente de la Ciudad de México, mediante la revisión de estudios de tomografía volumétrica computarizada. Resultados: Se encuentra la anastomosis arterial en el 90 por ciento de los estudios revisados, correspondiente a 1,005 estudios de tomografía.

Introduction: In order to avoid complications, it is essential for surgeonsto have a detailed knowledge of the anatomy of the superior maxillarybone prior to performing any sinus lift procedure. The alveolarantral artery forms an intraosseous anastomosis with the infraorbitalartery at the level of the anterolateral wall of the maxillary antrum at anapproximate distance of between 18.9 and 19.6 mm from the maxillaryalveolar ridge. The alveolar antral artery is responsible for providingvascularity to the mucous membrane of the maxillary sinus, the anteriorlateral wall of the sinus, and the underlying periosteal tissue. Objective:To analyze and establish the frequency, diameter, and locationof the anastomosis between the infraorbital artery and the posteriorsuperior alveolar artery known as the alveolar antral artery, and itsrelationship to the alveolar bone crest in a Mexican cohort. Materialand methods. We conducted a cross-sectional observational descriptivestudy involving a cohort comprised of 1,116 patients of the Institute forSocial Security and Services for State Workers (ISSSTE) on the eastside of Mexico City. The study consisted of a review of CBCT studies.Results: The arterial anastomosis was found in 90% of the 1,005 CBCTstudies reviewed, based on which the following values were determinedfor the distance between the alveolar ridge and the canal of the alveolarantral artery: for the fi rst premolar, 18.24 mm; second premolar,17.35 mm; fi rst molar, 16.96 mm, and for the second molar, 18.75 mm.Conclusions: We established the average measurements for the locationof the vascular bundle in question and the measurements neededto safeguard it along its course, which is important for the preservationand osseointegration of bone grafts placed during maxillary sinus liftprocedures, thus providing a margin of safety not previously reportedin the literature for a Mexican cohort.

Alveolar antral artery isolation during sinus lift procedure with the double window technique.

The sinus lift technique, introduced in 1976 by Tatum and subsequently described by Boyne in 1980, is nowadays considered a safe and reliable procedure for the rehabilitation of the atrophic upper posterior maxilla. The alveolar antral artery (AAA) is anastomoses between the posterior superior alveolar artery (PSAA) and the infraorbital artery (IOA) and may be present in the sinusal antrostomy. The haemorrhage of this vascular bundle represents the second intra-operatory complication in term of frequency during sinus lift procedure. Purpose of this study was to illustrate and describe a new technique allowing the AAA isolation during sinus lift procedure in cases in which the artery is clearly present inside the surgical area, detectable through CT scan exam. Presence, course and possible identification of the alveolar antral artery are also discussed, according to the studies present in the literature.