Vascular Precautions Before Sinus Lift Procedure

Preoperative Cone Beam Computed Topography Assessment of Maxillary Sinus Variations in Dental Implant Patients

This study aimed to evaluate the pathological factors and anatomical variations in the maxillary sinus in patients undergoing dental implant treatment using cone beam computed tomography (CBCT). CBCT, as a key imaging technique in dentistry, offers high-resolution images to assess bone morphology and quality, crucial for preoperative dental implant planning.

MATERIAL AND METHODS

The study included a cohort of 200 patients recommended for CBCT as part of their preoperative evaluation. The methodology involved detailed CBCT image analysis to identify and document various anatomical variations due to pneumatization, exostosis, hypoplasia, polyps, cysts, foreign bodies, and anthroliths within the maxillary sinus.

RESULTS

Pneumatization was the most common variation, present in 77.5% of subjects. Polypoid lesions were found in 17.5% of patients, with a higher prevalence in younger age groups (57.1% in ages 20-35). Cysts and polyps affected 17.5% of subjects, predominantly males (65.7%). Anthroliths were observed in a minimal percentage (2%), and foreign bodies were found in 1.5% of the patients. Positive correlations were observed between the patient's age and both mucosal thickness and polypoid lesions and between the patient's gender and bone thickening (p-values < 0.05).

CONCLUSIONS

The study concluded that CBCT is essential in the preoperative assessment of the maxillary sinus in dental implant candidates due to its superior imaging capabilities, allowing for the identification of critical anatomical variations and pathologies. This thorough evaluation is imperative to ensure the success of implant placement and to mitigate potential complications. However, further research with larger, more diverse populations is recommended to confirm these findings.

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.