Assessment of neurovascular channels in lateral maxillary sinus wall using cone-beam computed tomography: An imperative clinicians guide for implant placements

Background

The aim of this study is to evaluate the location and radio morphometric features of the posterior superior alveolar artery (PSAA) in patients undergoing rehabilitation of posterior maxilla and other sinus augmentation surgical procedures by cone-beam computed tomography (CBCT).

Materials and Methods

A total of 816 CBCT scans were included. Various radio morphometric measurements were done to assess the PSAA location, diameter, and distances to the sinus floor and alveolar crest.

Results

The PSAA was mostly intraosseous in the maximum in the age group 31-51 years (56%), in males (53.4%), and in dentate patients (57.4%). The artery tends to be wider in older patients. Distances to the sinus floor or the alveolar crest tend to be shorter in women.

Conclusions

This study suggests that CBCT is a valuable pre-surgical tool and the evaluation of the PSAA on CBCT images could reduce the likelihood of excess bleeding during surgery in the maxillary posterior region.

Comparative diagnosis of the alveolar antral artery canal in the lateral maxillary sinus wall in corresponding panoramic radiography and cone-beam computed tomography

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.

The Radiological Evaluation of the Anatomy of the Alveolar Antral Artery and the Lateral Wall Thickness Using Cone-Beam Computed Tomography: A Retrospective Study

The objectives study aims to assess the position and route of the alveolar antral artery and the lateral wall thickness of the maxillary sinus using cone-beam computed tomography (CBCT), reducing the risk of complications and improving the success rate of surgery.

MATERIALS AND METHODS

This study included CBCT scans from 238 patients. The detection diameter of AAA and distance of the lower border of AAA to the maxillary sinus floor at the first premolar, second premolar, first molar, and second molar locations were evaluated. The route of AAA was observed with novel classification. Furthermore, the distance from the maxillary sinus floor to the alveolar crest at four posterior tooth locations was measured respectively. Moreover, the lateral wall thickness at four locations was assessed. Data were subjected to statistical analysis.

RESULTS

AAA was observed in 62.18% of all sinuses. The mean diameter was 0.99±0.21 mm, with significant differences within gender. Half of the route of AAA was intrasinus intraosseous type. The mean distance between the maxillary sinus floor and AAA was 8.00±2.68 mm, with a significant difference between dentate and edentulous status at the first molar location. Distance from the sinus floor to the alveolar ridge crest in edentulous status negatively correlated with the distance from the sinus floor to AAA at the first molar location. The mean thickness of the lateral wall was 2.03±0.91 mm, and the difference in thickness between males and females at the four locations was statistically significant.

CONCLUSION

intrasinus-intraosseous type, is the most common route. Special care should be taken at the first molar location during a lateral window sinus floor elevation. CBCT is highly recommended to before lateral wall maxillary sinus floor elevation.

Evaluation of alveolar antral anastomosis in south Indian population using cone beam computed tomography: a prospective study

OBJECTIVES

The posterior superior alveolar artery (PSAA) and the infraorbital artery (IOA), both of which are ultimate branches of the maxillary artery, are connected by a horizontal anastomosis. PSAA anastomoses intraosseously and extraosseously with IOA. Profuse bleeding from the lateral wall while performing the direct sinus augmentation is a significant intraoperative complication.Thus the present study focused to assess the location of an alveolar antral anastomosis (AAA) in relation to the crest of the alveolar bone using cone beam computed tomography (CBCT).

METHODS

A total of 200 CBCT scans of patients who were indicated for implant surgery were chosen and assessed. Group 1 includes 100 dentate patients and Group 2 includes 100 partially edentulous patients. The location of anastomosis along the lateral wall of the maxillary sinus was evaluated in association with alveolar bone height with respect to three posterior maxillary teeth: first premolar, second premolar, and first molar.

RESULTS

The mean distance for P1, P2, and M1 was 21.94 ± 1.02 mm, 19.41 ± 0.40 mm, and 17.36 ± 0.51 mm, respectively, in the dentate group, whereas in the edentulous group, it was 20.07 ± 0.46 mm, 18.95 ± 0.32 mm, and 16.08 ± 0.16 mm. In 80% of participants, the distance of an AAA from the alveolar crest was between 16 and 23 mm, whereas in 12% of the participants the distance of an AAA from the alveolar crest was less than 16 mm.

CONCLUSION

The present study concludes that the first premolar region is safe for preparing the lateral window but for the second premolar and first molar additional care should be taken prior to surgery.

Association of location and diameter of alveolar antral artery to crest of alveolar bone in dentate and partially edentulous patients - A cone-beam computed tomography study

Background

One of the most challenging anatomical conditions to manage during sinus augmentation using lateral window approach is the alveolar antral artery (AAA) when it is unusually wide in diameter and passes through the area of the osteotomy with a complete intraosseous course. The purpose of this study was to investigate the association of location and diameter of AAA to the crest of alveolar bone in dentate and partially edentulous patients using cone-beam computed tomography (CBCT).

Materials and Methods

Totally 100 CBCT scans of patients (50 dentate and 50 edentulous) were selected and analyzed. The location and diameter of AAA in the lateral wall of the maxillary sinus were evaluated in association with alveolar bone height with respect to three posterior maxillary teeth: first premolar (P1), second premolar (P2), and first molar (M1).

Results

The diameter of AAA in dentate patients was higher in M1 region (1.32 ± 0.34 mm) than P1 (0.91 ± 0.20 mm) and P2 (1.07 ± 0.24 mm) regions as compared to edentulous patients. It was found that the location of AAA for P1 in the dentate group (22.35 ± 4.17 mm) was significantly higher than that of the edentulous group (20.37 ± 2.48 mm). A negative relationship has been found between age and the distance between the AAA canal and crest of the alveolar ridge in both dentate (P = 0.001) and edentulous (P = 0.003).

Conclusion

A significantly negative relationship existed between age, diameter, and location of AAA in both the dentate and edentulous groups.

Alveolar antral artery in edentulous patients and their visualization through cone beam computed tomography

OBJECTIVE OF THE STUDY

The aim of this study was to assess the anatomical features of the alveolar antral artery (AAA) in edentulous patients using cone beam computed tomography (CBCT).

PATIENTS

The sample consisted of 191 CBCT scans of maxillary sinuses (n=382) of male (n=59) and female (n=132) edentulous patients (age: 38-89 years).

MATERIAL AND METHODS

The images were analyzed in Dolphin™ 11.9 software. Visualization, location, and diameter of the AAA was registered.

RESULTS

AAA was present in 88.5% of the assessed maxillary sinuses. Bilateral visualization was predominant 77% (P<0.0001). The mean vertical distance from the most anterior part of the AAA to the sinus floor was 7.9±6mm in female patients (both sides) and 12±7.22mm on the right side and 10.9±6.86mm on the left side in males. The mean diameter of the AAA was 1.2±0.7mm on both sides in females. In males, the diameter was significantly (P<0.05) larger: 1.5±0.62mm on the right side and 1.4±0.69 on the left side in females.

CONCLUSION

The AAA had a higher visualization rate, better visualization, and larger diameter when it was present bilaterally in male and female patients.

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

OBJECTIVE

To investigate the prevalence, diameter, and position of the alveolar antral artery (AAA) canals and measure the distances from the canal to the maxillary sinus floor and to the edentulous alveolar crest in each posterior maxillary tooth locations by cone beam computed tomography (CBCT).

METHODS

CBCT images of the posterior maxillary region from 280 patients were investigated. The prevalence and diameter of the AAA canal were evaluated. The perpendicular distances from the canal to the maxillary sinus floor and to the edentulous alveolar crest of each tooth locations were measured. The mediolateral positions and routes of the canals were observed with novel classification. Statistical analyses were carried out to determine any significant differences in mean distances between the tooth locations along with mean distances of tooth location by age, gender, and dentate status.

RESULTS

The AAA canal was found in 94.6% with a mean diameter ± SD of 1.05 ± 0.34 mm. The mean ± SD perpendicular distance from AAA canal to the edentulous alveolar crest at the first (16.02 ± 3.94 mm) and the second molars (16.74 ± 3.51 mm) were significantly shorter than the second premolar region. The intrasinus mediolateral position of the canal (72.5%) was the most common in concordance with the all-in type mediolateral route (50.9%).

CONCLUSION

The intrasinus mediolateral position of the AAA canal is a common structure in the lateral wall of maxillary sinus, which could be detected with CBCT images. The all-in type is the most prevalent mediolateral route among a novel 7-type classification system of AAA routes. Owing to the short distance between the AAA canal and the alveolar crest in the first and second molar locations, CBCT images should be taken to investigate the AAA position and route before sinus lift procedure to prevent the risk of hemorrhage.

Alveolar antral artery isolation during sinus lift procedure with the double window technique

The sinus lift technique, introduced in 1976 by Tatum and subsequently described by Boyne in 1980, is nowadays considered a safe and reliable procedure for the rehabilitation of the atrophic upper posterior maxilla.

The alveolar antral artery (AAA) is anastomoses between the posterior superior alveolar artery (PSAA) and the infraorbital artery (IOA) and may be present in the sinusal antrostomy. The haemorrhage of this vascular bundle represents the second intra-operatory complication in term of frequency during sinus lift procedure.

Purpose of this study was to illustrate and describe a new technique allowing the AAA isolation during sinus lift procedure in cases in which the artery is clearly present inside the surgical area, detectable through CT scan exam. Presence, course and possible identification of the alveolar antral artery are also discussed, according to the studies present in the literature.