Retrospective analysis of maxillary sinus septa - A cone beam computed tomography study

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

AIM

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

METHODOLOGY

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

RESULTS

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

CONCLUSIONS

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

Evaluation of Maxillary Sinus Septa Using Cone Beam Computed Tomography (CBCT): A Retrospective Study

BACKGROUND

Maxillary sinus septa, which are bony structures dividing the sinus cavity, can pose challenges during sinus lift or implant surgeries by potentially causing perforation of the Schneiderian membrane. This study aimed to estimate the prevalence, height, location, orientation, and risk of perforation of the maxillary sinus septa using cone beam computed tomography (CBCT).

MATERIALS AND METHODS

This retrospective, cross-sectional study utilized CBCT (NewTom CBCT machine, of which the scan parameters were 90 KvP, 8 mAs, and 14 s exposure with a field of view (FOV) of 8×8 cm and a 0.2 mm3 voxel size) images of 300 maxillary sinuses from patients aged >18 years, obtained from Swami Devi Dyal Hospital and Dental College in Panchkula, India. Scans were analyzed for the presence, height, location, orientation, and risk of septal perforation. The data were categorized based on age, sex, and dentition status. Statistical analyses were performed to assess the prevalence, configuration, and risk factors.

RESULTS

The prevalence of maxillary sinus septa was 21.33%, with the majority showing a single septum (90.63%). Septa were predominantly found in the middle region (48.44%), with bucco-palatal orientation (93.75%) being more common than anteroposterior. The mean septa height was 6.16 mm. The perforation was classified as moderate (48.4%), low (46.8%), or high (4.6%). Class III septa were associated with the highest risk of perforation.

CONCLUSION

This study highlights a significant prevalence of maxillary sinus septa with variations in height, orientation, and location. The risk of perforation varies with the septa configuration and orientation. CBCT is essential for identifying these anatomical features to minimize surgical complications and to guide preoperative planning.

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

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

Research trends on maxillary sinus septa in 2019-2021: a scoping review with scientometric analysis

PURPOSE

This study aimed to conduct a bibliometric analysis of trends in the description items within the literature published from 2019 to 2021 with "maxillary sinus septum" in the title or subtitle.

METHODS

Electronic data from PubMed (MEDLINE), Google Scholar, and ScienceDirect were searched from 2019 to 2021. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) to select 21 of 243 articles and examined their studies. Statistical calculations from data recorded by the authors were performed using the Chi-square, Mann-Whitney, and independent tests. Significance was set at P < 0.05.

RESULTS

The number of articles decreased annually. The highest number of publications was from Asia (64.3%), accounting for 71.4% of publications. The features of the septum were described for eight items, with one septum (70.14%) mentioned significantly more frequently, followed by on one side (65.89%) or the right side (62.22%). Location was mentioned significantly more frequently in the middle (55.22%) and for those aged 45 years and older (50.38%). No significant differences were observed in prevalence, age, height, or width between sexes; the patients' ages ranged from 18 to 90 years. Septa were significantly more prevalent in dentulous (45.38%) and partially edentulous (48.58%) patients, with significantly more patients exhibiting buccopalatal orientation (82.39%).

CONCLUSIONS

This study focused primarily on anatomical features using CBCT examination, and analyses of male-female differences and the origin of the sinus septum are necessary for the future.

Prevalence and Characteristics of the Maxillary Sinus Septa in a Saudi Arabian Sub-population: A Retrospective Cone Beam Computed Tomography (CBCT)-Based Study

OBJECTIVES

This study aims to investigate and determine the prevalence, location, and morphological differences of the maxillary sinus septa using cone beam computed tomography (CBCT) images in the Madina region and to discuss its clinical implications during sinus surgery.

METHODS

This study was a retrospective cross-sectional radiographic analysis of 808 CBCT scans from patients who attended Taibah University's College of Dentistry between December 2018 and June 2023. Age, gender, number of septa present per side, location (anterior, middle, posterior), morphology (complete or partial), and type (primary or secondary) were among the study variables. For data statistics, correlation analysis was utilized.  Results: Eight hundred eight CBCT scans were included with a mean age of 34.7±15.08. Septal bone was absent in 60.64% of the sinuses examined. Single septa were more common than multiple septa (p=0.009). Bilateral septal presence and the left septal bone were more common than the right, but none of these distributions were statistically significant. Males showed more sinus septa compared to females, but the difference was not statistically significant (p=0.420). Single septa were more prevalent in people under the age of 25.

CONCLUSION

More than 60% of the Madina population had patent sinus cavities with no septal processes, but males with single septal processes predominated.

The CBCT Retrospective Study on Underwood Septa and Their Related Factors in Maxillary Sinuses-A Proposal of Classification

Introduction. The presence of bone septum in the maxillary sinus is one of the most common anatomical findings. So-called Underwood septa (US) are an atypical bone formation in the maxillary sinuses. Mostly they are quite easily found in CBCT studies and have major importance in sinus lift procedures in dental surgery. Furthermore, the shape, location, and size of the bony septa are important in each maxillary sinus surgery. Material and methods. A retrospective study of 120CBCT scans from the authors' own database was conducted. Results. Approximately 37.5% of each CBCT was associated with the occurrence of US, while just 25% had a full septum, and a total of only 14 patients had a half septa. More females have US, while healthy pneumatized maxillary sinus is most commonly found (82.22%). There is no correlation between the occurrence of silent sinus syndrome (p = 0.174), mucosal thickening (p = 0.325), or retention cyst formation (p = 0.272). Most sinuses are without any opacification in CBCT evaluation (91.11%), while other syndromes are not statistically relevant. Conclusions. It seems that the occurrence of Underwood septa is not statistically related to any clinical, radiological, or pathological condition within the sinus (p > 0.05). Furthermore, a more full or partial appearance of US was found in female patients.

Cone-beam computed tomographic analysis of maxillary sinus septa among Yemeni population: a cross-sectional study

BACKGROUND

Maxillary sinus septa increase perforation risk of Schneiderian membrane during the sinus floor elevation (SFE). Cone Beam Computed Tomography (CBCT) allows for a more precise assessment of the septal position; thus, preoperative CBCT analysis is substantial to avoid possible complications. This study aims to investigate the 3D characteristics of the maxillary sinus septa based on CBCT images. To our knowledge, no study reported the CBCT-based investigation for the sinus septa among Yemeni population.

MATERIALS AND METHODS

This is a retrospective cross-sectional analysis of 880 sinus CBCT images 440 patients. The septa prevalence, locations, orientations, morphology, and associated factors were analyzed. The effect of age, gender, and dental status on the sinus septa and the relationship between sinus membrane pathology and sinus septa were also analyzed. Anatomage (Invivo version 6) was used for CBCT images analysis. Descriptive and analytical statistics were performed, and a P-value < 0.05 was significantly considered.

RESULTS

The maxillary sinus septa were found among 63.9% of patients and 47% of sinuses. The average septa height was 5.2 mm. 15.7% of patients had septa in the right maxilla, 18% in the left, and 30.2% in both. Gender, age, and dental condition had no influence on the presence of septa, and septa presence did not influence sinus membrane pathology. Many septa originated from the floor (54.5%), located in the middle (43%), with coronal orientation (66%) and complete configuration (58.2%).

CONCLUSION

Based on our findings, the septa prevalence, locations, orientations, and morphology were significant and equivalent to the highest recorded in the literature yet. Thus, when sinus floor elevation is planned, CBCT imaging of the maxillary sinus is recommended for safe dental implantation.

Incidence of maxillary sinus septa in the saudi population

BACKGROUND

The variability in the maxillary sinus anatomy makes dental implant planning challenging. One of the anatomical landmarks that could affect the decision for implant placement around the maxillary sinus is the sinus septa. This study aimed to retrospectively determine the prevalence, anatomical distribution, and morphology of the maxillary sinus septa.

MATERIALS AND METHODS

This study included 309 CBCT images that were analyzed to determine the prevalence, height, location, and orientation of the maxillary sinus septa. Descriptive statistics, Mann‒Whitney U tests, and Kruskal‒Wallis tests were used for data analysis.

RESULTS

A total of 618 maxillary sinuses were analyzed. Maxillary septa were present in 30% (n = 188) of the sinuses and in approximately 45% of the analyzed images. The mean height of the septa was 5.09 mm. The presence of bilateral septa was evident in 49 subjects (35.25%). Female subjects were significantly more likely to have only one septum (n = 67, 53.6%, p < 0.05).

CONCLUSION

The presence of septa is very common, found in one-third to approximately half of the evaluated cases, which warrants careful examination before any surgical interventions to avoid possible complications.

Anatomical Variations of the Maxillary Sinus – A Cone Beam Computed Tomography Study

Objectives: The knowledge of the normal morphology of the maxillary sinuses and their variations is important for maxillofacial radiologists to achieve a better evaluation and delineation of pathologies and for pre-implant evaluation of the maxilla.

The aim of our study was to evaluate anatomical variations of maxillary sinuses using Cone Beam Computed Tomography (CBCT).

Materials and methods: 150 CBCT images where bilateral maxillary sinuses were scanned were included in the study following the inclusion and exclusion criteria. 75 CBCT scans each of males and females were studied using the Planmeca Romexis software (Version 4.6.2). Multiplanar images were searched for the presence of anatomical variations such as septae, haller cells and ethmomaxillary sinus. The data were subjected to Chi square test using SPSS software to compare and relate gender and site based differences in the occurrence of the anatomical variations.

Results: Sinus septa was the predominant variation in both males and females with significantly higher prevalence in females and on the right side. An ethmomaxillary sinus was seen significantly more often in males, while Haller cells did not show any gender based differences in their occurrence. Ethmomaxillary sinus and Haller cells showed no difference in occurrence on the right and left side.

Conclusions: Anatomic variations of the maxillary sinuses are a common finding. It necessary for the clinicians to be familiar with these variations to avoid clinical complications especially in cases of implant placements.

Application Effect of External and Internal Elevation of Maxillary Sinus in Implant Restoration of Posterior Maxilla

Objective

To explore and analyze the application effect of external and internal elevation of the maxillary sinus in implant restoration of the posterior maxilla.

Methods

A total of 84 patients undergoing implant restoration of the posterior maxilla in the hospital were enrolled between January 2019 and March 2021. According to the random number table method, they were divided into the observation group (n = 42) and the control group (n = 42). The control group underwent external elevation of the maxillary sinus, while the observation group underwent internal elevation of the maxillary sinus. At 6 h, 12 h, and 24 h after surgery, the pain degree between the two groups was compared. All were followed up at 6 months after surgery. The osseointegration (bone resorption around implants, elevation height of maxillary sinus floor, average healing time) and soft tissues (bleeding index, plaque index, probing depth) in both groups were observed. The occurrence of postoperative complications was recorded.

Results

At 6 h, 12 h, and 24 h after surgery, VAS scores in the observation group were significantly lower than those in the control group (P < 0.05). At 6 months after surgery, bone resorption and elevation height of the maxillary sinus floor in the observation group were significantly higher than those i.0.0n the control group, and the average healing time was significantly shorter than that in the control group (P < 0.05). The bleeding index, plaque index, and probing depth in the observation group were significantly lower than those in the control group (P < 0.05). There was no significant difference in the incidence of postoperative complications between the observation group and the control group (9.52% vs. 19.05%) (P > 0.05).

Conclusion

The application effect of internal elevation of the maxillary sinus is good in implant restoration of the posterior maxilla, which can relieve pain and swelling and improve implant effect.