Maxillary Sinus Area Research Articles

3D Cone Beam Radiodensitometry in Evaluation of Hydroxyapatite (HAP)/Tissue Hybrid after Maxillary Sinus Floor Elevation

Clinical and radiological outcomes of one and two stage maxillary sinus floor augmentation with HAP granules and dental implant insertion, degree of mineralization of residual bone and augmented sinus part were evaluated. 180 dental implant insertions in 84 patients in the age from 32-68 years were included in this study. Patient clinical and CBCT (Cone Beam Computer Tomography) were analyzed by quantitative radiodensitometry using HU (Hounsfield units) after 1 to 5 years after functional loading. Four implants were lost during osseointegration phase the 176 implants survived. We found 2.5 times denser synthetic HAP/bone area comparing with residual bone. With time there was a decrease in radiodensity in HAP augmented maxillary sinus area and an increase of radiodensity in the area of residual alveolar bone.

Evaluation of sinus bone resorption and marginal bone loss after sinus bone grafting and implant placement

The objective of this study was to evaluate the sinus bone graft resorption and marginal bone loss around the implants when allograft and xenograft are used. Sinus bone grafting and implant placement (Osstem, Korea) were performed on 28 patients from September 2003 to January 2006. In group I, a total of 49 implants were placed in 23 maxillary sinus areas of 16 patients together with bone graft using xenograft (Bio-Oss) and a minimal amount of autogenous bone. In group II, 24 implants were placed in 13 maxillary sinus areas of 12 patients together with bone graft using a minimal amount of autogenous bone and equal amounts of allograft (Regenaform) and Bio-Oss in group II. Early osseointegration failures of 3 implants in 3 patients (group I: 1 patient, 1 implant; group II: 2 patients, 2 implants) were observed, and revisions were performed for these 3 implant sites, followed by complete prosthodontic treatments. The average height of the remaining alveolar bone before the surgery, immediately after the surgery, and 1 year after the surgery was 4.9 mm, 19.0 mm, and 17.2 mm, respectively, in group I. In group II, the average height of the remaining alveolar bone was 4.0 mm, 19.2 mm, and 17.8 mm before the surgery, immediately after the surgery, and 1 year after the surgery, respectively. The average marginal bone loss 1 year after prosthodontic loading and after 20.8 months' follow-up was 0.6 mm and 0.7 mm, respectively, in group I. A 93.9% success rate was observed for group I, with 3 implants showing bone resorption of >1.5 mm within 1 year of loading. For group II, the average marginal bone loss 1 year after prosthodontic loading and after 19.7 months' follow-up was 0.7 mm and 1.0 mm, respectively. An 83.3% success rate was observed for group II, with 4 implants showing bone resorption of >1.5 mm within 1 year of loading. Based on the observations in this study, it was concluded that mixed grafting with demineralized bone matrix for maxillary sinus bone grafting has no significant short-term merit regarding bone healing and stability of implants compared with anorganic bovine bone alone.

Clinical, Radiographic and Pathohistological Outcomes of Hydroxyapatite (HAp) Ceramics and Dental Implants in Atrophic Posterior Maxilla

Clinical, Radiographic and Pathohistological Outcomes of Hydroxyapatite (HAp) Ceramics and Dental Implants in Atrophic Posterior Maxilla Introduction. Implant based prosthodontic rehabilitation of patients with atrophic edentulous posterior maxilla has necessity in reinforcement of alveolar bone using different bone substitutes. It is important to evaluate late outcomes in integration of synthetic HAp as biomaterial in chemical composition close to main natural bone mineral component in elevated maxillary sinus floor and osseointegration of dental implants. Aim of the study. To evaluate clinical and radiological outcomes of one stage maxillary sinus floor augmentation with synthetic HAp granules and dental implant insertion, mineralization degree of residual bone and augmented sinus part, morphological analysis of biopsies from HAp/host tissue hybrid and residual alveolar bone was performed. Materials and methods. One stage maxillary sinus floor elevation with synthetic HAp granules and 147 SEMADOS (BEGO) dental implant insertions in 70 patients were included in this study. Clinical and radiograph analyzes by dental X-rays, digital orthopantomogramms, quantitative radiodensitometry after 3 and 5 years was done. Trephine biopsies of residual alveolar bone and elevated part of maxillary sinus 6 months after implantation was done in 30 cases. Results. During this period 6 implants (4.2%) were lost. We found the decrease of radiodensity in HAp augmentated maxillary sinus area and increase of radiodensity in the area of residual alveolar bone. In biopsies after 6 months biomaterial/host tissue hybrid consisted of small bone trabecules, fibrous tissue and granules of irregular shape without inflammatory cells. Slow degradation of HAp granules by activity of osteoclast like macrophages was observed. Conclusions. Osseointegration was lost in 4.2% of inserted in augmented maxillary sinus implants. Radiodensitometry showed decrease of optical density in augmented sinus part and increase in residual alveolar bone. In biopsies of host tissue/biomaterial hybrid was bone newformation, connective tissue and biodegradation of HAp granules by osteoclast like cells.

Sinus augmentation using human mesenchymal stem cells loaded into a β-tricalcium phosphate/hydroxyapatite scaffold

Implant placement in the posterior maxilla may often be contraindicated because of insufficient bone volume and presence of the maxillary sinus. In these situations, sinus floor augmentation frequently has been proposed as the best treatment. This clinical study was based on the hypothesis that the clinical effectiveness of adult mesenchymal stem cells (MSCs) loaded to the biphasic scaffold. In this report, the clinical and radiographic results are presented on 6 consecutively treated patients using MSCs in combination with biphasic hydroxyl apatite/ beta-tricalcium phosphate (HA/TCP) for sinus elevation. All the patients in the study had less than 3 mm initial bone height in the posterior maxillary area (IBH). MSCs were cultured and expanded from bone marrow aspirate for each patient. Three months after sinus elevation, radiographic evaluation was performed for the patients and the secondary bone height was measured (SBH(1)). In the second stage surgery, 30 implants were placed. Trephine bur was used as a pilot drill and a core biopsy was obtained from each implant site. Prosthetic rehabilitation of the patients was performed after 4 months. Secondary bone height was measured 9 months after implant placement (SBH(2)). Of 30 implants, 28 (93%) were considered clinically successful. Two implants were removed due to mobility at the time of surgical exposure. Histologic evaluation of the biopsy specimens revealed numerous areas of osteoid and bone formation HA/TCP, with no evidence of inflammatory cell infiltrate. Mean bone regenerate was 41.34%. Clinically, no complications were observed, and all implants were considered clinically osseointegrated after 4 months. Mean bone height was measured 3 and 12 months after sinus grafting (mean of SBH(1)= 12.08 mm and mean of SBH(2)= 10.08 mm). These clinical and histological findings suggest that sinus grafting with HA/TCP in combination with MSCs provide a viable therapeutic alternative for implant placement. The findings suggest that the addition of MSCs to bone derivative/substitute materials may enhance bone formation in the maxillary sinus area. Of course more studies with the control groups are needed for the evaluation of this method as a clinical solution for the patients.

The radical transbasal approach for resection of anterior and midline skull base lesions

Craniofacial surgery can be performed to treat midline and anterior skull base lesions by creating a bicoronal scalp incision without the need for an additional transfacial procedure. Originally described as the transbasal approach, several modifications for further exposure of the skull base have been described. The authors present data on the application and outcomes of a modified transbasal approach. The radical transbasal approach consists of a bifrontal craniotomy and a frontoorbitonasal osteotomy. Between 1992 and 2002, 41 patients (28 male and 13 female patients with a mean age of 38.3 years [range 7-77 years]) underwent 44 radical transbasal procedures. Twenty-three malignant and 18 benign lesions involving the midline skull base were treated. These cases were reviewed retrospectively. Gross-total resection of 30 lesions was achieved. Seven lesions were resected subtotally and six partially; one lesion was debulked. Complications occurred in 26 (59.1%) of the 44 operations and mostly consisted of cerebrospinal fluid leakage. The surgery-related mortality rate was 6.8% (three patients). Based on their pre- and postoperative Karnofsky Performance Scale scores, 86.4% of patients improved or remained the same. The radical transbasal approach increases the midline craniofacial corridor by allowing the globes to be safely retracted laterally. It also enhances exposure of the maxillary sinus from above. The morbidity and mortality rates associated with this procedure are high but consistent with the known rates for craniofacial surgery. This approach is best suited for the treatment of anterior skull base tumors that extend into the nasal cavity, orbit, ethmoid sinus, nasopharynx, and upper clivus. The approach may allow resection of tumors involving the maxillary sinus area without the need for an additional transfacial approach.

Adenocarcinoma in the maxillary sinus: a case report

A case of adenocarcinoma, not otherwise specified, was documented, mainly from a radiographic perspective. The lesion, which occurred in the maxillary sinus, destroyed only a moderate amount of bone considering the tumor’s large size. There was no sign of necrosis on either computed tomography or magnetic resonance images. This case demonstrated one of the radiographic characteristics of this type of tumor: moderate bone destruction considering the area of the maxillary sinus occupied.

Growth Pattern of the Maxillary Sinus in the Miniature Pig (Sus scrofa)

The biological role of the paranasal sinuses is obscure, can be elucidated through a cross-sectional growth study of the maxillary sinus in miniature pigs. The maxillary sinus area was obtained from lateral cephalograms of left skull halves of 103 female miniature pigs of known ages, from newborn to 24 months. Out of several nonlinear models, the growth of the maxillary sinus was best described with the Gompertz model. The first derivative of the Gompertz curve revealed an increase in the growth rates of the maxillary sinus until 4 months, after which sinus growth slowed down. The eruption of the permanent molars did not seem to have a significant influence on this growth pattern. Furthermore, growth in maxillary sinus size in the miniature pig does not follow growth in skull size closely, which showed the highest growth rates in newborn animals. In addition, a correlation analysis revealed that the relationship between maxillary sinus area and different characteristics of the masticatory apparatus (including linear cranial dimensions, and the dry weight of the masseter and zygomatico-mandibularis muscles) were influenced greatly by skull size. These results suggest that the existence of pneumatic cavities within the mammalian skull is not satisfactorily explained solely by an architectural theory. Epigenetic factors are likely to influence the final shape of the maxillary sinus.

Anatomic site evaluation of edentulous maxillae for dental implant placement.

This study evaluated 17 edentulous cadavers for bone quantity and quality of the alveolar process of the maxilla for the purpose of dental implant placement. The maxillary arch was divided into four anatomically defined regions for measurements of bone quantity. Bone quality was assessed histologically and described by trabecular bone patterns and tissue composition. Average bone height with a minimum thickness of 4 mm was as follows: region 1, 12.1 +/- 4.9 mm; region 2, 14.1 +/- 7.2 mm; region 3, 6.1 +/- 2.8 mm; and region 4, 8.5 +/- 2.2 mm. Histological evaluation showed increased trabeculation and thicker cortex in the maxillary anterior area, regions 1 and 2. Region 3, the floor of the maxillary sinus area, had the least amount of bone; however, the quality of bone was superior to that of region 4, the maxillary tuberosity area. Trabecular distance or marrow spaces ranged from 40 microns to 2 mm with larger spaces associated with the posterior maxilla. Maxillary tuberosity is the least desirable site for the placement of implants in the maxilla. The area corresponding to the first and second molars had the least bone thickness. All measures of bone preservation need to be considered, especially in this area.

The study of the maxillary sinus areas in different orthodontic malocclusions

In the present study, the maxillary sinus areas have been investigated on orthopantomographs of 103 male and 86 female subjects either with ideal occlusions or with malocclusions. It has been found that malocclusions and sex factors have no effect on the size of the maxillary sinuses, and that sex is a significant factor only in Angle Class II malocclusions. The female subjects with Angle Class II malocclusions have larger maxillary sinuses than the male subjects and the other groups of female subjects.

Evaluation of the cross-sectional areas of the maxillary sinus

Cross-sectional areas of the maxillary sinus were evaluated by frontal section films using Polytome U. A frontal section of 3cm from Nasion was used. Two methods were adopted for the cross-sectional evaluations of the maxillary sinus areas. The direct method is to plot the area over semitransparent section paper divided into squares of which the unit area is 1mm2. The plotted area was directly calculated by the section paper. The indirect method is to use an approximated cross-sectional configuration of the maxillary sinus. The approximation was done by regarding the cross-sectional area as an trapezoid made of lines drawn by orbital floor, lateral wall of the inferior meatus, and the zygomatic recess, and so far. Sixty adults (male 35 and female 25) were included in the study. Majority of the cases were afflicted with chronic sinusitis and no bony destruction was noted.The results were analyzed as to the difference between the sides and gender, and the linear correlation between two methods of evaluation for the cross-sectional areas. Statistically no significant difference was seen between the right and left sides. The results for male were larger than those of female with statistical significance. The linear correlation between the direct and indirect methods is very high.The indirect method of evaluation for the cross-sectional area of the maxillary sinus is thus applicable to the evaluation of the postoperative changes of the maxillary sinus.

Pneumocele of the Maxillary Sinus

Pneumocele of the maxillary sinus is a rare condition in which the sinus cavity expands in any direction. Several authors attribute this disease to valve-like action of obstructed ostium of the maxillary sinus, resulting in air trapping.A 25 year old man had suffered from epiphora and dull pain on his left cheek since December 1975 and first visited our clinic on May 10, 1976.X-ray film showed hyperlucence of maxillary sinus areas of the left side, expanding of the left maxillary sinus cavity and thinning of the sinus wall. Dehiscence of bone was seen at the lateral wall of the left maxillary sinus. Ethmoid cells were also dilated significantly.Operation (Caldwell-Luc) was performed on June 2, 1976. The large maxillary sinus cavity contained nothing except air, and no communication with ethmoid cells was demonstrated. In the sinus cavity there were many balks or septums covered with thin mucous membrane. The postoperative course was uneventful.In this case pathogenesis was considered to be a transient hyperactivity of the pneumatization process of the maxilla. If obstruction of the ostium was the main genesis of this disease, there should have been mucous accummulation in the sinus cavity, and balks or septums are not likely to form under such circumstances.

Diagnosis and surgery in the maxillary sinus area

Diagnosis and surgery in the maxillary sinus area

A study of the cubic capacity and superficial area of the maxillary sinus

The maxillary sinus (antrum of Highmore), on account of the close relationship which it bears to rhinology and stomatology, perhaps has been more closely studied than any other of the accessory sinuses of the nose. It has been known for a long time that this sinus is pyramidal in shape; that the base is directed toward the nasal fossa and the apex is directed toward the malar bone; that the apices of the roots of the upper second bicuspid and first and second molar teeth often lie very close to the floor and sometimes perforate it; that the sinuses vary in shape and size in different persons and even on different sides of the same person. Clinical observation has shown that the maxillary sinus is subject to diseases which have their origin, not only in the nasal cavity, but also in some of the other accessory sinuses and in the