Radiographic maxillary sinus findings in the elderly

Association of Cigarette Consumption and Mucosal Thickening in the Paranasal Sinuses on MRI

OBJECTIVE

To investigate the impact of cigarette consumption on mucosal thickening in paranasal sinuses and the relationships of smoking-related factors and dental status with mucosal thickening at different maxillary sinus locations using MRI.

MATERIALS AND METHODS

This retrospective study investigated 1094 paranasal sinuses on MRIs by correlating mucosal thickening with smoking-related factors. Presence/absence of maxillary posterior teeth was correlated with mucosal thickening on the maxillary sinus floor and other sinus locations.

RESULTS

Compared with nonsmokers, current and former smokers exhibited similarly more mucosal thickening in the maxillary (58.9%/62.8% vs 38.3%, P < .01) and ethmoid (22.7%/17.1% vs 6.6%, P < .01) sinuses, but not in the sphenoid sinus (P = .08) and similarly more mucosal thickening on the medial/superior walls of the maxillary sinus (40.4%/41.5% vs 18.4%, P < .01). Patients with mucosal thickening in the maxillary and ethmoid sinuses had greater daily cigarette consumption and years of smoking than those without mucosal thickening in these sinuses (P < .01). Edentulous individuals had more mucosal thickening on the maxillary sinus floor compared to dentate individuals (43.7% vs 32.2%, P < .01).

CONCLUSION

Cigarette consumption is associated with increased mucosal thickening in paranasal sinuses, with a dose-response association. This thickening may be persistent after quitting smoking. Cigarette smoking may have a more pronounced impact on the sinus mucosa in areas near the primary maxillary ostium, while dental status may be more likely to affect that on the maxillary sinus floor.

Frequency of Accessory Maxillary Ostium in Patients With/Without Sinusitis, and Its Correlation with Anatomical Variations of Paranasal Sinuses: A Cone Beam Computed Tomography Study

This study assessed the frequency of accessory maxillary ostium (AMO) in patients with/without sinusitis and its correlation with anatomical variations using cone-beam computed tomography (CBCT). In this cross-sectional study, 244 CBCT scans were evaluated in two groups: with maxillary sinusitis having > 2 mm mucosal thickening and without max sinusitis as a normal group having normal or less than 2 mm mucosa. The CBCT scans of each group were carefully evaluated for the presence/absence of AMO, patency/obstruction of the primary maxillary ostium (PMO), and the presence of anatomical variations of the paranasal sinuses. Data were analyzed by independent t-test, Pearson Chi-square test, and Fisher's exact test (alpha = 0.05). CBCT scans of 134 females (54.9%) and 110 males (45.1%) with a mean age of 34.16 ± 19.01 years were evaluated. The presence of AMO had no significant correlation with maxillary sinusitis (P = 0.104). The two groups had no significant difference in the frequency of Haller cell, nasal septal deviation, and concha bullosa (P > 0.05). However, the frequency of paradoxical concha (PC; P < 0.001) and bifid concha (BC; P = 0.017) was significantly higher in the normal group, and the frequency of PMO obstruction was significantly higher in the sinusitis group (P < 0.001). AMO had no significant correlation with any anatomical variation in any group (P > 0.05). Gender had a significant effect on the presence of AMO (P = 0.013). The presence of AMO had no significant correlation with maxillary sinusitis. However, its frequency was significantly higher in females in normal group and males with sinusitis. The presence of AMO had no significant correlation with anatomical variations.

Radiographic feature changes in an antral pseudocyst that existed prior to sinus floor augmentation and dental implant placement, 15 years after initial detection - a case report

INTRODUCTION AND IMPORTANCE

Maxillary sinus floor augmentation is acceptable and safe for bone augmentation prior to insertion of dental implants in atrophied maxillary bones. Anatomical variations and lesions of the maxillary sinus, including antral pseudocysts, are common radiological findings that can affect the outcomes of maxillary sinus augmentation. We show the changes in the radiological features of an antral pseudocyst that existed before maxillary sinus augmentation and 15 years after the insertion of dental implants.

CASE PRESENTATION

The patient was a 69-year-old male with an unremarkable medical history. The initial orthopantomogram revealed a very large antral pseudocyst in the left maxillary sinus. After upper left second molar extraction and maxillary sinus augmentation, two dental implants were inserted in regions 26 and 27. The pseudocyst had changed radiologically 15 years later, but a biopsy showed no characteristic changes, and the dental implants showed no functional failures.

CLINICAL DISCUSSION

We present a case of an antral pseudocyst that was not removed before or during sinus floor augmentation. A debate is ongoing regarding whether antral pseudocysts affect maxillary sinus augmentation, and various strategies have been applied to prevent intraoperative and postoperative complications, including removal of pseudocysts 3-12 months before maxillary sinus augmentation, removal during maxillary sinus augmentation, and leaving them alone when the floor is raised.

CONCLUSION

The present case showed a preexisting antral pseudocyst at maxillary sinus floor augmentation and insertion of the implants, which changed radiologically 15 years later, but did not affect the function of the dental implants.

Risk factors and longitudinal regenerative outcomes of sinus membrane perforation during lateral window sinus floor elevation: A retrospective analysis up to 9 years

BACKGROUND

Lateral-window sinus floor elevation (LSFE) is a reliable procedure to reconstruct the posterior maxilla for implant therapy. This retrospective study aimed to investigate risk factors associated with Schneiderian membrane perforation (SMP) occurrence during LSFE and longitudinal regenerative outcomes following LSFE up to 9 years.

METHODS

Patients who had LSFE between 2010 and 2019 were included. All demographic and surgical-related data were retrieved from existing electronic health records. Radiographs were used to evaluate the vertical dimensional changes of ridge and graft materials and the potential anatomic factors of SMP.

RESULTS

A total of 122 LSFE procedures in 99 patients were included in the study. Mean ridge height gain and graft shrinkages were 9.5 ± 3.47 and 1.57 ± 2.85 mm. The influence of the healing period on graft shrinkage showed a positive trend; the longer the healing period, the greater the graft shrinkage (p = 0.09). The pathology in the sinus showed a positive correlation with SMP (p = 0.07). However, other anatomical factors did not negatively impact SMP and subsequent ridge height gain (p > 0.05).

CONCLUSIONS

With inherent limitation, the findings with up to 9 years of follow-up indicate a consistent ridge remodeling lasting for about 3 years after LSFE procedures. SMP or membrane thickening may not significantly affect the ridge gain following LSFE. The healing period had the most significant influence on graft shrinkage, showing that the longer the healing time between LSFE and implant placement, the greater the graft shrinkage.

Performance of panoramic radiography compared with computed tomography in the evaluation of pathological changes in the maxillary sinuses: a systematic review and meta-analysis

OBJECTIVE

A systematic review was performed to evaluate the performance of panoramic radiography (PR) vs CT or cone beam CT (CBCT) in the diagnosis of pathological maxillary sinuses.

METHODS

This review was registered in the PROSPERO database under the number CRD42020211766. Observational studies that compared PR with CT/CBCT were used to evaluate pathological changes in the maxillary sinuses. A complete search of seven primary databases and gray literature was carried out. The risk of bias was assessed according to the Newcastle-Ottawa tool, and the GRADE tool was used to assess the quality of evidence. A binary meta-analysis was performed to assess the effectiveness of evaluating pathological alterations in the maxillary sinuses in PR and CT/CBCT.

RESULTS

Seven studies were included in our study, out of which four were included in a quantitative analysis. All studies were classified as low risk of bias. Five studies compared PR with CBCT and two studies compared PR to CT. The most common pathological alteration in maxillary sinuses reported was mucosal thickening. CT/CBCT was seen to be the most effective method for assessing pathological changes in the maxillary sinus when compared to PR (RR = 0.19, 95% confidence interval [CI] = 0.05 to 0.70, p = 0.01).

CONCLUSION

CT/CBCT are the most appropriate imaging methods to evaluate pathological changes in the maxillary sinuses, while PR is still limited in the evaluation of these changes being considered only for initial diagnosis.

Comparison of Diagnostic Accuracy of Panoramic Radiography to CBCT in Maxillary Sinus Diseases

We aimed to compare the effectiveness of panoramic radiography (PR) and cone beam computed tomography (CBCT) in radiographic diagnosis of maxillary sinus (MS) diseases. MS diseases (mucosal thickening, mucus retention cyst, polyp sinusitis, mucocele and tumoral formations) was carried out on both PR and CBCT images belonging to 625 patients. Analyzes were performed separately for right and left maxillary sinus, and total of 1250 PR and CBCT images. While a diagnosis of disease was made in 42.96% of a total of 1250 MS according to CBCT. According to PR, diagnosis was made in 58.72%. The 537 diagnoses where lesion presence was determined on CBCT in our study were compared over PR, and it was observed that, there was the right diagnosis (true positive) in 106 (19.73%) of these including respectively mucus retention cyst (n = 88), polyp (n = 16), 1 sinusitis and 1 tumor, and there was an incorrect diagnosis (false positive) in 221 (41.15%). In 42.92% of the MS that were identified as healthy based on CBCT, the correct diagnosis was also made on PR (true negative). The use of CBCT instead of PR in the diagnosis of pathological or inflammatory diseases contributes to a more accurate radiographic differential diagnosis.

Assessment of Maxillary Sinus Variations Post-LeFort: A Systematic Review

Background

The purpose of this article was to systematically review maxillary sinus changes after LeFort. We examined and analyzed the anatomical abnormalities that occurred following LeFort I osteotomy, as well as the abnormalities of maxillary sinus volume (MSV) before and after the operation.

Methods

A systematic search was conducted on various databases, such as Google Scholar, PubMed, and Scopus. The articles used were in English and original. This study was conducted until September 2023, and after reviewing the articles, several keywords, such as "Maxillary sinus" and "LeFort I osteotomy", were employed. The obtained data were evaluated based on the PICO framework.

Results

Findings from 15 studies showed that the amount of MSV decreased before and after the operation (considering the three dimensions of the sinus, the measurement was performed linearly). These reduction values differed between men and women, with men having a greater reduction. As is the case with other operations, there were some side effects associated with this type of operation that some patients experienced postoperatively.

Conclusion

In both male and female patients, the MSV was reduced after one-piece and multi-segment osteotomies. Nonetheless, one-piece LeFort I osteotomy showed a higher reduction in MSV than the multi-segment osteotomy method, according to this systematic review and meta-analysis.

Evaluation of relationship between odontogenic infections and maxillary sinus changes: A Cone Beam Computed Tomography-based study

Introduction

Odontogenic infections affects the maxillary sinus mucosa. Cone Beam Computed Tomography (CBCT) is helpful in diagnosis of maxillary sinusitis of odontogenic origin. This cross-sectional study was planned with the aim to assess maxillary sinus changes associated with odontogenic infection by evaluating CBCT images.

Material and methods

In cross-sectional analytical study, total 213 patients (404 sinuses) were evaluated on CBCT after thorough clinical examination of the individuals and taking into consideration the history of rhino or allergic rhinitis. Based upon CBCT images and clinical examination, patients were divided into, study group (odontogenic infection) and control group (no associated odontogenic infection). Effect of the size of periapical lesion, spatial relationship of lesion to the sinus floor and periodontal bone loss on maxillary sinus changes were evaluated.

Results

Mucosal changes found in 200 sinuses (49.5%), mucosal thickening being the most prevalent and more commonly associated with odontogenic infections (p = 0.004). A significantly increased risk of mucosal thickening was observed with severe periodontal bone loss (p = 0.008). Size and spatial relationship of lesion to the maxillary sinus had no impact on the prevalence of mucosal thickening (p = 0.6, p = 0.4 respectively). Periodontal bone loss was 2.2 more likely to be associated with mucosal thickening than periapical or combined lesion.

Conclusions

Most prevalent sinus change was mucosal thickening. Periodontal bone loss was significantly associated with mucosal thickening. CBCT is an appropriate method for sinus evaluation.

Anatomical variations of the ethmoid sinuses and their association with health or pathology of the ethmoid and maxillary sinuses in a Southern Chinese population: An analysis using cone-beam computed tomography

Purpose

The aim of this study was to evaluate the prevalence of clinically relevant anatomical variations of the ethmoid sinuses and their potential association with ethmoid and maxillary sinus pathologies on cone-beam computed tomography (CBCT) scans. Additionally, potential associations with different sides and demographic factors, including age and sex, were evaluated.

Materials and Methods

In total, 273 CBCT scans with complete ethmoid and maxillary sinuses were analyzed to determine the prevalence of Agger nasi cell, supraorbital ethmoid cell, Haller cell, Onodi cell, and ethmomaxillary sinus. In addition, the health or pathology of the ethmoid and maxillary sinuses was also recorded to assess correlations with the aforementioned variations.

Results

The prevalence of Agger nasi cell was found to be the highest (95.6%) in this study, followed by Onodi cell (60.4%), Haller cell (29.3%), and supraorbital ethmoid cell (19.4%). Ethmomaxillary sinus was the least common finding (16.5%). Males and persons above 61 years of age had a significantly higher frequency of supraorbital ethmoid cell and Onodi cell, respectively. However, no significant relationships were noted between anatomical variations of the ethmoid sinus and pathologies of the ethmoid or maxillary sinus.

Conclusion

There was a high prevalence of ethmoid sinus variations in this Southern Chinese population. The prevalence of Agger nasi cell and Onodi cell was higher than that of other anatomical variations of the ethmoid sinuses. Anatomical variations of the ethmoid sinuses were not associated with ethmoid or maxillary sinus pathologies in this patient cohort.

Assessment of maxillary sinus lifting procedure in the presence of chronic sinusitis, a retrospective comparative study

INTRODUCTION

Chronic sinusitis can be considered a relative contraindication for sinus lifting procedure. However, its specific effects on bone height, infection and healing have not been as well investigated as its incidence as a post-operative complication.

METHODS

A retrospective comparative investigation was executed to evaluate the impact of chronic sinusitis on sinus lifting procedures regarding bone height, infection, and healing scores. Pre-operative and 6-month postoperative records (CBCT or CT and panoramic radiographs) of 40 patients who underwent sinus lifting procedure with graft and implant placement were split into two sets of 20 patients each; Group A is comprised of a patient with healthy sinus, whereas Group B includes patients with chronic sinusitis (identified as the presence of thickening of Schniederian membrane ≥ 2 mm, mucosal cyst, polyp or fluid level). Records of both groups were assessed for the difference in bone height of alveolar ridge between pre-operative radiograph and after six months postoperatively, and clinical notifications at the postoperative follow-up to report the healing and infection scores.

RESULTS

Statistically, there was non-significant difference in mean bone height gain (p-value > 0.05) in comparison to control group mean bone height (8.84 ± 0.93). Also, there was non-significant variation in mean healing and infection scores.

CONCLUSION

According to the available data, chronic sinusitis presenting as a thickening in the Schneiderian membrane has no significant effect on postoperative bone height, healing, or infection score in patients undergoing sinus augmentation with simultaneous implant placement. Further research is needed to better evaluate the effect of chronic sinusitis and its current status as a relative contraindication for sinus lifting procedure.

Does sinus floor elevation in the presence of Schneiderian membrane pathology increase therisk of membrane perforation and implant failure rate?

Schneiderian membrane (SM) thickness >2mm is regarded to be a pathological mucosal change. The aim of the current study is to answer the question" Does presence of pathological changes in the SM increase the risk of sinus perforation during surgical sinus floor elevation (SFE)?" An electronic database (PubMed, Embase, Cochrane Library, and Chinese database) were systemically searched for the studies published until February 2020. Randomized and non-randomized studies that reported the incidence of SM perforation in patients with SM pathology (antral pseudocyst or mucosal thickening) during SFE. The outcome measures were the incidence of SM perforation and implant survival rate. The pooled odds ratio (OR) with 95% confidence intervals and the Fixed-effects model were calculated. P-value ≤ 0.05 was considered to be statistically significant. Eighteen studies with a total of 1542 patients and 1797 SFE were included. Statistically insignificant difference in the incidence of SM perforation was observed between the normal-appearing sinus and thickened sinus mucosa (Fixed; OR, 0.896; 95%CI, 0.504 - 1.59; P =0.707, I 2 =32%). The rate of SM perforation in the normal sinus, mucosal thickening, and antral pseudocysts was 14%, 6%, and 6% respectively. The Implant survival rate was 98% in the normal sinus, and 100% in antral pseudocyst and mucosal thickening. SM thickening or antral pseudocyst did not increase the risk of membrane perforation and implant failure rates. Future RCTs are needed to evaluate the risk of the presence of pathological changes in the SM on the failure of the bone augmentation and dental implant.

One-year implant survival following lateral window sinus augmentation using plasma rich in growth factors (PRGF): a retrospective study

Background

The aim of this study was to assess one-year implant survival after lateral window sinus augmentation using PRGF combined with various bone grafting materials.

Material and Methods

This was a retrospective chart review and radiographic analysis of patients that had undergone lateral window sinus augmentation with PRGF and had dental implants placed at least 6 months post augmentation. All implants included were followed up for at least one year after placement. Demographic, sinus and implant related characteristics (residual ridge height, sinus membrane perforation, type of graft material, implant length and width and ISQ at placement) were analyzed.

Results

A total of 31 patients with 39 sinus augmentations and 48 implants were included. The mean follow up was 22.8 ± 9.9 months. Implant survival was 95.8%, with 2 implants overall failing. Among all the variables assessed, the only one found to be associated with an increased risk for implant failure was the use of xenograft as bone grafting material in the sinus.

Conclusions

Within the limitations of this study, dental implants placed in maxillary sinuses grafted with PRGF in combination with bone grafting materials, exhibit high implant survival rates after at least one year follow up.

Key words:PRGF, sinus graft, growth factors, implant survival, platelet concentrates.

Assessment of relationship between maxillary sinus membrane thickening and the adjacent teeth health by cone-beam computed tomography

Background/purpose

Maxillary posterior teeth have close anatomical proximity to the maxillary sinus floor. The aim of this retrospective study was to evaluate the associations between maxillary sinus membrane thickening and the adjacent teeth health by cone-beam computed tomography (CBCT).

Materials and methods

CBCT images were collected from 235 Taiwanese patients. The sinus mucosal thickening >2 mm is considered a pathologic sinus membrane. Demographic data such as sex, age, the thickness of sinus membrane, and the adjacent teeth health were recorded, graded, and analyzed.

Results

A total prevalence of maxillary sinus membrane thickening of 36.6% (86/235) was found in this study. The sinus membrane thickening was significantly associated with periodontal bone loss (p < 0.001) and periapical lesions (p < 0.001), respectively. A multivariate logistic regression model demonstrated that males had a significantly higher risk of sinus membrane thickening than females (OR: 2.08, 95% CI = 1.21–3.56). The patients in the age group ≥60 years showed a 4.35-fold increased risk of sinus membrane thickening compared with the patients in the age group ≤35 years (95% CI: 1.94–9.77). Severe periodontal bone loss was significantly associated with mucosal thickening with an OR of 4.78 as compared with normal to mild group (95% CI: 1.69–13.58). The patients having teeth with apical lesions had a 5.04 time OR for sinus membrane thickening than those having teeth without apical lesions (95% C.I.: 2.37–10.69).

Conclusion

The prevalence of maxillary sinus membrane thickening was more frequently occurred in male and older people. Periodontal bone loss and periapical lesions were significantly associated with maxillary sinus membrane thickening.

Schneiderian Membrane Thickness Is Increased in Patients With Cleft Lip and Palate

OBJECTIVE

Patients with cleft lip and palate (CLP) are more likely to have sinusitis. The purpose of this study is to determine whether patients with CLP have thickening of the Schneiderian membrane. Specific aims were to (1) compare Schneiderian membrane thickness in patients with CLP to noncleft controls, (2) evaluate whether membrane thickening is associated with cleft side in patients with unilateral cleft lip and palate (UCLP), and (3) evaluate if age and sex are predictors of mucosal thickening.

DESIGN

Case-control study.

SETTING

Tertiary care center.

PATIENTS

Patients with CLP and controls.

MAIN OUTCOME MEASURE

The primary outcome variable was maximum Schneiderian membrane thickness measured on cone beam computed tomography. The primary predictor variable was the presence of a cleft. Additional variables were cleft phenotype, age, and sex.

RESULTS

There were 225 patients with CLP and 93 controls. Median mucosal thickness was 2.4 mm in cleft group and 0.0 mm in controls (P = .006). In cleft group, 56.7% of sinuses had mucosal thickness >2.0 mm compared to 38.2% in controls (P = < .004). Pathologic membrane thickening (>4.0 mm) was significantly higher in cleft group (P = .005). No statistically significant difference in mucosal thickness between cleft and noncleft sides in patients with UCLP. Linear regression showed no association between age or sex and Schneiderian membrane thickness.

CONCLUSION

Schneiderian membrane thickening is more common in patients with CLP and is not associated with the side of the cleft in patients with UCLP.

Frequency, location, and morphology of accessory maxillary sinus ostia: a retrospective study using cone beam computed tomography (CBCT)

PURPOSE

To evaluate the reliability of cone beam computed tomography (CBCT) imagining in the assessment of the frequency, location, and morphological characteristics of accessory maxillary ostia (AMOs), and to analyze a potential association with sinus and dentoalveolar pathologies.

METHODS

CBCT scans with bilateral maxillary sinuses that were acquired from September 2016 to September 2018 were initially screened. A total of 160 CBCT scans (320 sinuses) that fulfilled the inclusion criteria were included for further analysis. The presence, location, and morphological characteristics of the AMOs were evaluated in axial, coronal, and sagittal CBCT views. The findings were correlated with age, gender, sinus, and dentoalveolar pathology to assess for potential influencing factors on AMOs.

RESULTS

An AMO was present in 151 (47.2%) of the 320 sinuses. Most of the AMOs were located within the region of the nasal fontanelle or hiatus semilunaris (81.1%) presenting with an ovaloid (48.4%) or a round shape (39.0%). The average length of the AMOs was 2.33 ± 1.42 mm, occupying an area of 3.43 ± 4.51 mm², respectively. Morphological changes of the maxillary sinus mucosa were positively associated with length and area of AMOs. Furthermore, the status of the dentition in the posterior maxilla seemed to be an influencing factor on AMO shape.

CONCLUSIONS

Nearly half of the maxillary sinuses assessed in the present study population had an AMO. Pathologies of the maxillary sinus seem to have an impact on AMOs, which is demonstrated here by morphological changes of the sinus mucosa being associated with an increase in length and area of accessory ostia.

Raising the transcrestal sinus floor in the presence of antral pseudocysts, and in sinus floors with a normal Schneiderian membrane: a retrospective cohort study

In this study we sought to investigate the influence of antral pseudocysts on the raising of the transcrestal sinus floor. We retrospectively studied two groups (test group: those with antral pseudocysts, and controls: those with normal Schneiderian membranes). The crestal approach with simultaneous placement of implants was used for all patients. Cone-beam computed tomography was done before, immediately afterwards, and 4-6 months postoperatively. Nineteen participants (16 male, three female, mean (SD) age 48 (10) years) were enrolled in the test group, and 73 (38 male, 35 female, 44 (11) years) in the control group. Immediately postoperatively the mean (SD) residual bone height was 5.15 (1.34) mm in the test group and 5.36 (1.28) mm in the control group (p = 0.15), and the raised heights of the sinus floor were 4.98 (2.01) mm and 5.47 (2.13) mm (p = 0.35) in the test and control groups, respectively. Four to six months postoperatively the endo-sinus bone gain values were 3.55 (2.46) mm and 4.03 (2.33) mm in the test and control groups, respectively (p = 0.26). All pseudocysts swelled immediately after operation. Four to six months postoperatively, two had remained unchanged, three had increased in volume, six had disappeared, and eight had decreased in volume. The survival rate of implants was 100% for both groups. Within the limitations of this study, transcrestal raising of the sinus floor in the presence of antral pseudocysts may be a viable technique, as they may not influence the clinical effects of raising the sinus floor during healing.

Visibility, location, and morphology of the primary maxillary sinus ostium and presence of accessory ostia: a retrospective analysis using cone beam computed tomography (CBCT)

OBJECTIVES

This retrospective study evaluated the visibility, location, and morphology of the primary maxillary ostium (PMO), as well as the presence and number of accessory maxillary ostia (AMO) in the maxillary sinus using cone beam computed tomography (CBCT).

MATERIALS AND METHODS

CBCT scans with a large field of view with both maxillary sinuses entirely visible, acquired from February 2016 to February 2018, were initially screened. Patients were included if there was no history of surgical intervention/trauma in the sinus region. Two observers evaluated the CBCTs for PMO and AMOs independently. PMO and AMOs were evaluated in axial, coronal, and sagittal CBCT views. In case of disagreement, a third observer served as a referee. The findings were correlated with age, gender, condition of the sinus mucosa, and status of the dentition to assess for potential influencing factors.

RESULTS

A total of 184 patients (368 maxillary sinuses) were included. PMO was present and patent in 346 (94.0%) of the 368 analyzed sinuses. Most of the PMOs were located above the attachment of and in the middle third of the inferior turbinate (76.1%) and exhibited a slit shape (71.1%). An AMO was present in 167 (45.5%) of the 368 analyzed sinuses, and 66 (17.9%) sinuses had multiple AMOs. Gender and sinus mucosa morphology were found to be influencing factors for the patency of the PMO. Furthermore, gender seems to be influencing the presence of an AMO.

CONCLUSIONS

Most of the analyzed maxillary sinus cavities in the present population had a patent PMO. Being male and having morphological changes of the sinus mucosa were factors associated with a reduced prevalence of a patent PMO.

CLINICAL RELEVANCE

A maxillary sinus with pathological findings of the mucosa seems to have a reduced prevalence of patent PMOs. Therefore, clinicians should take care to assess any clinical and radiographical sign indicating a potential maxillary sinusitis prior to surgical interventions in this region, especially in cases with planned sinus floor elevation.

Osteotome Sinus Floor Elevation Without Grafting: A 10-Year Clinical and Cone-Beam Sinus Assessment

PURPOSE

To evaluate the thickness of the sinus membrane in contact with implants inserted 10 years before using an augmentation procedure without grafting material, and to identify adverse events correlated with implant protrusion in the sinus.

MATERIALS AND METHODS

Osteotome sinus floor elevations were performed without grafting material. The implants (Straumann AG, Basel, Switzerland) were placed simultaneously, all protruded into the sinus. After 10 years, implants were considered viable in the absence of mobility, pain, infection, or continued radiolucency. Sinus health was assessed using cone-beam computed tomography and by the way of a questionnaire in which patients reported symptoms of sinusitis they might have had.

RESULTS

Controlled implants (21 implants, 13 patients) were osseointegrated. The membrane thickness was <2 mm in 11 patients and 2 to 3 mm with flat thickening in 2 patients. No patients exhibited any clinical or radiographic signs of sinusitis.

CONCLUSIONS

No sinus complications were observed after 10 years. The initial protrusion of implants into the sinus did not influence long-term sinus health. The maintenance of successful integration is thus the key to avoiding sinus complication.

Analysis of association between periodontal disease and thickness of maxillary sinus mucosa using cone beam computed tomography - A retrospective study

Purpose

The aim of this study was to measure the thickness of the mucous membrane lining the maxillary sinus and to correlate this thickening of the Schneiderian membrane with the presence or absence of periodontal bone loss of adjacent teeth, by using cone beam computed tomography (CBCT).

Methods

255 CBCT images were analyzed of which 140 images were selected for the study. Based upon the absence of radiographic periodontal bone loss and presence of 50% or more bone loss, these CBCT images were respectively divided into two groups viz. Group I (Healthy) and Group II (Periodontal Bone Loss Group), each group consisting of 70 images each. The thickening of the mucous membrane lining of the floor of maxillary sinus was measured at four points on the CBCT. These points were the anterior most point of the thickened mucosa, the posterior most point of the thickened mucosa, at the midpoint (MP) (point midway between the anterior most and the posterior most point) and the point of maximum thickness of the sinus mucosa.

Results

The age adjusted mean thickness for Group II was significantly greater than that of Group I (p < 0.001) at all the four points. There was a positive association between presence of periodontal bone loss and thickening of Schneiderian membrane at the floor of the sinus. There was a weak positive association between age and mucosal thickness. Of all the four points measured, the maximum correlation between age and thickness was obtained at MP (r = 0.171), which was statistically significant (p = 0.044).

Conclusion

The present study concluded that there is a positive association between presence of periodontal bone loss and thickening of mucosa of floor of maxillary sinus and also exhibited a weak positive relation between age and increased mucosal thickening of floor of maxillary sinus.

Effect of periodontal therapy on maxillary sinus mucous membrane thickening in chronic periodontitis: A split-mouth study

Background. This study evaluated the effect of periodontal therapy on mucous membrane thickening in maxillary sinus in chronic periodontitis patients using radiovisiography (RVG) and cone-beam computed tomography (CBCT).

Methods. The study population included 30 patients diagnosed with chronic periodontitis, exhibiting bilateral mucosal thickening of maxillary sinus. The selected sites were randomly assigned to group I (control group - not receiving periodontal therapy) and group II (test group - receiving periodontal therapy). The clinical parameters and mucosal thickening of the maxillary sinus were evaluated at baseline and after 9 months.

Results. There was a significant decrease in the PPD, CAL as well as mucosal thickening in group II while, group I showed an increase in these parameters. In group II at the end of 9 months the mean mucosal thickening reduction as assessed by CBCT was 0.76±0.18, 0.73±0.24, 0.88±0.42 and 1.13±0.43 mm at the most anterior point (AP), the most posterior point (PP), the mid-point (MP), point of maximum thickness (MT) as well as in the length of the thickened mucosal lining, respectively.

Conclusion. The results of our study indicated a reduction in the mucosal thickening of the maxillary sinus after surgical periodontal therapy. The trial was registered with the Clinical Trial Registry of India (Trial REF/ 2016/02/010805).

Evaluation of the Characteristics and Association Between Schneiderian Membrane Thickness and Nasal Septum Deviation

OBJECTIVE

Nasal septum deviation (NSD) is an anomaly that disturbs normal mucus drainage in sinuses, leading to recurrent sinusitis. Sinusitis, infections, and mucosal irritations are the potential causes of Schneiderian membrane thickening (SMT). The aim of this study was to evaluate the characteristics and association between NSD and SMT along with factors such as age, gender, and tooth groups using cone-beam computed tomography (CBCT) imaging.

METHODS

The maxillary sinus and nasal cavity of 249 patients (136 females and 113 males) were examined retrospectively using CBCT. The statistical analysis was performed to determine the association between SMT, NSD, gender, and age.

RESULTS

No statistically significant relation was detected between NSD and SMT. The NSD was found in 50.6% of patients without gender predilection. Age was not associated with the presence of NSD. The mean thickness of the membrane was least in the third molar region and highest in the first molar region. The average SMT was found to be higher in males for all the examined tooth areas (P ≤ 0.05).

CONCLUSION

A retrospective evaluation of CBCT images emphasized the concept that NSD was not a factor that affected the thickening of maxillary sinus mucosa. The CBCT imaging could be used for evaluating the maxillary sinuses and nasal septum.

Frequency and type of incidentally detected radiodensities in the maxillary sinus: a retrospective analysis using cone beam computed tomography (CBCT)

OBJECTIVES

To evaluate the frequency, location, and characteristics of radiodensities in the maxillary sinus using cone beam computed tomography (CBCT).

MATERIALS AND METHODS

All CBCT scans with a large field of view with both maxillary sinuses entirely visible were initially screened. Patients were included, if there was no suspicion of sinus pathology and no history of surgical intervention/trauma in the sinus region. The location and shape of the radiodensities were evaluated in axial, coronal, and sagittal CBCT views. The findings were correlated with age, gender, condition of the sinus mucosa, and status of the dentition.

RESULTS

A total of 169 patients (338 maxillary sinuses) were included. Radiodensities were found in 35 sinuses (10.4%) of 28 patients (16.6%) with a mean age of 32.0 years. Most of the 35 affected sinuses had one radiodensity (19/54.2%). The radiodensities were typically located at the sinus floor (22/62.9%). Of the sinuses presenting with radiodensities, 17 (48.6%) were exhibiting reactive changes of the Schneiderian membrane. The presence of periodontal pathology was found to be associated with the presence of radiodensities. Age and sinus pathology were influencing factors on the shape of radiodensities, and the status of the dentition was an influencing factor on the number of lesions.

CONCLUSIONS

One-sixth of the patients analyzed had incidentally diagnosed radiodensities in their maxillary sinuses. As almost 50% of the sinuses with radiodensities exhibited a form of chronic rhinosinusitis, the diagnosed ectopic calcifications may have formed as a result of mucosal changes of inflammatory origin. The presence of periodontal pathology was associated with a higher incidence of radiodensities. Nevertheless, this finding has to be interpreted with some caution due to the limited sample size available.

CLINICAL RELEVANCE

Incidentally detected radiodensities in the maxillary sinus are not an infrequent finding in CBCT scans of asymptomatic patients, and are located typically on the sinus floor. Future studies are needed to assess the clinical significance of these findings especially with regard to planned surgical interventions in the posterior maxilla.

Crestal endoscopic approach for evaluating sinus membrane elevation technique

Abstract

Closed sinus lifting is a unique technique in being simple and less invasive (Summers, Compendium 15(6):698, 1994). However, it is blind to assess the safety of sinus lining during lifting without perforation. Previously, sinus membrane was assessed endoscopically in an invasive way. We aimed to judge clinically the sinus membrane integrity after crestal elevation by a direct simple less invasive endoscopic visual assessment through the crestal osteotomy site. To confirm undetected perforation, the sinus membrane was monitored dynamically by introducing the endoscope through a trephined opening in the lateral wall of the sinus (Nkenke et al., Int J Oral Maxillofac Implants 17(4):557–66, 2002).

Patients

Twelve patients suffering atrophic posterior maxillae ranging 3–5 mm bone height below the sinus membrane were included to perform closed sinus lifting with simultaneous immediate implant placement under direct endoscopic assessment.

Results

The floor was lifted without perforation in 83.33% of cases. However, it varied according to its thickness. Minor perforations occurred in two cases (16.67%). Both perforations were detected from the crestal endoscopic view while one of them was detected from the lateral endoscopic approach.

Conclusion

Crestal endoscopic access gives better direct vision to the membrane than the induced opening in the lateral wall of the maxillary sinus. Moreover, it uses the same prepared osteotomy site without doing any extra procedures. Perforation depends on the thickness of sinus lining and its ability to stretch during elevation. Intact crestal sinus floor elevation can never be guaranteed under endoscopic monitoring especially with thin irregular membranes.

Use of cone beam computed tomography in implant dentistry: current concepts, indications and limitations for clinical practice and research

Diagnostic radiology is an essential component of treatment planning in the field of implant dentistry. This narrative review will present current concepts for the use of cone beam computed tomography imaging, before and after implant placement, in daily clinical practice and research. Guidelines for the selection of three-dimensional imaging will be discussed, and limitations will be highlighted. Current concepts of radiation dose optimization, including novel imaging modalities using low-dose protocols, will be presented. For preoperative cross-sectional imaging, data are still not available which demonstrate that cone beam computed tomography results in fewer intraoperative complications such as nerve damage or bleeding incidents, or that implants inserted using preoperative cone beam computed tomography data sets for planning purposes will exhibit higher survival or success rates. The use of cone beam computed tomography following the insertion of dental implants should be restricted to specific postoperative complications, such as damage of neurovascular structures or postoperative infections in relation to the maxillary sinus. Regarding peri-implantitis, the diagnosis and severity of the disease should be evaluated primarily based on clinical parameters and on radiological findings based on periapical radiographs (two dimensional). The use of cone beam computed tomography scans in clinical research might not yield any evident beneficial effect for the patient included. As many of the cone beam computed tomography scans performed for research have no direct therapeutic consequence, dose optimization measures should be implemented by using appropriate exposure parameters and by reducing the field of view to the actual region of interest.

Incidence of Maxillary Sinus Disease Before Sinus Floor Elevation Surgery as Identified by Cone-Beam Computed Tomography: A Literature Review

The purpose of this study is to review the literature to assess the incidence of maxillary sinus disease before sinus floor elevation surgery (SFE) as identified by cone-beam computerized tomography (CBCT). Only studies in which CBCT was performed in patients for dental implant placement in the past 10 years were considered. Eleven studies were identified. A total of 1792 patients were collected. All the studies reviewed reported on thickening of the sinus mucosa as a criterion for sinus disease with different threshold values. All studies reported mucosal thickening (MT) ranging between 25.5% and 93.1%. The mean incidence of MT was 54.99%. Two studies examined the correlation of MT with clinical symptoms. Three studies reported evaluation of the ostiomeatal complex (OMC). There is a high probability of detecting a certain degree of MT in patients referred for SFE. There is no consensus regarding the threshold values beyond which MT is considered pathological. Independently from the threshold values or the type of MT, the studies lack correlation with clinical data regarding patients' sinusitis-related history or symptoms. CBCT with a large field of view to evaluate the OMC is appropriate in patients scheduled for SFE. Future studies should include a systematic correlation with clinical symptoms and the possible presence of OMC obstruction. A clinical assessment that includes nasal endoscopy is indicated when MT and obstruction of the OMC are identified. Surgical correction of OMC obstruction seems to be appropriate to increase the success rate and to avoid possible complication after SFE.

Odontogenic sinusitis: a comprehensive review

Odontogenic sinusitis (OS) is a highly prevalent, underappreciated and underdiagnosed disease that has been known for over 100 years. Apical periodontitis, periodontal disease and iatrogenic extrusion of foreign bodies into the sinus are the main causes of OS. Although the prevalence of sinus pathosis of dental origin is still controversial, otolaryngologists recognize that in the presence of recalcitrant sinusitis, a dental origin should be considered and properly treated. Currently, cone-beam computed tomography is the gold-standard imaging technique to assess the relationship between dental conditions, especially apical periodontitis and sinus diseases, and whenever this association is detected, patients should be seen by both a dentist and an otolaryngologist in order to achieve complete recovery. This article reviews the current concepts regarding the definitions, diagnosis and management of OS from a clinical point of view.

Frequency, location, and association with dental pathology of mucous retention cysts in the maxillary sinus. A radiographic study using cone beam computed tomography (CBCT)

OBJECTIVES

The purpose of the present study was to evaluate the frequency, locations, and dimensions of mucous retention cysts of the maxillary sinus and analyze potential associated dental pathology.

MATERIALS AND METHODS

A total of 156 cone beam computed tomography (CBCT) scans were included in the analysis, resulting in an evaluation of 310 maxillary sinuses. The presence of mucous retention cysts (MRC) manifesting as dome-shaped radiopacities in the sinus was diagnosed. Their locations were recorded, and dimensions (mm) were measured in coronal and sagittal/axial slices. The patients were grouped into (a) patients/sinuses with MRCs (test), and (b) patients/sinuses with healthy or any other changes (control) for further comparison and evaluation.

RESULTS

There were 40 sinuses (12.9%) with a presence of a total of 56 MRCs. The mean age of involved patients was 29.0 years. The analysis showed that gender, age, sinus side, status of dentition, endodontic status, and periodontal status did not have a significant influence on the presence of MRCs when compared between test and control groups. Age and endodontic status exhibited a significant association with cyst location.

CONCLUSIONS

Most of the sinuses analyzed (79.5%) did not present any MRC, and only 28.6% of the cysts diagnosed were found on the floor of the maxillary sinus. The mean dimension of the MRCs measured 6.28 ± 2.93 mm. No influencing factors on the presence or absence of MRCs were found in the present study.

CLINICAL RELEVANCE

Most MRCs were not located on the floor of maxillary sinus. Future studies should assess their impact on surgical interventions in the sinus.

Characterization of the Maxillary Sinus Using Cone Beam Computed Tomography. A Retrospective Radiographic Study

PURPOSE

To analyze the anatomical findings and alterations of the maxillary sinus in asymptomatic patients observed by cone beam computed tomography.

MATERIALS AND METHODS

A cross-sectional retrospective study of the anatomical variations and alterations of the maxillary sinus was made in 160 patients-71 males (44.3%) and 89 females (55.6%), with an age range of 18 to 74 years-measuring the thickness of the Schneiderian membrane and the cortical thickness of the lower margin of the maxillary sinus (in its most caudal portion), and correlations among the different study variables were assessed.

RESULTS

Sinus pneumatization was the most frequent anatomical finding (81.3%). A negative correlation was observed between the thickness of the Schneiderian membrane and the presence of Underwood septa (P < 0.005). Mucosal thickening of more than 2 mm was directly correlated with the presence of maxillary sinus lesions (opacification, discontinuity of the floor of the sinus, polypoid lesions, or air-liquid levels).

CONCLUSION

The presence or absence of septa seems to be related to the thickness of the Schneiderian membrane.

Panoramic radiographs made before complete removable dental prostheses fabrication: A retrospective study of clinical significance

STATEMENT OF PROBLEM

The value of digital panoramic radiographs to screen for problems before fabricating conventional complete dentures is unclear.

PURPOSE

The purpose of this retrospective study was to examine the influence of pretreatment digital panoramic radiographs on the clinical management of patients receiving complete removable dental prostheses.

MATERIAL AND METHODS

The clinical records, including panoramic radiographs, of 169 patients seeking new complete removable dental prostheses over a 6-year period were interpreted independently by both a prosthodontist and an oral and maxillofacial radiologist to identify radiographic findings that influenced clinical patient management. A 95% confidence interval and an observed proportion of agreement were used to interpret the results.

RESULTS

Sixty percent of the 169 radiographs examined had 1 or more abnormal or positive radiographic findings; however, only 6 (<4%) of 165 abnormalities detected influenced patient management, and 3 of them were identified during the clinical examination.

CONCLUSIONS

Pretreatment digital panoramic radiographs revealed very few abnormalities that influenced the treatment of patients requiring complete removable dental prostheses. Furthermore, the digital images in this study revealed positive findings at a rate similar to those found in studies assessing analog radiographs, reinforcing current guidelines that recommend against radiographic screening of patients who seek new complete removable dental prostheses.

Radiological Study of Maxillary Sinus using CBCT: Relationship between Mucosal Thickening and Common Anatomic Variants in Chronic Rhinosinusitis

INTRODUCTION

Inflammatory diseases of the maxillary sinus favour the thickening of the sinus mucosa. Therefore, it might be possible to establish a radiological, pathological threshold of mucosal thickening. Furthermore, there is an association between common anatomic variants of the nose and maxillary mucosal thickening.

AIM

To define the pathological thickening of maxillary sinus mucosa and its association with the presence of common anatomic variants (concha bullosa, Haller's cell and accessory maxillary ostium).

MATERIALS AND METHODS

From March 2014 to February 2016, Two hundred patients underwent Cone Beam Computed Tomography (CBCT) of the paranasal sinus. We conducted this retrospective study of total 70 patients, 34 patients i.e., a total of 68 meatus-maxillary units (study group - those affected by Chronic Rhinosinusitis (CRS) and another 36 patients i.e., a total of 72 meatus maxillary units (control group - without symptoms of CRS). We assessed the degree of thickening of the sinus mucosa distinguishing between ≥ 2mm or ≤ 2mm, than we analysed the behaviour of the thickness in the study group and in the control group. Chi-Square test was used to compare mucosal thickening between study and control group and the presence of some common anatomic variants or closure of maxillary ostium.

RESULTS

In the study group we observed a clear association between maxillary mucosal thickening ≥ 2mm and CRS (p<0.01). We however, observed no association between the presence of common anatomic variations and thickening of the maxillary mucosa and between the presence of common anatomic variations and the study group. Instead, using a binary logistic regression, we observed a significant association (p<0.01) between closure of natural ostium of the maxillary sinus and mucosal thickening or between closure of natural ostium and study group.

CONCLUSION

We believe that a thickening of the maxillary mucosa ≥ 2mm and closure of natural maxillary ostium are statistically associated with CRS. The common anatomical variants do not seem to be associated with this condition.

Cone beam computed tomographic analysis of maxillary premolars and molars to detect the relationship between periapical and marginal bone loss and mucosal thickness of maxillary sinus

Background

This study assessed the relationship between mucosal thickness (MT) of the maxillary sinus and periodontal bone loss (PBL) and periapical condition of related teeth. We also aimed to identify the association between root apices and the inferior wall of the maxillary sinus using Cone beam computed tomography (CBCT).

Material and Methods

In this study, CBCT images of 205 patients with 410 maxillary sinuses were examined, retrospectively. A total of 582 maxillary molars and 587 premolars were observed. The relationship of each root with maxillary sinus and apical lesions of these roots were classified, PBL was examined and the situations of adjacent teeth were estimated. The effect of these conditions on sinus mucosal thickness (MT) was evaluated.

Results

There was a significant correlation between MT of maxillary sinus and both PBL and age (r = 0.52, p=0.000 and r = 0.111, p= 0.002, respectively). The frequency of MT increased as the severity of apical lesion enlarged. A positive correlation was found between MT and degree of PBL and periapical lesions. To reveal the association between MT and pulpoperiapical condition bivariate correlation was done and a significant relationship between the pulpoperiapical condition and MT was found (r = 0.17, p=0.000).

Conclusions

This retrospective study showed that MT of the maxillary sinus was common among patients with PBL and MT was significantly associated with PBL and apical lesions. The relationship of maxillary sinus to adjacent teeth had also positive correlation with MT. CBCT imaging enabled better evaluation of maxillary sinus, posterior teeth and surrounding structures compared to other imaging tools.

Key words:Maxillary sinus mucosal thickness, apical periodontitis, periodontal bone loss, CBCT.

Sinus mucosal thickening in bisphosphonate-related osteonecrosis of the jaws: a case-control study

Osteonecrosis of the jaws is a clinically significant complication of bisphosphonate (BP) medications. Otherwise, the effects of BPs on oral soft tissue or cells remain unknown. The main objective of the present study was to determine whether the presence of sinus mucosal thickening was significantly related to BP-related osteonecrosis of the jaw (BRONJ). A case-control study was conducted on 32 patients who underwent treatment of BRONJ with conventional radiological investigations (panoramic radiographs) and computed tomography. The results indicated that patients with BRONJ had a 5.57-fold greater probability of presenting sinus mucosal thickening than controls. Although the existence of this thickening was more common in patients with advanced-stage disease or low levels of C-telopeptide-cross-linked type I collagen, no significant difference was observed between cases and controls. While considering the limitations inherent in the design and number of cases analyzed in our study, patients with osteonecrosis of the jaw were found to have a 5.57-fold greater probability of presenting sinus mucosal thickening (>3 mm) than healthy subjects.

The influence of sinus membrane thickness upon membrane perforation during transcrestal sinus lift procedure

OBJECTIVES

Schneiderian membrane perforation is one of the main complications during sinus augmentation. The reasons may be associated with surgical technique, septum, inadequate ridge height, and membrane thickness. However, reports that used cone-beam computed tomography (CBCT) to quantify the thickness of sinus membrane were limited. The aims of this retrospective study were: to study the correlation between membrane thickness and perforation rate during transcrestal sinus lift and to propose a classification system of sinus membrane thickness based upon CBCT data.

MATERIAL AND METHODS

One hundred and twenty-two subjects who received dental implant restorations over posterior maxilla with a total of 185 transcrestal sinus lift procedures between years 2010 to 2013 were selected consequently. Each patient selected had to have taken CBCT in the initial examination and immediately after surgery. The membrane thickness, perforation rate, residual bone height, and elevated bone height were recorded and processed for statistical analysis.

RESULTS

The mean thickness of the Schneiderian membrane was 1.78 ± 1.99 mm. There was a significant correlation between membrane thickness and perforation rate (P < 0.05), and the perforation rate was higher in thicker (≥3 mm) and thinner membrane (≤0.5 mm). Among the thickness group, Class B (between ≥1 and <2 mm) had the lowest perforation rate. No significant difference was between the perforation and the membrane morphology. A negative relationship between residual bone height and membrane thickness was found. Trend showed that in the thicker and the thinner residual bone height, the higher the perforation rate would be.

CONCLUSIONS

There was a significant correlation between membrane thickness and perforation rate. The perforation rate was lowest when the thickness was 1.5-2 mm.

Residual ridge dimensions at edentulous maxillary first molar sites and periodontal bone loss among two ethnic cohorts seeking tooth replacement

OBJECTIVES

To study residual ridge dimensions at edentulous first molar sites in relation to periodontal bone loss among cohorts of partially edentulous Asian Indian and Hong Kong Chinese subjects seeking tooth replacement.

MATERIALS AND METHODS

A total of 628 edentulous maxillary first molar sites were analyzed on Cone Beam Computed Tomography scans of 225 Asian Indian (I) and 232 Hong Kong Chinese (C) partially edentulous adults seeking tooth replacement. Age, ethnicity, gender, total tooth loss, the presence or absence of adjacent teeth, categories of periodontal status defined according to radiographic alveolar bone loss (P0: periodontal health, P1: incipient to moderate disease, P2: severe periodontal disease) and sinus membrane abnormalities were noted. Alveolar ridge height (RH), widths at 1 and 3 mm from crest (RW1; RW3), and relative position of the bone crest (RR) were measured.

RESULTS

Prevalence of P2 status was most frequent in both cohorts(C: 50.4% I: 49.2%). P2 had lowest ridge heights; 13.1% C P2 and 14%I P2 had RH < 2 mm. Sites with both RH <8 mm and RW1 < 6 mm occurred at 59%C P2 and 68%I P2. Sinus membrane abnormalities were most frequent in P2. Periodontal status and sinus membrane abnormality increased the odds of RH <5 mm and RH <8 mm more than 2-fold; additionally, gender and ethnicity significantly impacted RH <8 mm. Gender and adjacent tooth status significantly affected RW1.

CONCLUSION

Incident advanced periodontal disease was common among Asian Indian and Hong Kong Chinese subjects seeking tooth replacement and associated with lower available bone heights. Ethnicity, gender, sinus membrane thickening affected available bone height in the subsinus region, while the presence of adjacent teeth- and age-affected residual ridge width.

Transient swelling of the Schneiderian membrane after transversal sinus augmentation: a pilot study

OBJECTIVE

The predictability and simplicity of the Summers' technique for sinus floor elevation encouraged many clinicians to consider this new approach. The impact of such intervention on the sinus mucosa has, however, not been explored extensively. This pilot study followed the response of the Schneiderian membrane, longitudinally, via cone-beam CT images.

MATERIAL AND METHODS

Ten consecutive patients (five women, mean age 58.7 years) referred for implant therapy in the posterior part of the maxilla, in combination with a trans-alveolar sinus floor elevation (13 sinuses involved), were enrolled. CBCT images were taken prior to and at 1 week and 1 month after surgery. The changes in thickness of the Schneiderian membrane were scored at nine standardized points per sinus using reformatted cross-sectional images.

RESULTS

One week after sinus floor elevation, the Schneiderian membrane showed a significant swelling of 9.2 mm in the middle (SD 0.3; P < 0.005), 7.2 mm medially (SD 2.5; P < 0.005) and 3.9 mm laterally (SD 0,3; P < 0.05), respectively, resulting in an overall mean of 6.7 mm (SD 2.6), which fully disappeared 3 weeks later. This swelling involved the entire floor of the sinus and not only the augmented area.

CONCLUSIONS

Within the limitations of this pilot study, one can conclude that the Schneiderian membrane responds with a significant "transient" swelling (5-10× its size) during the first weeks of healing.

Characteristics and dimensions of the Schneiderian membrane and apical bone in maxillary molars referred for apical surgery: a comparative radiographic analysis using limited cone beam computed tomography

INTRODUCTION

The purpose of the present study was to evaluate the thickness and the anatomic characteristics of the Schneiderian membrane and cortical bone using limited cone beam computed tomography (CBCT) scannning in patients referred for planning of apical surgery of maxillary molars.

METHODS

This controlled study included 2 cohorts of patients (n = 50 for each group). For patients in group 1 (with apical pathology), 3 measurements in millimeters were performed using coronal and sagittal CBCT slices: the dimension of the apical lesion in the axis of the root, the width of the cortical bone in the axis of the root, and the thickness of the Schneiderian membrane perpendicular to the underlying cortical bone. For the analysis of CBCT scans of group 2 (without apical pathologies), 2 measurements were performed using coronal and sagittal CBCT slices: the width of the cortical bone in the axis of the root and the thickness of the Schneiderian membrane perpendicular to the underlying cortical bone.

RESULTS

For group 1, the periapical lesions evaluated measured between 0.27 and 7.41 mm in diameter, the apical bone separating the apical lesions from the maxillary sinus ranged from 0.13 to 7.83 mm, and the dimensions of the Schneiderian membrane ranged from 0.25 to 13.98 mm. The apical bone was generally thicker in patients with periapical lesions. Regarding the dimensions of the Schneiderian membrane, the values were statistically significantly higher for the patients in group 1 compared with group 2.

CONCLUSIONS

The study showed that the Schneiderian membrane in the vicinity of roots with apical lesions tends to be significantly thicker when compared with the roots of teeth without apical pathoses.

Cone-beam computed tomographic evidence of the association between periodontal bone loss and mucosal thickening of the maxillary sinus

BACKGROUND

The aim of the present study is to determine the relationship between dental findings and mucosal abnormalities of the maxillary sinus among dental patients, using cone-beam computed tomography (CBCT).

METHODS

Two hundred fifty CBCT scans of dental patients were studied. Dental findings of the upper posterior teeth, including periodontal bone loss, periapical lesions, and root canal fillings, were assessed. The presence of mucosal thickening and mucosal cysts of the maxillary sinus was recorded. Logistic regression analysis was used to determine the influence of periodontal bone loss, periapical lesions, and root canal fillings on these sinus mucosal abnormalities.

RESULTS

Mucosal thickening was present in 42% of patients and in 29.2% of sinuses studied. Mucosal cysts were observed in 16.4% of patients and in 10% of sinuses studied. Both abnormalities were present more frequently among males than females. Severe periodontal bone loss was significantly associated with mucosal thickening (odds ratio: 3.02, P <0.001), whereas periapical lesions and root canal fillings were not. There was no association between dental findings and mucosal cysts.

CONCLUSIONS

Severe periodontal bone loss was significantly associated with mucosal thickening of the maxillary sinus. Sinuses with severe periodontal bone loss were three times more likely to have mucosal thickening. Mucosal cysts were not associated with any dental findings.

Sinus floor elevation from a maxillary molar tooth extraction socket in a patient with chronic inflammation

BACKGROUND

The compromised nature of the residual interradicular bone after extraction of periodontally hopeless maxillary molars often requires a sinus elevation procedure to ideally place the implants to accept future prosthesis. Maxillary sinus elevation surgery is a procedure used to increase the volume of bone mass so that dental implants can be placed. This article documents a sinus floor elevation technique through an extraction socket in a 65-year-old white male with chronic inflammation to increase the bone mass after the extraction of a periodontally involved maxillary molar tooth.

METHODS

Computerized tomography revealed an increased thickness of the sinus membrane, which was attributed to possible chronic sinus inflammation and periodontal inflammation. After consultation with the Department of Otolaryngology, it was diagnosed as chronic inflammation without any contraindication for sinus elevation surgery or implant placement. One month after the extraction, the sinus floor elevation surgery was performed through the extraction socket, and implants were placed 4 months later.

RESULTS

An uneventful healing was noted after 6 months of osseointegration; two porcelain-fused-to-metal crowns were fabricated. Clinical follow-up took place every 3 months for 3 years, and successful healing was achieved. The patient was satisfied with the esthetic and functional results of the oral rehabilitation.

CONCLUSION

Sinus floor elevation through an extraction socket without any residual bone, followed by dental implant placement, provided successful functional results and acceptable stability.

Prevalence of maxillary sinus septa in 1024 subjects with edentulous upper jaws: a retrospective study

Maxillary sinus floor augmentation has been routinely performed to optimize dental implant placement in the posterior maxilla. However, complications during a sinus grafting procedure, such as perforation of the Schneiderian membrane, have been reported. This complication is generally associated with the presence of maxillary septa. Therefore, the aim of this retrospective study was to evaluate the prevalence of maxillary sinus septae in completely edentulous subjects by means of panoramic radiography. A total of 1024 panoramic radiographs were evaluated by 3 calibrated examiners. From these radiographs, 307 maxillary septa were detected in 221 subjects (21.58%); 86 (8.40%) of the subjects showed maxillary septa in both maxillary sinuses. Logistic regression failed to detect any correlation between the presence of maxillary septa, age, and gender (P > .05). Within the limits of the study, the prevalence of maxillary septa in this Brazilian population was shown to be moderate, indicating that dentists must be aware of the presence of this anatomic structure during maxillary sinus elevation grafting.

Maxillary sinus augmentation in the presence of antral pseudocyst: a clinical approach

OBJECTIVE

The objective of this study is to present patients with sinus augmentation in the presence of an antral pseudocyst and the surgical procedure, complications, and outcome.

STUDY DESIGN

From 2002 to 2005, 109 patients were scheduled for 1- or 2-stage maxillary sinus floor augmentation (n = 129) because of inadequate alveolar bone height for implant placement. Radiographically, a significant antral pseudocyst was shown.

RESULTS

In 8 (7.3%) patients, an antral pseudocyst was diagnosed, and in 2 a history of inactive sinusitis was found preoperatively. A faint dome-shaped radiopacity was found at the lower border of the maxillary sinus. Average lesion size was 5.09 cm2. All implants functioned well at follow-up (mean 20 months).

CONCLUSION

A pseudocyst of the maxillary sinus is not a contraindication for sinus augmentation. The low frequency of sinus membrane perforation and postsurgery sinusitis make the operation safe. In large lesions and in cases with an unclear diagnosis, further evaluation is needed before sinus augmentation.

Prevalence of maxillary sinus disease and abnormalities in patients scheduled for sinus lift procedures

BACKGROUND

The purpose of the present study was to determine the prevalence of sinus disease and abnormalities among patients scheduled to undergo direct sinus augmentation.

METHODS

Forty-five patients attending a private periodontal practice and consecutively treatment planned for sinus augmentation were referred for otorhinolaryngologic evaluation, which included a medical history and radiographic (computed tomography), clinical, and endoscopic examinations. Pathological findings were recorded and otorhinolaryngologic treatment was provided. Six months later the sinus augmentation procedure was performed and followed by postoperative evaluations for 4 to 6 months.

RESULTS

Of the 45 subjects, 98% (44) were diagnosed with chronic periodontitis, 51% were smokers, and 27% reported a history of symptoms indicative of sinus disease. Eighteen subjects were diagnosed with sinus disease and/or abnormalities. The diagnosed conditions included chronic sinusitis, sinus cysts, nasal septum deviation, and ostium stenosis. No significant differences in age, gender, or smoking status between patients with and without sinus conditions were found (P >0.05). There was a significant association between history of symptoms and diagnosis of sinus conditions (P <0.0001). Three subjects (one treated for preoperative sinus conditions) experienced notable intra- or postoperative complications related to the sinus augmentation procedure.

CONCLUSIONS

The results indicate that, in a population of patients with chronic periodontitis, presence of sinus conditions is strongly associated with a history of indicative symptoms and is independent of age, gender, and smoking status. The results reinforce the importance of careful detailed history taking and thorough clinical and radiographic evaluation prior to performing sinus augmentation.