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

Evaluation of the location of posterior superior alveolar artery and infraorbital foramen originating from the same source by using cone beam computed tomography

AIM

This study aimed to evaluate the prevalence, location and diameters of Posterior superior alveolar artery (PSAA) and Infraorbital foramen (IOF) to find out whether there is any relationship between PSAA and IOF, and to predict their location relative to each other in surgical procedures by using cone beam computed tomography (CBCT).

MATERIAL AND METHOD

Bilateral maxillary sinuses were analysed retrospectively in 170 patients with no missing teeth in the maxillary posterior region. The largest locations of PSAA and IOF in the maxillary sinus were determined and their size, shape, location in relation to the teeth and distances from anatomical points were evaluated. For statistical analysis, Kolmogorov-Smirnov, Shapiro-Wilk tests, Intraclass Correlation Coefficient, and Kappa Test were used.

RESULTS

The incidence rate of PSAA on CBCT was found as 56.2%. While the rate of those with a vertical diameter of ≥ 1 mm was 92.1%, the rate of those with a horizontal diameter of ≥ 1 mm was 65.4%. In terms of location, the highest rate was found in the distal of the second molar. Mean horizontal diameter of IOF was found as 3.47 mm, while its mean vertical diameter was found as 3.68 mm. In terms of location, the most common location was at the second premolar tooth level with a rate of 39.7%. While IOF was mostly seen at the first premolar tooth level in young participants, it was mostly seen at the distal of second premolar tooth in old age. No statistical correlation was found between PSAA and IOF (p > 0.05). However, the median values of diameters to the anatomical structures were found to be higher in males when compared to females.

CONCLUSION

In the present study, our hypothesis of predicting the position of PSAA and IOF relative to each other in surgical procedures of the maxillary sinus was not confirmed. It may be useful to conduct more detailed studies with higher resolution CBCT devices in which more patients are included. In order to prevent a possible bleeding that can occur, clinicians are recommended to evaluate the size and location of these anatomical structures with CBCT before surgical procedures, especially in male patients and older patients.

Anatomical Factors Affecting the Complexity of Maxillary Sinus Augmentation in Saudi Patients: A Cone Beam Computed Tomography (CBCT) Study

AIM

This study aims to evaluate the anatomical variations of the maxillary sinus and determine the difficulty score of maxillary sinus augmentation (MSA) in Saudi patients seeking dental implant rehabilitation of the posterior maxilla using cone beam computed tomography (CBCT).

METHODOLOGY

CBCT records of dental patients seeking treatment at a University Dental Teaching Hospital between 2019 and 2023 were retrospectively analyzed. Measurements were obtained from CBCT images, including membrane thickness, sinus width, buccal bone thickness, presence of maxillary sinus septa, residual alveolar ridge height, angle of the buccolingual sinus wall, and the presence of the alveolar antral artery (AAA). The difficulty score for MSA was determined based on these anatomical factors.

RESULTS

A total of 107 maxillary sinuses in 86 subjects were evaluated. The average membrane thickness was 2.23 mm, with males showing significantly higher thickness than females. Sinus septa were found in 54 (50.5%) sinuses, with 18 (17%) of sinuses having interfering septa. Twenty-three (21.5%) sinuses had a residual alveolar ridge height of less than 4 mm. The average angle of the buccolingual sinus wall was 79.39°, indicating a high prevalence of wide-shaped sinuses. The average sinus width was 14.09 mm, with 55 sinuses (51.4%) less than 15 mm. The average buccal bone thickness was 1.07 mm, in 29 (27%) sinuses, the thickness was more than 2 mm. AAA was visualized in 60 (56%) of sinuses, with 45 (42%) of sinuses having AAA interfering with the MSA window.

CONCLUSIONS

In this study, most sinuses were classified as simple or moderate difficulty, with higher membrane thickness, presence of septa, and AAA being the significant risk factors for complications. These findings provide valuable insights for implant surgeons in Saudi patients seeking dental implant rehabilitation of the posterior maxilla, enabling them to anticipate and minimize potential complications during MSA procedures.

Retrospective evaluation and descriptive analysis of the prevalence of anatomical structures and variations in CBCT images before dental implant planning in a group Turkish population, part I

PURPOSE

The aim of this study is to emphasize the importance of using cone-beam computed-tomography in order to determine the anatomical structures and their variations before the treatment in patients who apply to the dentist clinic for implant treatment.

METHODS

In the study, CBCT images of 500 adult patients (240 female and 260 male), aged between 21 and 82 years, who applied for implant treatment due to missing teeth, were retrospectively analyzed. Anatomical structures and variations such as nasopalatine canal(NPC), canalis sinuosus(CS), antral alveolar artery(AAA), were evaluated in multiplanar reformation(MPR) sections which are axial, sagittal and coronal can be viewed in consistence with each other.

RESULTS

The incidence of anatomical variation of CS in the right region was similar according to gender. The "Funnel" appearance of the NPC shape was found most common shape in both female and male patients (n = 89; 37.1% for females and n = 71; 27.3% for males).

CONCLUSION

CBCT has become the most popular 3D imaging method in dental practice especially for planning dental implants. Understanding the relationship with important anatomical structures before implant applications is crucial in dealing with potential complications that may arise afterward. Assessing significant anatomical structures by CBCT and taking precautions against possible risks facilitate the work of dentists during and after procedures.

Morphometric Assessment of Alveolar Antral Artery Using Medical Computed Tomography

This study aimed to investigate the prevalence, diameter, and position of the alveolar antral artery (AAA) in paranasal sinus computed tomography (CT) images and to correlate the location of the AAA with tooth position, the presence of teeth, and residual alveolar bone height (ABH). A retrospective study was conducted at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, from November 2016 to October 2021. CT images of 100 maxillary sinuses from 50 patients managed for modified endoscopic sinus surgery and sinus lifting by a single surgeon were selected and obtained from the Infinitt picture archiving and communication system radiology system (Infinitt Healthcare Co., Seoul, Korea). The location of the AAA in the lateral wall of the maxillary sinus was evaluated in correlation with the area of the first and second molars (M1 and M2), the presence of teeth, and the residual ABH. In this study, we found that the intraosseous type is the most common type of AAA. Furthermore, the location and distance of the AAA are significantly affected by tooth position, an edentulous state in the case of the first molar, and residual ABH. Pre-evaluation of the diameter, position, and distance to the AAA using CT images is essential to help prevent hemorrhage. The existence and wide range of the AAA distances based on the tooth position, edentulous state, and residual ABH should be considered even if CT imaging cannot locate the AAA.

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.

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.

[Topographic assessment of the vascular anastomosis in the maxillary sinus wall using cone-beam computed tomography]

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.