Variation in bucco‐palatal maxillary sinus width does not permit a meaningful sinus classification

Abstract

Objectives The bucco‐palatal sinus width (SW) appears as relevant factor for graft consolidation after maxillary sinus (MS) floor augmentation. The present study aimed to assess (a) SW at different height levels of posterior teeth, (b) possible factors influencing SW, and (c) whether a simple/meaningful sinus classification based on SW is possible. Methods The following parameters were recorded on computed tomographies of 76 edentulous and 86 partially edentulous maxillary quadrants displaying 383 tooth sites in total: (a) alveolar ridge height, (b) ‐area, (c) ‐width 2 mm apical to the alveolar crest, (d) ‐width at the sinus floor, and (e) SW and sinus area at a level 2, 4, 6, 8, and 10 mm above the sinus floor. The possible influence of gender, tooth position [i.e., premolar (PM); molar (M)], tooth‐gap extent, and residual alveolar ridge dimensions on SW was assessed. Further, based on percentiles of average values or on the frequency distribution of SW <10, 10–15, or >15 mm, it was attempted to classify the sinus at each given site into narrow, average, or wide. Results Gender and tooth‐gap extent presented no relevant impact on MS dimensions; however, significant differences were observed among the various tooth positions regarding all evaluated parameters. The lower the residual alveolar ridge, the wider the MS at 4–10 mm height, while the wider the residual alveolar ridge, the wider the MS. Large variation in SW classes among the different height levels within the same tooth position and among tooth positions within the same person was observed, irrespective of the threshold applied. Further, at a MS height of 10 mm at PM1, PM2, M1, and M2, SW was <10 mm in 68%, 33%, 0%, and 7% of the cases, respectively, while in 3%, 21%, 65%, and 57%, respectively, SW was >15 mm. Conclusions There is a large variation in SW depending on the height level within the sinus and on tooth position, which does not permit a simple/meaningful classification of each sinus as “narrow,” “average,” or “wide.” Nevertheless, narrow sinuses (<10 mm) are rather prevalent in the premolar region, while wide sinuses (>15 mm) in the molar region; further, a wider and shorter residual alveolar ridge is associated with a wider SW.

Quantitative assessment of the jawbone quality classification: A meta-analysis study

“…Regarding the different areas of the jaws, the outcomes of our study show a continuous increase in RW from anterior to posterior areas of both the dentate maxilla and mandible. This finding is in accordance with other studies, both in dentate [ 46 , 58 ] and in edentulous jaws [ 35 , 40 , 50 , 54 ]. A similar trend was shown for BW and PW/LW, as in [ 31 , 49 ], which clearly outlines and support the importance of defining different areas of the jaws .…”

Maxillary Sinus Floor Augmentation with Autogenous Bone Graft Alone Compared with Alternate Grafting Materials: a Systematic Review and Meta-Analysis Focusing on Histomorphometric Outcome

“…The included studies presented to some extent opposing results and conclusions drawn from the results of the present systematic review and meta-analysis should therefore be interpreted with caution. Moreover, histomorphometric outcomes after MSFA are influences by various confounding factors including sinus cavity dimensions, size of the lateral window, barrier membrane coverage of the lateral window, and retrievement of bone cores for histomorphometric analysis at different locations [58][59][60][61]. Varying degree of heterogeneity according to these parameters were present among the included studies [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45].…”

The Potential Influence of Medial Sinus wall Exposure During Lateral Sinus Floor Elevation Procedure on the Blood Supply to the Grafted Material: A Cohort Study

“…Our main results revealed that there was a significant medial drop that accounted for 42% of the augmentation height and that sinuses wider than 15mm had statistically significantly higher medial and lateral drops than narrower sinuses. Zeng et al found a positive correlation between wide sinuses and high (linear height) bone graft resorption, and their explanation was related to the vascular supply [22]. From an anatomical point of view, if denuded from soft tissue, the main blood supply to the grafted material may be from the medial bony wall, which is nourished by the posterior lateral nasal artery.…”

“…Other sources of vascular supply are the posterior alveolar artery and the infraorbital artery on the lateral wall [19]. Zeng and his colleagues assumed that in wide sinuses, the blood supply is inadequate, resulting in higher bone resorption in comparison to narrow sinuses, where the intimate blood supply from the close walls enhances angiogenesis and graft remodeling [22].…”

“…In wide sinuses, this reduced support may result in reduced stability and a drop in the grafted material, like that observed against the medial wall and lateral wall. The sinus width, i.e., the distance between the medial and lateral walls, was negatively associated with the percentage of new bone formation using the lateral approach technique [22][23][24]. In addition, in wide sinuses, it may be technically difficult to approach and reflect the Schneiderian membrane from the medial wall.…”