Next Article in Journal
Improper Light Curing of Bulkfill Composite Drives Surface Changes and Increases S. mutans Biofilm Growth as a Pathway for Higher Risk of Recurrent Caries around Restorations
Previous Article in Journal
Compound Odontoma Removed by Endoscopic Intraoral Approach: Case Report
 
 
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Sinus Mucosa Thickness Changes and Ostium Involvement after Maxillary Sinus Floor Elevation in Sinus with Septa. A Cone Beam Computed Tomography Study

1
ARDEC Academy, 47923 Rimini, Italy
2
Department of Oral Implantology, Osaka Dental University, Osaka 573-1144, Japan
3
ARDEC Foundation, Cartagena de Indias 130001, Colombia
4
Department of Oral Biology, Medical University of Vienna, 1090 Vienna, Austria
*
Author to whom correspondence should be addressed.
Submission received: 15 May 2021 / Revised: 13 July 2021 / Accepted: 19 July 2021 / Published: 21 July 2021

Abstract

:
Background: A thickening of the sinus mucosa is observed after sinus floor augmentation. The objective of this retrospective study was to evaluate the influence of the presence of septa in the dimensional variation and ostium involvement over time of the Schneiderian mucosa after sinus floor augmentation. Materials and Methods: Fifteen sinuses with septa (septa group) and 15 without (control group) were selected. CBCTs taken before surgery, and were analyzed after 1 week and after 9 months. Schneiderian membrane thickness changes over time and involvement of the ostium were evaluated. Results: Four perforations occurred in the septa group and none in the control group. After 1 week of healing, the sinus mucosa thickness increased in height by 5.7 mm and 7.1 mm in the septa and control groups, respectively. In this period, the patency of the ostium decreased in both groups, and three infundibula were obstructed in the septa group, and five in the control group. The mucosa was thicker and the edema was closer to the ostium in the control compared to in the septa group. After 9 months of healing, the dimensions regressed to normal pattern and no obstruction of the infundibula were observed. No statistically significant differences were found between septa and control groups. Conclusions: after one week of healing, the sinus mucosa increased in dimensions in both septa and control groups. However, the sinus mucosa presented a tendency of being thicker and closer to the ostium, resulting in a higher number of infundibula obstructions, in the control group compared to in the septa group. After 9 months, the sinus mucosa regressed to normal dimensions and no obstructions of the infundibula were observed in any group.

1. Introduction

Maxillary sinus floor elevation is nowadays considered a safe and effective surgical technique to allow the prosthetic restauration supported by implants in an atrophic posterior region of the maxilla [1]. Nevertheless, various anatomical conditions must be considered when applying this approach [2]. Excluding the presence of sinus pathology that might contra-indicate sinus surgery, the height of the residual bone crest defines the limits to which this technique is indicated, while the width of the lateral wall of the sinus might make the preparation of the antrostomy difficult [2]. The distance between the palatal-nasal recess (PNR) and the floor of the sinus, as well as the angle formed between the palatal and nasal walls in this region, may also influence the prognosis. In fact, an angle of the PNR <90° is considered a risk factor for perforation during mucosa elevation [3]. The position of the posterior superior alveolar artery may influence the position of the antrostomy [4,5]. Moreover, in case of lesion of the artery, hemorrhagic events may seriously complicate the surgery [6].
The presence of septa might also influence the surgical approach and generate perforations of the mucosa during the elevation procedures [7,8,9,10].
Other aspects that should be evaluated are the dimensions of the ostium and patency of the infundibulum [2,11]. This aspect is truly relevant because the edema and bleeding after the surgery will increase the dimensions of the sinus mucosa, as documented in experimental [12,13], pilot [14,15], retrospective [16] and prospective studies [17,18], as well as in randomized controlled trials [4,5,19,20]. However, the association between the presence of septa and the changes in dimensions of the sinus mucosa after sinus lifting and the involvement of the ostium and infundibulum has not yet been documented. Hence, the aim of the present study was to evaluate the influence of the presence of septa in the dimensional variation and ostium involvement over time of the Schneiderian mucosa after sinus floor augmentation.

2. Materials and Methods

The records of patients included in randomized controlled trials (RCT) [4,5,19,20] performed at the University Corporation Rafael Núñez, Cartagena de Indias, Colombia were further evaluated after the approval for supplementary assessments of the data by the local ethical committee (protocol # CURN-0002-CE282020).
The following inclusion criteria had to be fulfilled by the patients to be included in the RCTs mentioned above: (i) presence of an edentulous region in the posterior region of the maxilla; (ii) height of the bone crest ≤4 mm; (iii) ≥21 years of age; (iv) good general health; (v) not pregnant. An additional analysis of the same set of data was performed with the following inclusion criteria: (i) treated for sinus floor elevation with a lateral access; (ii) presence of septa that might interfere with the surgery within the maxillary sinus; (iii) availability of good quality cone beam computed tomographies (CBCTs) before surgery (T0), and after 1 week (T1w) and 9 months (T9m). As control group, a similar number of sinuses from different patients treated for sinus floor elevation with a lateral access were randomly selected among the group without septa.
As references for the coronal view, the x-axis, drawn at the base of the nose, and the base of the sinus floor were used (Figure 1). The following assessments were performed in the coronal view of the CBCTs taken at T0: (i) the distance between the maxillary sinus ostium (MSO) and the sinus floor; (ii) the MSO diameter; (iii) the infundibulum length; (iv) the number of infundibula out of patency; (v) the sinus mucosa thickness [21].
The following assessments were performed in the coronal view of the CBCTs taken at T1w and T9m: (i) the MSO diameter; (ii) the number of infundibula out of patency; (iii) the sinus mucosa thickness; (iv) the distance between ostium and edema.
In the lateral view, the vertical extension of the edema above (+) or below (−) an axis drawn at the base of the nose (Z-axis) was measured at T1w and T9m.
The height of the septa and the distance between the ostium and the septum were also measured. Moreover, the Irinakis classification of the septa was adopted [8]. This classification basically includes the following categories according to the orientation of the septa: Class I, buccal-lingual direction; Class II, mesial-distal direction; Class III, horizontal orientation; Class IV: septum of a combination of Class I, II, or III.
All CBCTs were taken using a 3D Accuitomo 170 Tomograph (J Morita Corporation, Kyoto, Japan). The CBCT measurements were performed with the i-Dixel 2.0 software (J. Morita Corporation, Kyoto, Japan).

Data Analyses

The main variables were sinus height and ostium diameter. A Mann–Whitney test was applied to evaluate the differences between the septa group and the control group. As an explorative aim, the differences between periods were also evaluated for all parameters using a Wilcoxon test. The analyses were performed with the IBM SPSS Statistics software v19.0 (IBM Inc., Chicago, IL, USA).

3. Results

3.1. Clinical Report

The CBCTs of eighty-eight sinuses of seventy-five patients were assessed. Fifteen sinuses from 12 patients satisfied the inclusion criteria (mean age 55.2 ± 9.4 years). Fifteen randomly selected patients (mean age 57.8 ± 8.1 years) without septa in the maxillary sinus were included in the control group (Table 1). Ten out of thirty sinuses were located at the right side, while twenty were at the left side.
At the analysis of the records, a lateral access window was adopted for all patients included in the study. It was observed that 10 sinuses in each group received OsteoBiol Gen-Os®, 250–1000 µm (Tecnoss, Giaveno, Italy) as filler material and a collagen membrane OsteoBiol® Evolution, 0.3 mm (Tecnoss, Giaveno, Italy) to protect the antrostomy. Five sinuses in each group received Cerabone granulate 1.0–2.0 mm (Botiss Biomaterials GmbH, Zossen, Germany) as filler material, while the antrostomy was protected with Collprotect® collagen membrane (Botiss Biomaterials GmbH).
Four perforations were reported during surgery in the septa group (26.7%), all protected with a collagen membrane, while no perforations were reported in the control group. The perforations were about 1, 2, 3 and 3 × 5 mm in dimensions, respectively. No unexpected complications were reported.

3.2. CBCTs Assessments

At the baseline, the septa presented a mean height of 6.3 ± 2.4 mm (min 2.9 mm; max 9.8 mm) and were mainly positioned in the molar region (Figure 2A,B,C), 9.6 ± 4.9 mm distally to the ostium. According to the Irinakis classification [8], eleven septa were Class I, one Class II, and three Class IV. Ten sinuses presented one single septum, three presented two septa, and two presented three septa.
The ostia were mainly located in the premolar region, but some ostia could be found in the molar region. In the control group, they were located more distally compared to the septa group (Table 1). The distance between the ostium (MSO) and the base of the sinus was 33.2 ± 3.9 mm in the septa group and 32.6 ± 4.6 mm in the control group. The MSO diameter was 1.7 ± 0.4 mm and 2.1 ± 0.8 mm in the septa and the control group (Table 2). The respective infundibulum lengths were 8.5 ± 1.3 mm and 9.2 ± 2.1 mm. No obstructions of the infundibula were found before surgery. The mucosa thickness was 1.1 ± 0.7 mm and 1.0 ± 0.7 mm, respectively. None of the differences between the septa and control groups was statistically significant.
After 1 week of healing (Table 2), the MSO diameter decreased in both groups to 1.0 ± 0.6 mm in the septa group, and to 1.0 ± 0.8 mm in the control group, while the sinus mucosa width increased to 6.7 ± 7.8 mm and to 8.2 ± 7.0 mm in the septa and control group, respectively (Figure 3).
The distance between the extension of the edema to the ostium was 11.8 ± 10.7 mm in the septa group, and 7.5 ± 8.8 mm in the control group (p = 0.310). Three obstructions of the infundibula in the septa group (20%) and five in the control group (33.3%) were found. None of the differences between the septa and control groups was statistically significant.
Nine months after the surgery (Table 2), the MSO diameter returned to about the same diameter in both groups, as well as the mucosa width in the septa group. However, in the control group, the mucosa presented a higher width compared to the dimensions before surgery. None of the differences between the septa and control groups was statistically significant excluding the difference in mucosa thickness (p = 0.028) and mucosa area (p = 0.029) in the coronal view. The distance of the edema from the ostium decreased both in the coronal and in the lateral view (Table 3) in both groups. No obstructions of any infundibula were found.

4. Discussion

The aim of the present study was to evaluate the influence of the presence of septa in the dimensional variation over time of the Schneiderian mucosa after sinus floor augmentation. The sinuses of the control group presented a tendency of a higher increase in the mucosa width and involvement of the ostium.
The mean height of the septa in the present study was 5.7 mm, dimension within the range of the height reported in a review on maxillary sinus septa [22]. The location of the septa was mainly at the level of the first and second molars, with the data being in agreement with those described in a clinical study [23].
The initial width of the sinus mucosa was 1.1 mm in the septa group and 1.0 in the control group; dimension slight smaller than those reported in another study in which the evaluation was performed in patients also scheduled for sinus floor elevation [24]. In that study, the width of the sinus mucosa was 2 mm. It has to be considered, however, that the width of the sinus mucosa may vary depending on the region where the assessment is performed [25]. Moreover, the presence of periapical lesions, incongruous endodontic treatment, severe caries and periodontal bone loss increases the width of the sinus mucosa [26]. The extraction of teeth presenting such pathologies might reduce, but not completely resolve, the thickening of the sinus mucosa [26,27].
In the sinuses of both groups, one week after the surgery, a transient increase in the thickness of the sinus mucosa was observed. This is due to the clot/edema that is formed after the surgery so that it should be considered a virtual increase in the sinus mucosa thickness [21]. Various studies described the increasing in the thickness of the sinus mucosa after sinus floor elevation. In an experimental study in monkeys [12], edema and clot were seen both macroscopically and histologically during the first periods of healing. The swelling regressed completely within a month. It was shown that the thickness of the sinus mucosa increases progressively during the first week of haling after sinus floor elevation applying a lateral access [18]. The return to normality of the dimensions of the sinus mucosa has been reported to occur within 3 weeks in the transcrestal approach [14] or few months in the lateral access [16,17,18,19,20]. It has been also shown that the increase in mucosa thickness after sinus floor elevation is directly correlated to the dimensions of the antrostomies [5]. In the present study, a higher increase in the mucosa thickness was seen in the control compared to the septa group. Even though the difference was not statistically significant, a difference of 1.5 mm in thickness might mean that the presence of the septa may limit the extension of the edema, as confirmed by other data reported in the present study. In fact, the extension of the edema on the palatal wall one week after the surgery was 4.3 mm closer to the ostium in the control group compared to the septa group. Indeed, the edema also involved the ostium as shown by the higher number of obstructions of the infundibula in the control group (5 events) compared to the septa group (3 events). Nevertheless, none of these cases reported clinical complications. This agrees with a clinical study [17], in which the initial sinus mucosa thickness was 1.9 mm. Seven infundibula in 53 CBCTs were out of patency before sinus floor elevation. After surgery, the mucosa increased to about 4 mm, and 16 infundibula were obstructed. The width returned to normality after 7.5 months. However, five obstruction were still observed.
In the present study, after 9 months of healing, the sinus mucosa returned to normality in the septa group. In the control group, however, the sinus mucosa was 1.2 mm thicker compared to T0. This was mainly due to a single case that still presented a thick sinus mucosa. This sinus, however, did not show any pathological appearance, nor did the patient refer any symptom. At this stage of healing, no obstructions of any infundibula were observed, and all sinuses were devoid of pathologies.
Four perforations (26.7%) were reported in the septa group; an event that did not occur in the control group. Nevertheless, the dimensions of the perforations were small so that the placement of a collagen membrane subjacent the sinus mucosa allowed all surgeries to be successfully accomplished. The presence of septa exposes to a higher risk of sinus mucosa perforations, as reported in various studies [7,8,9,10]. In a retrospective clinical study [8], the outcomes of 79 consecutive sinus floor elevations with lateral window approach were evaluated. Interfering septa were found in about 48% of sinuses. Seventeen perforations (44.7%) were recorded at the sinuses with septa, while only one perforation occurred at the sinus without septa.
As limitations of the present study, the 2-dimensional analysis performed and the retrospective design should be included. Another limitation is represented by the difficulties to discriminate on CBCT between the real sinus mucosa thickness and thickening generated by the edema. For this reason, the term virtual sinus mucosa thickening was introduced [21]. A larger sample might allow statistically significant differences between groups to be found, especially in relation to sinus mucosa thickening and extension of the edema toward the ostium.

5. Conclusions

In conclusion, after one week of healing, the sinus mucosa increased in dimensions in both septa and control groups. However, the sinus mucosa presented a tendency of being thicker and closer to the ostium, resulting in a higher number of infundibula obstructions in the control group compared to in the septa group. After 9 months, the sinus mucosa regressed to normal dimensions and no obstructions of the infundibula were observed in any group.

Author Contributions

Conceptualization, S.K., Y.O., M.K., A.H., M.F., K.A.A.A. and D.B.; methodology, S.K., K.A.A.A., D.B.; validation, Y.O., M.K., A.H., D.B.; formal analysis, S.K., K.A.A.A. and D.B.; investigation, M.F., D.B.; data curation, K.A.A.A. and D.B.; writing—original draft preparation, S.K., K.A.A.A., D.B.; supervision, S.K., Y.O., M.K., D.B.; funding acquisition, D.B.; writing—review and editing, S.K. and D.B. All authors have read and agreed to the published version of the manuscript.

Funding

This study has been funded by ARDEC Academy, Italy.

Institutional Review Board Statement

The records of patients included in randomized controlled trials (RCT) [4,5,17,20] performed at the University Corporation Rafael Núñez, Cartagena de Indias, Colombia were further evaluated after the approval for supplementary assessments of the data by the local ethical committee (protocol # CURN-0002-CE282020).

Informed Consent Statement

All patients add signed an informed consent.

Data Availability Statement

The data are available on reasonable request.

Acknowledgments

The biomaterial was offered free of charge by OsteoBiol, Tecnoss, Giaveno, Italy and Botiss Biomaterials GmbH, Zossen, Germany).

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Del Fabbro, M.; Wallace, S.S.; Testori, T. Long-term implant survival in the grafted maxillary sinus: A systematic review. Int. J. Periodontics Restor. Dent. 2013, 33, 773–783. [Google Scholar] [CrossRef] [PubMed]
  2. Kawakami, S.; Botticelli, D.; Nakajima, Y.; Sakuma, S.; Baba, S. Anatomical analyses for maxillary sinus floor augmentation with a lateral approach: A cone beam computed tomography study. Ann. Anat. 2019, 226, 29–34. [Google Scholar] [CrossRef] [PubMed]
  3. Chan, H.L.; Monje, A.; Suarez, F.; Benavides, E.; Wang, H.L. Palatonasal recess on medial wall of the maxillary sinus and clinical implications for sinus augmentation via lateral window approach. J. Periodontol. 2013, 84, 1087–1093. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  4. Kawakami, S.; Lang, N.P.; Iida, T.; Ferri, M.; Apaza Alccayhuaman, K.A.; Botticelli, D. Influence of the position of the antrostomy in sinus floor elevation assessed with cone-beam computed tomography: A randomized clinical trial. J. Investig. Clin. Dent. 2018, 9, e12362. [Google Scholar] [CrossRef]
  5. Kawakami, S.; Lang, N.P.; Ferri, M.; Apaza Alccayhuaman, K.A.; Botticelli, D. Influence of the height of the antrostomy in sinus floor elevation assessed by cone beam computed tomography—A randomized clinical trial. Int J. Oral Maxillofac. Implants. 2019, 34, 223–232. [Google Scholar] [CrossRef]
  6. Testori, T.; Rosano, G.; Taschieri, S.; Del Fabbro, M. Ligation of an unusually large vessel during maxillary sinus floor augmentation. A case report. Eur. J. Oral Implantol. 2010, 3, 255–258. [Google Scholar]
  7. Tükel, H.C.; Tatli, U. Risk factors and clinical outcomes of sinus membrane perforation during lateral window sinus lifting: Analysis of 120 patients. Int. J. Oral Maxillofac. Surg. 2018, 47, 1189–1194. [Google Scholar] [CrossRef]
  8. Irinakis, T.; Dabuleanu, V.; Aldahlawi, S. Complications During Maxillary Sinus Augmentation Associated with Interfering Septa: A New Classification of Septa. Open Dent. J. 2017, 11, 140–150. [Google Scholar] [CrossRef] [Green Version]
  9. Becker, S.T.; Terheyden, H.; Steinriede, A.; Behrens, E.; Springer, I.; Wiltfang, J. Prospective observation of 41 perforations of the Schneiderian membrane during sinus floor elevation. Clin. Oral Implant. Res. 2008, 19, 1285–1289. [Google Scholar] [CrossRef]
  10. Nolan, P.J.; Freeman, K.; Kraut, R.A. Correlation between Schneiderian membrane perforation and sinus lift graft outcome: A retrospective evaluation of 359 augmented sinus. J. Oral Maxillofac. Surg. 2014, 72, 47–52. [Google Scholar] [CrossRef]
  11. Shanbhag, S.; Karnik, P.; Shirke, P.; Shanbhag, V. Cone-beam computed tomographic analysis of sinus membrane thickness, ostium patency, and residual ridge heights in the posterior maxilla: Implications for sinus floor elevation. Clin. Oral Implant. Res. 2014, 25, 755–760. [Google Scholar] [CrossRef]
  12. Scala, A.; Botticelli, D.; Faeda, R.S.; Rangel, I.G., Jr. Américo de Oliveira, J.; Lang, N.P. Lack of influence of the Schneiderian membrane in forming new bone apical to implants simultaneously installed with sinus floor elevation: An experimental study in monkeys. Clin. Oral Implant. Res. 2012, 23, 175–181. [Google Scholar] [CrossRef]
  13. Scala, A.; Botticelli, D.; Rangel, I.G., Jr.; De Oliveira, J.A.; Okamoto, R.; Lang, N.P. Early healing after elevation of the maxillary sinus floor applying a lateral access: A histological study in monkeys. Clin. Oral Implant. Res. 2010, 21, 1320–1326. [Google Scholar] [CrossRef]
  14. Quirynen, M.; Lefever, D.; Hellings, P.; Jacobs, R. Transient swelling of the Schneiderian membrane after transversal sinus augmentation: A pilot study. Clin. Oral Implant. Res. 2014, 25, 36–41. [Google Scholar] [CrossRef]
  15. Temmerman, A.; Van Dessel, J.; Cortellini, S.; Jacobs, R.; Teughels, W.; Quirynen, M. Volumetric changes of grafted volumes and the Schneiderian membrane after transcrestal and lateral sinus floor elevation procedures: A clinical, pilot study. J. Clin. Periodontol. 2017, 44, 660–671. [Google Scholar] [CrossRef]
  16. Nosaka, Y.; Nosaka, H.; Arai, Y. Complications of postoperative swelling of the maxillary sinus membrane after sinus floor augmentation. J. Oral Sci. Rehabil. 2015, 1, 26–33. [Google Scholar]
  17. Guo, Z.Z.; Liu, Y.; Qin, L.; Song, Y.L.; Xie, C.; Li, D.H. Longitudinal response of membrane thickness and ostium patency following sinus floor elevation: A prospective cohort study. Clin. Oral Implants Res. 2016, 27, 724–729. [Google Scholar] [CrossRef]
  18. Makary, C.; Rebaudi, A.; Menhall, A.; Naaman, N. Changes in Sinus Membrane Thickness After Lateral Sinus Floor Elevation: A Radiographic Study. Int. J. Oral Maxillofac. Implants 2016, 31, 331–337. [Google Scholar] [CrossRef] [Green Version]
  19. Hirota, A.; Lang, N.P.; Ferri, M.; Fortich Mesa, N.; Apaza Alccayhuaman, K.A. Botticelli Tomographic evaluation of the influence of the placement of a collagen membrane subjacent to the sinus mucosa during maxillary sinus floor augmentation: A randomized clinical trial. Int. J. Implant. Dent. 2019, 5, 31. [Google Scholar] [CrossRef]
  20. Imai, H.; Lang, N.P.; Ferri, M.; Hirota, A.; Apaza Alccayhuaman, K.A.; Botticelli, D. Tomographic Assessment on the Influence of the Use of a Collagen Membrane on Dimensional Variations to Protect the Antrostomy After Maxillary Sinus Floor Augmentation: A Randomized Clinical Trial. Int. J. Oral Maxillofac. Implant. 2020, 35, 350–356. [Google Scholar] [CrossRef]
  21. Sakuma, S.; Ferri, M.; Imai, H.; Fortich Mesa, N.; Blanco Victorio, D.J.; Apaza Alccayhuaman, K.A.; Botticelli, D. Involvement of the maxillary sinus ostium (MSO) in the edematous processes after sinus floor augmentation: A cone-beam computed tomographic study. Int. J. Implant. Dent. 2020, 6, 35. [Google Scholar] [CrossRef]
  22. Maestre-Ferrín, L.; Galán-Gil, S.; Rubio-Serrano, M.; Peñarrocha-Diago, M.; Peñarrocha-Oltra, D. Maxillary sinus septa: A systematic review. Med. Oral Patol Oral Cir. Bucal. 2010, 15, e383–e386. [Google Scholar] [CrossRef] [Green Version]
  23. Bornstein, M.M.; Seiffert, C.; Maestre-Ferrín, L.; Fodich, I.; Jacobs, R.; Buser, D.; von Arx, T. An Analysis of Frequency, Morphology, and Locations of Maxillary Sinus Septa Using Cone Beam Computed Tomography. Int. J. Oral Maxillofac. Implants 2016, 31, 280–287. [Google Scholar] [CrossRef] [Green Version]
  24. Lozano-Carrascal, N.; Salomó-Coll, O.; Gehrke, S.A.; Calvo-Guirado, J.L.; Hernández-Alfaro, F.; Gargallo-Albiol, J. Radiological evaluation of maxillary Sinus anatomy: A cross-sectional study of 300 patients. Ann. Anat. 2017, 214, 1–8. [Google Scholar] [CrossRef] [PubMed]
  25. Janner, S.F.; Caversaccio, M.D.; Dubach, P.; Sendi, P.; Buser, D.; Bornstein, M.M. Characteristics and dimensions of the Schneiderian membrane: A radiographic analysis using cone beam computed tomography in patients referred for dental implant surgery in the posterior maxilla. Clin. Oral Implants Res. 2011, 22, 1446–1453. [Google Scholar] [CrossRef] [PubMed]
  26. Kuligowski, P.; Jaroń, A.; Preuss, O.; Gabrysz-Trybek, E.; Bladowska, J.; Trybek, G. Association between Odontogenic and Maxillary Sinus Conditions: A Retrospective Cone-Beam Computed Tomographic Study. J. Clin. Med. 2021, 10, 2849. [Google Scholar] [CrossRef] [PubMed]
  27. Block, M.S.; Dastoury, K. Prevalence of sinus membrane thickening and association with unhealthy teeth: A retrospective review of 831 consecutive patients with 1662 cone-beam scans. J. Oral Maxillofac. Surg. 2014, 72, 2454–2460. [Google Scholar] [CrossRef]
Figure 1. Coronal view of tomographic images of a maxillary sinus before surgery (A), and after 1 week (B) and 9 months (C). X-axis, nose floor; X-AM, area of the sinus mucosa (delimited by dotted green lines); IL, infundibulum length; OD, maxillary sinus ostium diameter; F, sinus floor; X-F, distance between X-axis and F; X-O, distance between X-axis and maxillary sinus ostium. Yellow arrows, positions of the measurements of the thickness of the mucosa. Note the loss of patency at ostium and infundibulum after 1 week from sinus floor elevation.
Figure 1. Coronal view of tomographic images of a maxillary sinus before surgery (A), and after 1 week (B) and 9 months (C). X-axis, nose floor; X-AM, area of the sinus mucosa (delimited by dotted green lines); IL, infundibulum length; OD, maxillary sinus ostium diameter; F, sinus floor; X-F, distance between X-axis and F; X-O, distance between X-axis and maxillary sinus ostium. Yellow arrows, positions of the measurements of the thickness of the mucosa. Note the loss of patency at ostium and infundibulum after 1 week from sinus floor elevation.
Dentistry 09 00082 g001
Figure 2. CBCT images illustrating the situation before surgery of a septa sinus. The yellow arrows indicate a septum in the left sinus in the (A) coronal, (B) lateral, and (C) axial views. In C, a septum is visible also in the right sinus.
Figure 2. CBCT images illustrating the situation before surgery of a septa sinus. The yellow arrows indicate a septum in the left sinus in the (A) coronal, (B) lateral, and (C) axial views. In C, a septum is visible also in the right sinus.
Dentistry 09 00082 g002
Figure 3. Lateral view of the case in Figure 1, 1 week after the sinus floor elevation. The sinus mucosa showed an increase in dimensions above anteriorly and posteriorly the septum.
Figure 3. Lateral view of the case in Figure 1, 1 week after the sinus floor elevation. The sinus mucosa showed an increase in dimensions above anteriorly and posteriorly the septum.
Dentistry 09 00082 g003
Table 1. Demographic and clinical data. Sinuses n = 15.
Table 1. Demographic and clinical data. Sinuses n = 15.
GenderAge (Years)SmokersSinus SideType of EdentulismOstium PositionSepta Position
SEPTA9 females
3 males
55.2 ± 9.4NONE7 right; 8 left10 partial, 5 total9 PM1, 4 PM2, 2 M11 PM2, 3 M1, 11 M2
CONTROL8 females
7 males
57.8 ± 8.1NONE3 right; 12 left13 partial, 2 total2 PM1, 7 PM2, 6 M1
PM1, PM2 = First or second premolar regions; M1, M2 = First or second molar regions.
Table 2. Radiographic anatomical measures in the coronal view of CBCTs taken at T0 (before surgery), at T1w (1 week after surgery), and at T9m (9 months after surgery). Data in millimeters or square millimeters only for the mucosa area.
Table 2. Radiographic anatomical measures in the coronal view of CBCTs taken at T0 (before surgery), at T1w (1 week after surgery), and at T9m (9 months after surgery). Data in millimeters or square millimeters only for the mucosa area.
MSO
to X-Axis
MSO to Sinus FloorInfundibulum LengthMSO DiameterNumber of ObstructionsMucosa ThicknessMucosa AreaDistance between Ostium and Edema
SEPTA
Mean values ± SD
Minimum; Maximum
T024.2 ± 3.4
18.5; 31.1
33.2 ± 3.9
25.2; 38.4
8.5 ± 1.3
6.3; 10.8
1.7 ± 0.4 b
1.3; 2.7
01.1 ± 0.7 b
0.3; 2.3
13.2 ± 8.3 b
5.6; 27.1
-
T1w --1.0 ± 0.6 b,c
0.0; 2.2
3 (20%)6.7 ± 7.8 b,c
0.5; 31.2
168.7 ± 161.0 b.c
7.9; 576.4
11.8 ± 10.7 c
−1.4; 29.5
T9m --1.6 ± 0.4 c
1.3; 2.2
00.9 ± 0.6 a,c
0.5; 2.4
14.3 ± 7.3 a,c
10.0; 27.8
24.6 ± 6.0 c
9.8; 31.9
CONTROL
Mean values ± SD
Minimum; Maximum
T024.9 ± 4.1
13.7; 30.0
32.6 ± 4.6
26.3; 41
9.2 ± 2.1
7.0; 13.6
2.1 ± 0.8 b
1.2; 4.6
01.0 ± 0.7 b
0.5; 2.4
14.7 ± 15.7 b
5.4; 66.3
-
T1w --1.0 ± 0.8 b,c
0.0; 2.5
5 (33.3%)8.2 ± 7.0 b,c
0.9; 24.1
199.9 ± 135.7 b,c
11.3; 449.5
7.5 ± 8.8 c
1.5; 24.7
T9m --1.6 ± 0.7 c
0.6; 2.9
02.3 ± 2.8 a,c
0.6; 11.4
44.0 ± 69.1 a,c
8.7; 283.0
21.5 ± 8.0 c
11.7; 34.7
SD, Standard deviation. MSO, Maxillary sinus ostium. a = p < 0.05 between septa and control groups; b = p < 0.05 between T0 and T1w; c = p < 0.05 between T1 and T9w. No differences between T0 and T9m.
Table 3. Radiographic anatomical measures in the lateral view of CBCTs taken at T0 (before surgery), at T1w (1 week after surgery), and at T9m (9 months after surgery). Data in millimeters or square millimeters only for the virtual mucosa area.
Table 3. Radiographic anatomical measures in the lateral view of CBCTs taken at T0 (before surgery), at T1w (1 week after surgery), and at T9m (9 months after surgery). Data in millimeters or square millimeters only for the virtual mucosa area.
Mucosa AreaMesial Vertical Extension above (+) or below (−) the Z-AxisDistal Vertical Extension above (+) or below (−) the Z-Axis
SEPTA
Mean values ± SD
Minimum; Maximum
T029.8 ± 30.7 b
15.8; 122.9
--
T1w297.7 ± 262.0 b,c
11.8; 875.7
10.8 ± 9.1 c
−2.8; 25.9
14.2 ± 10.4
2.6; 30.4
T9m41.2 ± 41.6 c
9.7; 157.9
1.7 ± 4.0 c
−2.7; 8.3
0.7 ± 4.0
−2.8; 12.4
CONTROL
Mean values ± SD
Minimum; Maximum
T026.7 ± 20.0 b
11.8; 83.3
--
T1w311.5 ± 205.3 b,c
21.5; 585.9
14.1 ± 10.8 c
−5.7; 30.0
12.8 ± 11.1
−7.0; 36.0
T9m82.4 ± 144.8 c
14.2; 575.9
2.8 ± 6.9 c
−5.9; 18.4
2.2 ± 6.1
−7.5; 19.0
SD, Standard deviation. b = p < 0.05 between T0 and T1w; c = p < 0.05 between T1 and T9w. No statistically significant differences were found between the septa and control groups and between T0 and T9m in both groups.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Kato, S.; Omori, Y.; Kanayama, M.; Hirota, A.; Ferri, M.; Apaza Alccayhuaman, K.A.; Botticelli, D. Sinus Mucosa Thickness Changes and Ostium Involvement after Maxillary Sinus Floor Elevation in Sinus with Septa. A Cone Beam Computed Tomography Study. Dent. J. 2021, 9, 82. https://0-doi-org.brum.beds.ac.uk/10.3390/dj9080082

AMA Style

Kato S, Omori Y, Kanayama M, Hirota A, Ferri M, Apaza Alccayhuaman KA, Botticelli D. Sinus Mucosa Thickness Changes and Ostium Involvement after Maxillary Sinus Floor Elevation in Sinus with Septa. A Cone Beam Computed Tomography Study. Dentistry Journal. 2021; 9(8):82. https://0-doi-org.brum.beds.ac.uk/10.3390/dj9080082

Chicago/Turabian Style

Kato, Shingo, Yuki Omori, Masatsugu Kanayama, Atsuya Hirota, Mauro Ferri, Karol Alí Apaza Alccayhuaman, and Daniele Botticelli. 2021. "Sinus Mucosa Thickness Changes and Ostium Involvement after Maxillary Sinus Floor Elevation in Sinus with Septa. A Cone Beam Computed Tomography Study" Dentistry Journal 9, no. 8: 82. https://0-doi-org.brum.beds.ac.uk/10.3390/dj9080082

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop