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Bernardi S, Bianchi S, Gerardi D, Petrelli P, Rinaldi F, Piattelli M, Macchiarelli G, Varvara G. Anatomy of Maxillary Sinus: Focus on Vascularization and Underwood Septa via 3D Imaging. Tomography 2024; 10:444-458. [PMID: 38668392 PMCID: PMC11054790 DOI: 10.3390/tomography10040034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 04/29/2024] Open
Abstract
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.
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Affiliation(s)
- Sara Bernardi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.B.); (D.G.); (G.M.)
| | - Serena Bianchi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.B.); (D.G.); (G.M.)
| | - Davide Gerardi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.B.); (D.G.); (G.M.)
| | - Pierpaolo Petrelli
- Department of Innovative Technologies in Medicine & Dentistry, Dental School, ‘G. D’Annunzio’ University of Chieti-Pescara, 66100 Chieti, Italy; (P.P.); (F.R.); (M.P.); (G.V.)
| | - Fabiola Rinaldi
- Department of Innovative Technologies in Medicine & Dentistry, Dental School, ‘G. D’Annunzio’ University of Chieti-Pescara, 66100 Chieti, Italy; (P.P.); (F.R.); (M.P.); (G.V.)
| | - Maurizio Piattelli
- Department of Innovative Technologies in Medicine & Dentistry, Dental School, ‘G. D’Annunzio’ University of Chieti-Pescara, 66100 Chieti, Italy; (P.P.); (F.R.); (M.P.); (G.V.)
| | - Guido Macchiarelli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.B.); (D.G.); (G.M.)
| | - Giuseppe Varvara
- Department of Innovative Technologies in Medicine & Dentistry, Dental School, ‘G. D’Annunzio’ University of Chieti-Pescara, 66100 Chieti, Italy; (P.P.); (F.R.); (M.P.); (G.V.)
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Aboelmaaty W, Alfadley A, Awawdeh M, Sapri AS, Awawdeh L, Mira ES. Utilizing a Novel AI Tool to Detect the Posterior Superior Alveolar Artery's Location's Impact on Maxillary Sinus Mucosal Thickening in the Presence of Periapical Lesions. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:140. [PMID: 38256400 PMCID: PMC10820000 DOI: 10.3390/medicina60010140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024]
Abstract
Periapical lesions have been implicated in sinus-related complications, but the precise influence of anatomical variations in the posterior superior alveolar artery (PSAA) on mucosal thickening remains an uncharted aspect. The new AI tool employed in this research utilizes advanced image processing algorithms to enhance image visualization. Background and Objectives: This study examines the accuracy of a new cone beam computed tomography (CBCT) software (eVol DXS, version 1.0.1.0) employing AI to detect the PSAA's location and the effect of that on maxillary sinus thickening in the presence of periapical lesions. Materials and Methods: This retrospective study included 120 CBCT cases with posterior maxillary periapical lesions and 120 without odontogenic infections. Teeth with proximity (<2 mm) to the sinus were excluded in both groups to eliminate the sinus floor's perforation effect. Both the PSAA locations and maxillary sinus thickening were classified and compared. Results: The mucosal thickening differs significantly (p < 0.001) between the study group and the control group. The study showed that an increased sinus thickness occurred when the PSAA was beneath the sinus membrane in the study group (62.5% compared to 8.6%; p < 0.001 *). The AI tool helped to achieve a 100% identification rate in determining the PSAA locations. Conclusions: AI algorithms for PSAA localization, which affects mucosal thickness in response to periapical lesions, yield excellent results.
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Affiliation(s)
- Wael Aboelmaaty
- Maxillofacial Surgery and Diagnostic Sciences Department, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh 11426, Saudi Arabia
- Oral Radiology and Diagnostic Sciences Department, Faculty of Dentistry, Mansoura University, Mansoura City 35516, Egypt;
- Dental Services, King Abdulaziz Medical City, Ministry of the National Guard—Health Affairs, Riyadh 11426, Saudi Arabia; (A.A.); (M.A.)
- King Abdullah International Medical Research Center, Ministry of National Guard—Health Affairs, Riyadh 11481, Saudi Arabia
| | - Abdulmohsen Alfadley
- Dental Services, King Abdulaziz Medical City, Ministry of the National Guard—Health Affairs, Riyadh 11426, Saudi Arabia; (A.A.); (M.A.)
- King Abdullah International Medical Research Center, Ministry of National Guard—Health Affairs, Riyadh 11481, Saudi Arabia
- Department of Restorative and Prosthetic Dental Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia
| | - Mohammed Awawdeh
- Dental Services, King Abdulaziz Medical City, Ministry of the National Guard—Health Affairs, Riyadh 11426, Saudi Arabia; (A.A.); (M.A.)
- King Abdullah International Medical Research Center, Ministry of National Guard—Health Affairs, Riyadh 11481, Saudi Arabia
- Preventive Dental Science Department, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh 11426, Saudi Arabia
- College of Medicine & Dentistry, Ulster University, Birmingham B4 6BN, UK
| | - Ahmed Saaduddin Sapri
- Division of Oral and Maxillofacial Surgery, Batterjee Medical College, Jeddah 21442, Saudi Arabia;
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Mansoura University, Mansoura City 35516, Egypt
| | - Lama Awawdeh
- Department of Conservative Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Eman Shawky Mira
- Oral Radiology and Diagnostic Sciences Department, Faculty of Dentistry, Mansoura University, Mansoura City 35516, Egypt;
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Ketabi AR, Hassfeld S, Lauer HC, Piwowarczyk A. Comparative diagnosis of the alveolar antral artery canal in the lateral maxillary sinus wall in corresponding panoramic radiography and cone-beam computed tomography. Int J Implant Dent 2023; 9:30. [PMID: 37725181 PMCID: PMC10509091 DOI: 10.1186/s40729-023-00497-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023] Open
Abstract
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.
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Affiliation(s)
- Ali-Reza Ketabi
- Department of Prosthodontics, School of Dentistry, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 45, 58455, Witten, Germany.
- Private Dental Office of Dr Ali-Reza Ketabi, Epplestraße 29 a, 70597, Stuttgart, Germany.
| | - Stefan Hassfeld
- Department of Oral and Maxillofacial Surgery, Dortmund Hospital GmbH and Faculty of Health, Witten/Herdecke University, Muensterstr. 240, 44145, Dortmund, Germany
| | - Hans-Christoph Lauer
- Department of Prosthodontics, Center for Dentistry and Oral Medicine (Carolinum), Goethe-University, Theodor-Stern-Kai 7, 60596, Frankfurt, Germany
| | - Andree Piwowarczyk
- Department of Prosthodontics, School of Dentistry, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 45, 58455, Witten, Germany
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Radmand F, Razi T, Baseri M, Gavgani LF, Salehnia F, Faramarzi M. Anatomic evaluation of the posterior superior alveolar artery using cone-beam computed tomography: A systematic review and meta-analysis. Imaging Sci Dent 2023; 53:177-191. [PMID: 37799745 PMCID: PMC10548151 DOI: 10.5624/isd.20230009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/25/2023] [Accepted: 03/31/2023] [Indexed: 10/07/2023] Open
Abstract
Purpose This systematic review examined the detection of the posterior superior alveolar artery, along with various anatomic characteristics, on cone-beam computed tomography images. Materials and Methods Studies were identified electronically through the Web of Science, MEDLINE, Scopus, and Embase databases. The quality of the included studies was evaluated using a 5-item binary scale. The detection rate, location, and classified diameter of the posterior superior alveolar artery were estimated as prevalence values. The diameter of this artery, as well as the distances from the artery to the alveolar crest and sinus floor, were estimated as means with associated 95% confidence intervals. Results Thirty-seven studies were enrolled, with 34 of these included in the meta-analysis. The mean detection rate was 79% (range: 72%-84%), and the mean diameter was 1.06±0.05 mm (range: 0.96-1.16 mm). The posterior superior alveolar artery was located intraosseously in 64% of cases. The mean distance of the artery from the alveolar crest was 16.71±0.49 mm (range: 15.75-17.68 mm), while the mean distance from the artery to the sinus floor was 8.85±0.4 mm (range: 8.05-9.64 mm). Conclusion According to the findings of this meta-analysis regarding various anatomic characteristics of the posterior superior alveolar artery, severe hemorrhage after damage to this artery during sinus augmentation procedures is not a substantial clinical problem.
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Affiliation(s)
- Faraz Radmand
- Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tahmineh Razi
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Milad Baseri
- Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leili Faraji Gavgani
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Salehnia
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoumeh Faramarzi
- Department of Periodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
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Alves N, Torres-Villar C, Ceballos F, Deana NF. Frequency, location, and diameter of the anastomosis between the posterior superior alveolar artery and the infraorbital artery in imaging studies: systematic review and meta-analysis. Surg Radiol Anat 2023; 45:431-443. [PMID: 36754890 DOI: 10.1007/s00276-023-03091-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/21/2023] [Indexed: 02/10/2023]
Abstract
The anastomosis between the posterior superior alveolar artery (PSAA) and the infraorbital artery (IOA) courses along half of the lateral wall of the maxillary sinus. Risk of injury to the anastomosis between PSAA and IOA during surgical procedures has been reported. The aim of the present study was to carry out a systematic review and meta-analysis to determine the frequency, location, and diameter of the anastomosis between PSAA and IOA in imaging studies (cone-beam computed tomography, spiral cone-beam computed tomography, and computed tomography). A search was carried out in the PubMed, EMBASE, and LILACS. Original works were included reporting imaging studies to analyze the frequency, location, and diameter of the anastomosis in humans. The risks of bias were analyzed using the AQUA tool. Generalized linear mixed models were used to estimate the frequency and the 95% CI in the meta-analysis. The variance in prevalence estimates was stabilized by logit transformation. The qualitative analysis included 49 studies with 10,837 patients. The frequency of the anastomosis between PSAA and IOA was 74% (prediction interval 0.20-0.97%). The anastomosis was most frequently located in the intraosseous region (60.0%), followed by the submembranous region (33.0%), and least frequently in an extraosseous location (5.0%). Arteries with diameter of 1.0-1.9 mm were most frequent (32.0%), followed by arteries with diameter less than 1 mm (23.0%); a small number with diameter greater than 2 mm was recorded (4.0%). These data can be used as a reference to help surgeons when planning interventions in the lateral wall of the maxillary sinus. Registration number: INPLASY, number 202120071.
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Affiliation(s)
- Nilton Alves
- Center of Excellence in Surgical and Morphological Research (CEMyQ), Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
- Applied Morphology Research Center (CIMA), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
| | - Carlos Torres-Villar
- Department of Morphological Sciences, Faculty of Medicine and Science, Universidad San Sebastián, Lago Panguipulli 1390, 5501842, Puerto Montt, Chile
- School of Medical Technology, Universidad Austral de Chile, Puerto Montt, Chile
- Doctoral Program in Morphological Sciences, Universidad de La Frontera, Temuco, Chile
| | | | - Naira Figueiredo Deana
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile.
- Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile.
- Doctoral Program in Morphological Sciences, Universidad de La Frontera, Temuco, Chile.
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Areizaga-Madina M, Pardal-Peláez B, Montero J. Maxillary Sinus Pathology and its Relationship with Pathology and Dental Treatments. Systematic Review. REVISTA ORL 2023. [DOI: 10.14201/orl.29553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Introduction and objective: The aim of this review is to evaluate to what extent sinus pathology originates from dental pathology or treatment, and to assess the occurrence frequency of sinus pathology in its different forms using cone beam computed tomography (CBCT).
Method: The literature review was conducted using PubMed, Scopus and the Cochrane Library. Forty-two articles were included (25 case series, ten cross- sectional studies, three case-control studies, two cohort studies, one prospective study, and one retrospective study).
Results: Forty-two articles involving a total of 13,191 patients and 17,374 CBCTs were included in this review. The most frequent pathological findings were, by a considerable degree, inflammatory diseases, which represented 75.16% of the total findings, followed by infection (12.13%), tumours (6.88%), and high pneumatisation (2.07%). Within dental pathology, there is a direct Pearson correlation with polyps (1) and opacification (0.999), and an almost direct correlation with retention cysts (0.981) and sinus-associated dental elements (0.972).
Conclusions: Our results further support the argument that dental modifications and treatments are an important cause of sinus pathology. For this reason, dental aetiologies must be taken into account by both dentists, maxillofacial surgeons and ENT when considering the most appropriate treatment for patients with maxillary sinusitis.
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Lee JH, Ahn HN, Park JT. Three-dimensional visualization of the alveolar bone and posterior superior alveolar foramen in gender. Surg Radiol Anat 2020; 43:261-266. [PMID: 32960307 DOI: 10.1007/s00276-020-02576-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/12/2020] [Indexed: 11/24/2022]
Abstract
The present study applied a three-dimensional (3D) program to measure the distances from the maxillary sinus floor (MSF) to the lingual and buccal alveolar bone and also to the posterior superior alveolar foramen (PSAF), with the aim of determining differences according to gender. The study also attempted to verify the accuracy of measurements obtained from 3D images by performing comparisons with the results obtained in a preliminary study. The results showed that the alveolar bone length and the MAF-PSAF were generally larger in males than in females. It is also predicted that the accuracy of data obtained from a 3D program will be higher than that of data derived from conventional two-dimensional (2D) images. The accurate measurements obtained in this study are anticipated to prove useful in assessments related to dental implantation and anatomical structures. The fundamental data obtained in this study may also assist in setting the goals of future studies utilizing 3D programs.
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Affiliation(s)
- Jeong-Hyun Lee
- Department of Oral Anatomy, Dental College, Dan-Kook University, Cheonan, 330-714, South Korea
| | - Hyun-Na Ahn
- Department of Oral Anatomy, Dental College, Dan-Kook University, Cheonan, 330-714, South Korea
| | - Jong-Tae Park
- Department of Oral Anatomy, Dental College Dankook Institute For Future Science and Emerging Convergence, Dan-Kook University, Cheonan, 330-714, South Korea.
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Study of factors influencing preoperative detection of alveolar antral artery by CBCT in sinus floor elevation. Sci Rep 2020; 10:10820. [PMID: 32616752 PMCID: PMC7331631 DOI: 10.1038/s41598-020-67644-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 06/01/2020] [Indexed: 11/23/2022] Open
Abstract
This study aimed at assessing the prevalence of alveolar antral artery (AAA) detection by CBCT, its related variables, and at describing explanatory models useful in surgical planning, by retrospective evaluation of CBCT explorations. The modelling of the probability for detecting AAA was undertaken using logistic generalized additive models (GAM). The capacity for discriminating detection/no detection was assessed by receiver operating characteristic curves. A total of 466 sinuses were studied. Univariate models showed detection probability was linked to sinus width and thickness of the lateral bony wall, together with the shape and height of the osseous crest. AAA detection probability increased steadily until the thickness of the bony wall reached 6 mm. Multivariate models resulted good discriminators for AAA detection, particularly for females, showing an area under the curve (AUC) of 0.85. Models considering patients altogether, and those including only males offered slightly lower values (AUC = 0.79). The probability of AAA detection by CBCT was influenced by gender (higher in males and for narrow sinuses) and increases with the thickness of the sinus lateral bony wall and the height of the residual alveolar ridge. Besides, and particularly for women, the thickness of the ridge at the basal level seems to improve the explanatory model for AAA detection.
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Guided Lateral Sinus Lift Procedure Using 3-Dimensionally Printed Templates for a Safe Surgical Approach: A Proof-of-Concept Case Report. J Oral Maxillofac Surg 2020; 78:1529-1537. [PMID: 32531267 DOI: 10.1016/j.joms.2020.04.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 11/20/2022]
Abstract
The purpose of this article was to present a guided lateral window sinus lift procedure with the aid of a fully digital workflow using surgical templates for window osteotomy preparation and implant placement. A 22-year-old patient with insufficient residual bone height in the posterior maxilla was treated with a maxillary sinus augmentation procedure with a lateral window technique and simultaneous implant installation using 3-dimensionally printed surgical guides. The surgical guides, used for the preparation of both the lateral window and the implant site according to the optimal prosthodontic and anatomic position, were based on a fully digital workflow and virtual pre-planning with modified implant-planning software. Successful functional and esthetic rehabilitation of the patient was accomplished using standard surgical techniques and instruments but an innovative method for the production and application of surgical templates ensured a precise and safe approach for the lateral window osteotomy preparation. This guided lateral window sinus lift technique may reduce the incidence of surgical complications and failures and enhance patient-related outcomes.
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Sinus Imaging of Asymptomatic Patients: Putting the Cart Before the Horse. J Oral Maxillofac Surg 2019; 78:3. [PMID: 31629756 DOI: 10.1016/j.joms.2019.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 08/22/2019] [Indexed: 11/23/2022]
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Yalcin ED, Akyol S. In Reply. J Oral Maxillofac Surg 2019; 78:3-4. [PMID: 31629757 DOI: 10.1016/j.joms.2019.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 11/16/2022]
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