Maxillary Sinus Pneumatization Research Articles

Zygomatic Implant Rehabilitation: A Prosthodontic Driven Approach: A Review

Zygoma implants, sometimes called zygomatic implants, are different from conventional dental implants in that they are affixed in the zygomatic bone, not the maxilla. They can be used in situations when there is not enough maxillary bone, either in terms of quantity or consistency, to support a dental implant. Insufficient maxillary bone volume may result from a combination of maxillary sinus pneumatization and bone resorption. To guarantee proper implant survival, the normal implant placement in the posterior maxilla requires a bone height of about 10 mm. Increased bone volume can be achieved by sinus elevation and bone grafting techniques in cases when there is insufficient bone available. The drawbacks of bone grafting procedures in the jaws include the need for prolonged care, restrictions on denture wear, morbidity at the donor surgical site, and graft rejection. Keywords: Zygomatic implants, Prosthodontic Rehabilitation, Prosthetically driven approach

Closed sinus lift and fixed prostheses versus implant-assisted overdentures in management of atrophied distal extension maxillary ridges: A one-year randomized clinical trial

Rehabilitation of elderly or medically compromised patients with an atrophied unilateral posterior maxillary ridge by an implant-supported prosthesis may be complicated by maxillary sinus pneumatization with insufficient bone for implant placement. This short-term clinical trial assessed clinical results of closed sinus lift and fixed prosthesis versus implant-assisted overdentures in the management of participants with atrophied distal extension maxillary ridges. Forty participants with unilateral atrophying distal extension maxillary ridges were randomly assigned into 2 groups. The CSL group (n=20) participants received fixed prostheses supported by 3 implants following a closed sinus lift. The IOD group (n=20) participants received removable partial overdentures assisted by a single implant that was positioned mesially to the maxillary sinus. The modified plaque index (MPI), modified gingival index (MGI), pocket depth (PD), implant stability (IS), and vertical bone loss (VBL) were measured at prosthesis delivery (T0), and 6 (T6) and 12 months (T12) after delivery. The oral health impact profile (OHIP-14) questionnaire was used to assess oral health-related quality of life (OHRQoL) at T12. Significant differences between observation times were performed using Friedman and Wilcoxon signed-rank tests for MPI and MGI and using repeated measures ANOVA with Bonferroni correction of P values for PD, IS, VBL, and OHIP. Between-group comparison of MPI and MGI the Mann-Whitney test was used, while for PD, IS, VBL, and OHIP comparison was made using independent samples t test (α=.05 for all tests). The implant survival rates were 100% for both groups. MPI and PD significantly increased with time for both groups. MGI significantly increased with time for the CSL group only (P=.049). The IS significantly decreased with time for the IOD group. VBL increased significantly from T6 to T12 for the CSL (P=.042) and the IOD (P=.002) groups. The CSL group recorded higher MPI, MGI, PD, and IS values than the IOD group (P<.05). The IOD group recorded higher VBL than the CSL group (P<.001). The CSL group scored significantly lower OHIP-14 values (better OHRQoL) than the IOD group for all values (P<.05). In comparison with implant-assisted partial overdentures, closed sinus lift with fixed prostheses had higher implant stability, reduced bone loss, and higher participant OHRQoL. However, peri-implant soft tissue health was found to be better with implant overdentures.

New perspectives in the treatment of the severe atrophic posterior maxilla: interpositional sandwich osteotomy combined with sinus floor grafting - a novel technique

Purpose: Dental implant installation in the posterior maxilla depends fundamentally on the presence of an adequate bone quantity. Tooth loss in the posterior maxilla is followed by extensive loss of the alveolar ridge and increased maxillary sinus pneumatization that often makes implant installation difficult to achieve. Maxillary sinus floor augmentation is traditionally the common surgical technique to overcome this situation. When the deficiency in the vertical dimension relates more to severe ridge resorption, crestal ridge augmentation should also be considered. Posterior maxillary sandwich osteotomy combined with sinus augmentation, using inter–positional bone graft might be a viable option to address this problem. This study describes a successful implementation of this technique to solve a severe vertical osseous ridge defect under the sinus floor. Material and Methods: A two–stage lateral wall sinus floor augmentation combined with inter–positional sandwich osteotomy followed by the insertion of dental implants with adequate length and diameter was performed. Deproteinized natural bovine bone mineral (DBBM) covered by a resorbable collagen membrane were used. Rehabilitation of this area was completed by a standard prosthetic protocol. Results: As a result of completing the above procedure favourable bone mass and form was created to enable implant placement in positions that are optimal from a prosthetic and esthetic point of view in terms of reshaping the alveolar crest and normali- zing the interocclusal distance improving the crown–implant ratio. Conclusion: This case demonstrates a step–by–step illustration of an innovative technique for overcoming a vertical ridge defect combined with increased maxillary sinus pneumatization. It can be concluded that this novel technique is recommended to meet the dimensional requirements of bone augmentation both crestal and intrasinusal in severe atrophic posterior maxilla to achieve an improved alveolar plane, equalized crown–to–implant ratios, and a more favourable gingival shape.

Relation between maxillary sinus pneumatization and the thickness of the mandibular inferior border in panoramic radiographs

BackgroundMaxillary sinus pneumatization is a physiological process that can adversely affect bone availability for further dental rehabilitation. If a relation between the thickness of the mandibular cortex and maxillary sinus pneumatization is proven, future bone availability can be deducted. Material and methodsIn this cross-sectional study, 85 panoramic radiographs were evaluated. All patients were between 19 and 70, had at least lost a second premolar, first molar, or second molar on one side of the maxilla, and had these teeth on the other side. Four lines were digitally drawn on the radiographs to determine the superior and inferior borders of the sinus on both sides. The amount of inferior sinus border progression was deducted using the digitally-measured lines' ratios. The following tests were done using IBM SPSS ver. 24: Pearson's correlation coefficient test, Tukey's dual comparison posthoc test, One-way ANOVA test, and the independent T-test (p = 0.05). ResultsThere was a negative correlation between the inferior mandibular cortex's thickness and the maxillary sinus's pneumatization (p < 0.001). Also, there was a significant difference between maxilla sinus pneumatization in the second premolar, first, and second molar areas based on the inferior mandibular cortex’s thickness (p = 0.009). ConclusionsBased on the present study, there is a significant relationship between the thickness of the inferior mandibular cortex and maxillary sinus pneumatization, especially for women and patients above 40 years old.

The Impact of Maxillary Sinus Pneumatization on the Quality of the Alveolar Bone in Dentated and Edentulous Patients: A Cone-Beam Computed Tomography Radiographic Analysis.

Background This study aimed todescribe the morphometric differencesof maxillary alveolar bone's height, width, and densitometric differences in the posterior region where maxillary sinus pneumatization occurred. Methodology A cross-sectional, cone-beam computed tomography (CBCT) study used 123 CBCT images as a non-randomized convenient sample of sinus pneumatized cases. Bone height, bone width (in mm), and average density of the remaining ridge of all patients were used as study variables. Analysis of the qualitative variables were as frequency and percentages. Parametric Student's t-test and non-parametric chi-squared tests were used to compare the groups. The significance level was set at a p-value ≤0.05. Results The sample included CBCT radiographs for patients who had a mean age of 42.79 ± 12.32 with males constituting 69 (56.1%) of the patients. There was no gender difference between the present and missing teeth at the measured sites of the first premolar, second premolar, first molar, and second molar (p > 0.05). The mean measurements of height and average bone density were significantly higher in the dentate sites; however, the mean width was higher in the edentulous sites (p = 0.001). Conclusions Average bone height and density were significantly decreased at the edentulous sites of sinus pneumatized cases than the dentate sites with no gender difference.

A Systematic Approach to Restoring Full Arch Length with Maxillary Fixed Implant Reconstruction: The PATZi Protocol.

The traditional configuration of four maxillary implants to restore full-arch maxillary fixed implant prostheses is not without pitfalls. Intraoperative variability, such as bone quality and quantity, may lead to unexpected intraoperative challenges that may not allow for execution of the original treatment plan. Additionally, extensive maxillary sinus pneumatization may inhibit posterior spread and lead to a shortened dental arch or excessive cantilever forces. The PATZi protocol is a systematized algorithm for maxillary full-arch implant treatment planning that addresses such intraoperative surprises and achieves full arch length in the planned prosthesis. PATZi also assigns a numbering classification to each implant configuration, which leads to uniform communication and grading of surgical difficulty, as well as predictable planning for developing future salvage plans. By using the PATZi protocol as a guideline, the surgeon may improve composite torque value and anteroposterior (AP) spread, eliminate distal cantilever forces, and ultimately improve the predictability of the prosthetic treatment plan.

Does the Protrusion of Corticobasal Implants in the Maxillary Sinuses Affect Sinus Health? A Retrospective Study.

The aim of this retrospective study is to investigate the effect of corticobasal implant penetration in the nasal and maxillary sinuses on sinus health and implant survival rate in cases of severely atrophid ridges. This retrospective study was conducted on thirty patients with 172 implants who underwent corticobasal implant treatment between 2014 and 2018. Implants were divided into two groups according to the penetration depths (Group A, <4 mm; Group B, 4 mm). Inclusion criteria for the study included: (A) patients with severe maxillary ridge resorption with an immediately loaded corticobasal implant-supported prosthesis that showed implant protrusion inside the maxillary sinus on cone-beam computed tomography (CBCT); and (B) patients with a preoperative and postoperative follow-up CBCT scan using the same standard technique and machine. (C) Patients without any history of sinusitis before implant insertion patients who fulfilled the inclusion criteria were recalled for follow-up. The presence of sinus complications was clinically assessed according to the clinical practice guidelines for adult sinusitis of the American Academy of Otolaryngology-Head and Neck Surgery and Radiologically using CBCT. Moreover, patient satisfaction was evaluated using yes-or-no questions. The result was statistically analyzed using Fisher's Exact test. Despite the differences in implant penetration depths, no clinical signs of sinusitis were evident in any patient. One patient presented with transient epistaxis after the surgery, and 2 patients with nine implants revealed nonsignificant thickening of the sinus membrane radiologically (p = 0.055). All implants showed optimum bone-implant contact with a 100% survival rate. A significant relationship was reported between the thickness of the membrane and the patient's gender, hypertension, and smoking habits. (p = 0.001*, p = 0.002*, and p = 0.034*, respectively). Penetration of corticobasal implants in the maxillary sinus did not compromise the health of the maxillary sinus or implant survival rate. Limited posterior maxillary bony support and maxillary sinus pneumatization present challenges in implant dentistry and increase the possibility of implant protrusion inside the maxillary and nasal cavities. Hence, studying the effect of this protrusion on the maxillary sinuses' health and implant survival is highly significant.

Role of CBCT in Prediction of Oro-antral Communication Post Third Molar Extraction: A Retrospective Study.

Oro-antral communication (OAC) is one of the most frequently encountered complications during third molar extraction. Various radiographic factors, like excessive maxillary sinus pneumatization, long periods of edentulism, periapical lesions, etc., have been considered high-risk factors for OAC. However, a panoramic radiograph has not proven to be accurate in predicting the chances of OAC. Through this retrospective study, we evaluated the efficacy of a CBCT in predicting the incidence of OAC after maxillary third molar extraction. We conducted a retrospective study in our department, which included the patients who had undergone extraction of a maxillary third molar over five years with the presence of panoramic X-rays and/or CBCT scans prior to extraction. Primary outcomes assessed from the case files were intra-operative complications like OAC, root fracture, tuberosity fracture, pterygoid plate fracture, etc. The incidence of these complications was correlated with the presence or absence of CBCT before extraction. Out of 920 extracted maxillary third molar, only 148 teeth (16.1%) had a CBCT record before extraction. The most commonly encountered complication was broken inaccessible root piece/s (4.9%), followed by OAC (3.5%). An inter-group comparison showed that a significantly higher percentage of patients (p < 0.001) with CBCT records had an incidence of OAC (11.5%) as against the group of patients with no CBCT record (1.9%). A CBCT scan prior to cases with high-risk factors for OAC can be a valuable tool in accurately predicting the chances of OAC after maxillary third molar extraction.

Effect of Maxillary Sinus Pneumatization on the Ease of Access to Prelacrimal Recess.

Prelacrimal recess approach can be used to access lesions of the anterior wall of the maxillary sinus (MS). Moreover, the longer the prelacrimal recess window distance (PLRWD), the easier it is to access the anterior wall. This study aimed to define the correlation between maxillary sinus pneumatization (MSP) and PLRWD, a previously defined anatomic factor predictive of the ease of prelacrimal recess approach (PLRA). In total, 506 sides of 253 participants were studied. In the axial image, the PLRWD, the distance between the anterior wall of the MS and the lacrimal duct, was measured through radioanatomical analysis and classified as type I (<3 mm), type II (3-7 mm), or type III (>7 mm). On the coronal image, the distance between the nasal floor and the lower end of the MS was measured. When MSP did not reach the nasal floor, it was classified as grade I, as grade II when MSP reached the nasal floor, and grade III when the MS was pneumatized below the nasal floor. Type I included 115 sides (22.7%); type II, 277 sides (54.7%); and type III, 114 sides (22.5%). Grade I was observed in 58 sides (11.5%), grade II in 38 sides (7.5%), and grade III in 410 sides (81.0%). The mean PLRWD of grade I was 2.35 ± 2.41 mm, II was 3.37 ± 2.46 mm, and III was 5.55 ± 2.54 mm, showing a significant difference (P < .001). Post hoc analysis showed significant differences in the mean PLRWD among grades I, II, and III. Two anatomical factors, the MSP and PLRWD, were positively correlated (r = .507, P < .001). This study demonstrates a correlation between the feasibility of MSP and PLRA. Both MSP and PLRWD are essential diagnostic parameters for preoperative planning and better surgical outcomes.

Clinical, Radiographic, and Histological Evaluation of the Mineralized Plasmatic Matrix/Xenograft Mixture in Maxillary Sinus Floor Augmentation (A Randomized Controlled Clinical Trial)

Introduction: Maxillary sinus pneumatization and alveolar ridge resorption following the extraction of posterior teeth make the installation of dental implants in the maxillary posterior region challenging. The direct sinus lift procedure proved to be a viable treatment option for such conditions. Aim of the study: to evaluate the mineralized plasmatic matrix/xenograft mixture in sinus elevation surgery. Materials and Methods: Eighteen patients were selected and randomly allocated into two groups; study group received a mineralized plasmatic matrix/xenograft mixture, while the control group received xenograft alone following sinus lifting. Results: The early wound healing index score showed a non-significant difference between both groups. Also, bone height was evaluated at the 6-month follow-up period, and there was a non-statistically significant difference. Core biopsies were taken for histological examination by H&amp;E from both groups, revealing the presence of a more mature bone matrix in relation to the test group. Conclusion: The addition of mineralized plasmatic matrix to xenograft can speed up bone formation, thus reducing treatment duration.

Evaluation of maxillary sinus dimensions and volume using cone beam computed tomography in patients with unilaterally displaced palatal and buccal maxillary canines

ObjectivesTo evaluate and compare the maxillary sinus (MS) dimensions and volume in unilaterally displaced palatal and buccal maxillary canines.MethodsCBCT images for 133 patients were included in the study. Maxillary canines were unilaterally displaced palatally in 83 patients (PDCs) and buccally in 50 patients(BDCs). The following variables were measured: canine position in relation to MS walls, MS pneumatization and MS dimensions and volume.ResultsMS was extended to the incisor region in 10% and 13% and to the canine region in 48% and 23% in BDCs and PDCs subjects, respectively. In BDC subjects, maxillary canine crown tip was more laterally (24.23 mm compared to 22.93 mm (p < 0.05)) and closer vertically (5.82 mm compared to 9.58 mm (p < 0.001)) to the MS, maxillary canine root tip was closer to the MS anterior (0 mm compared to 1.64 mm (p < 0.05)) and lateral (19.70 mm compared to 22.02 mm (p < 0.001)) walls and the MS volume (11.57mm3 compared to 9.09 mm3 (p < 0.001)) was increased in the displaced side compared to the non-displaced side. In PDC subjects, a significant difference between the displaced and non-displaced sides was detected in the vertical (3.28 mm compared to 5.89 mm (p < 0.001)) and lateral (21.63 mm compared to 24.25 mm (p < 0.001)) position of maxillary canine to the MS wall, the anterior (− 0.84 mm compared to 1.13 mm (p < 0.05)) and lateral (20.48 mm compared to 22.44 mm (p < 0.001)) position of canine root tip to the MS and the MS volume (7.71mm3 compared to 9.14mm3 (p < 0.001)). PDC sides differed from BDC sides in the lateral and vertical position of canine crown tip to MS and in MS volume. PDC showed negative association with MS volume and anteroposterior skeletal relationship and a positive association with MS height.ConclusionsPDCs subjects have a reduced MS volume and BDCs subjects have an increased MS volume. PDCs are associated with reduced MS volume, increased MS height and Class III skeletal relationship.

Cone-beam computed tomography-based analysis of maxillary sinus pneumatization extended into the alveolar process in different age groups

ObjectiveThis study aimed to measure the amount of maxillary sinus pneumatization (MSP) extended into alveolar processes in different age groups via cone-beam computed tomography (CBCT) and its association with age.MethodsThe data of 293 adult patients (533 maxillary sinuses) who underwent CBCT at our hospital from January 2020 to October 2020 were analyzed and divided into the following age groups: group I (18–34 years old, youth group), group II (35–59 years old, middle-aged group) and group III (≥ 60 years old, elderly group). The distance between the lowest point of the maxillary sinus floor and nasal cavity floor in the central area of the maxillary posterior teeth was measured and recorded as the amount of MSP. Further, according to the positional relation between the maxillary posterior teeth and maxillary sinus floor, MSP was divided into type I (normal pneumatization) and type II (extensive pneumatization). The distribution of pneumatization types and degree and change of pneumatization for the different age groups were also analyzed. P < 0.05 was used as the threshold for statistical significance.ResultsThe amount of MSP of group I [(3.75 ± 3.77) mm] was significantly higher than that of group II [(2.30 ± 4.48) mm] and group III [(2.09 ± 4.70) mm], but there was no significant difference between group II and group III. We also found that the amount decreased gradually with increasing age (rs = − 0.2), with the youth group showing a higher prevalence of extensive pneumatization (youth vs. middle-age vs. elderly: 66.44% vs. 36.81% vs. 22.28%, respectively). There was no statistically significant difference in the amount of MSP between males and females and between left and right maxillary sinus in each group (P > 0.05).ConclusionThe amount of MSP was significantly higher in the 18–34 years old group compared to older age groups, showed a decreasing trend with age and was not associated with sex and maxillary sinus sides.

Characterizing the respiratory-induced mechanical stimulation at the maxillary sinus floor following sinus augmentation by computational fluid dynamics

Background: The relationship between maxillary sinus pneumatization and respiratory-induced fluid mechanics remains unclear. The purpose of this study was to simulate and measure the respiratory-induced mechanical stimulation at the sinus floor under different respiratory conditions and to investigate its potential effect on the elevated sinus following sinus-lifting procedures. Methods: The nasal airway together with the bilateral maxillary sinuses of the selected patient was segmented and digitally modeled from a computed tomographic image. The sinus floors of the models were elevated by simulated sinus augmentations using computer-aided design. The numerical simulations of sinus fluid motion under different respiratory conditions were performed using a computational fluid dynamics (CFD) algorithm. Sinus wall shear stress and static pressure on the pre-surgical and altered sinus floors were examined and quantitatively compared. Results: Streamlines with minimum airflow velocity were visualized in the sinus. The sinus floor pressure and the wall shear stress increased with the elevated inlet flow rate, but the magnitude of these mechanical stimulations remained at a negligible level. The surgical technique and elevated height had no significant influence on the wall pressure and the fluid mechanics. Conclusion: This study shows that respiratory-induced mechanical stimulation in the sinus floor is negligible before and after sinus augmentation.

Human Maxillary Sinus Development, Pneumatization, Anatomy, Blood Supply, Innervation and Functional Theories: An Update Review

The maxillary sinus is one of four pair’s air-filled spaces that surround the nasal cavity. The majority of previously published researches considering the maxillary sinus commonly concentrated on its pathological conditions and the recent surgical or medical management procedures. However, to understand the diseases of this sinus in a better manner, it is essential to have some basic medical details. Therefore, the present review is an attempt to focus light on this sinus by doing a cosmopolitan update on its development and anatomy, besides the functional theories by searching through many well-known scientific databases including Medline, Scopus, EMBASE, PubMed Central (PMC), PubMed, Cochrane Library, and Web of Science.&#x0D; In the current review, the author tried to approach, recognize and explain the fundamental data that may provide better ideas to imagine the pathological problems related to the maxillary sinus. In addition, the author did not conduct a new study on human nor animal subjects because the previously implemented articles were the chief and the only source for this review.&#x0D; In conclusion, the functions and physiology of the maxillary sinus are the subjects that reflect the anatomical complexity mentioned in the most recent articles may probably show that all its functions could be a part of a large and more complicated image than that apparent nowadays.

Treatment effects after maxillary total arch distalization using a modified C-palatal plate in patients with Class II malocclusion with sinus pneumatization

The purpose of this study was to evaluate the treatment effects after molar distalization using modified C-palatal plates in patients with Class II malocclusion with maxillary sinus pneumatization. This study consisted of 70 lateral cephalograms derived from cone-beam computerized tomography images of 35 patients with Class II malocclusion (mean age 22.3 ± 7.4 years) who had undergone bilateral total arch distalization of the maxillary dentition using modified C-palatal plates. The samples were divided into 2 groups according to sinus pneumatization; group 1 (n= 40), cephalograms with sinus pneumatization and group 2 (n= 30) cephalograms without sinus pneumatization. Paired t tests and independent-sample t tests were used to compare the changes in each group and between groups. The distal movement of the maxillary first molars was 4.3 mm for group 1 and 3.5 mm for group 2, with the intrusion of 1.4 mm and 2.5 mm, respectively. There was no statistically significant difference between the 2 groups. Group 1 showed 3.5° of distal tipping of the maxillary second molars, which was significantly greater than the 0.2° in group 2 (P<0.05). The total treatment period, including distalization, was 2.2 years for group 1 and 1.9 years for group 2, but the difference was not significant. There was no significant difference in the amount of distal movement and intrusion of the maxillary first molars between groups 1 and 2. Therefore, these results suggest that regardless of sinus pneumatization, molar distalization using temporary skeletal anchorage devices in Class II patients can be performed as a nonextraction treatment.

Is Resonance Frequency Analysis a Reliable Evaluation for Primary Stability of Implants Without Apical Contact?

The primary stability of dental implants is one of the most crucial factors for providing long-term success of osseointegration. Vertical deficiencies, such as those due to maxillary sinus pneumatization, may cause a severe vertical limitation to residual bone height. This study aimed to examine the primary stabilization of implants without apical contacts. Eighty bone-level implants (4.1-mm diameter/10-mm length) were placed into polyurethane test blocks without apical contacts. According to coronal bone-to-implant contact, groups were set as 4, 6, 8, and 10 mm, respectively. Resonance frequency analysis (RFA) using a SmartPeg was performed separately toward the transversal and horizontal axes by two independent researchers. Data were statistically compared for interobserver and among groups. Interobserver reliability varied from moderate to excellent (intraclass correlation coefficient [ICC]: 0.629 to 0.985). There were no significant differences among the 6 mm, 8 mm, and 10 mm groups, although the 4 mm group showed the significantly lowest stability (P < .001). Transversal and longitudinal measurements of the same groups did not show a parallel correlation statistically. RFA values may be affected by the finger torque in tightening of the SmartPeg among different researchers. Fully placed implants did not significantly show the highest stability among various apically contactless groups. Consequently, RFA should not be used alone to evaluate primary stability for implants without an apical contact.

Orthodontic space management in first molar missing or unusual extraction patients

This article aimed to describe the various clinical considerations when opening or closing first molar spaces caused by missing or extracted first molars. Orthodontic patients sometimes need unusual first molar extraction or have some missing first molars. Orthodontic treatment can manage those spaces in one of two ways: prosthetic treatment preceded by regaining orthodontic space by uprighting the adjacent teeth or orthodontic space closure without additional prostheses. To determine whether to close or open the first molar missing or extracted spaces, various factors, including adjacent periodontal status, maxillary sinus pneumatization, gingival invagination, different malocclusions, and cephalometric variables and facial treatment objectives, should be considered. The first molar missing or unusual extraction spaces should be managed with careful consideration and proper orthodontic mechanics to maximize the benefits of treatment and minimize potential risks. The chances of extraction of problematic molar vs sound premolar and molar extraction space closure with missing spaces, rather than opening spaces, increase with the development of orthodontic mechanics. Therefore, it is essential to understand the factors that determine the prognosis.

Platelet-rich plasma in maxillary sinus augmentation, direct maxillary sinus floor augmentation

The placement of endosseous implants in posterior edentulous maxilla is normally a challenging task in implant dentistry due to maxillary sinus pneumatization. Various sinus augmentation techniques have been used with impressive success rates aimed at developing these sites for implant placement. Knowledge of anatomy of maxillary sinus guides us not only in proper preoperative treatment planning but also helps us to avoid the possible complications that may arise during sinus augmentation procedure. This topic attracts a rising number of publications with most of them reporting results that suggest, the patients with atrophic maxilla requiring implant treatment can benefit considerably from the use of sinus augmentation. This article explains the basic technique namely direct techniques used for maxillary sinus elevation and augmentation.

Clinical Characteristics According to the Radiological Classifications of Maxillary Sinus Fungus Ball

Background and Objectives: The purpose of this study was to classify radiological findings of patients diagnosed with maxillary sinus fungus ball and to analyze the differences in surgical approach methods and postoperative results.Methods: As a retrospective study, we reviewed the medical records of 221 patients (unilateral in 216: bilateral in 5).Results: On computed tomography (CT), 49% of the lesions had an irregular surface or a protruding part. There was a significant difference in surgical approach according to pneumatization of the maxillary sinus when middle meatal antrostomy (MMA) was performed alone or combined with MMA and inferior meatal antrostomy (IMA) (p=0.042). Extension of a maxillary sinus lesion caused by fungus ball was not associated with stenosis of the MMA (p=0.328).Conclusion: Diagnosis of maxillary sinus fungus on CT was associated with irregular lesion surface or a protruding calcification. In patients with fungus ball of the maxillary sinus, the more severe is the maxillary sinus pneumatization, the larger is the extent of IMA needed.

A Clinical Paradigm and Pertinent Literature Review for Placing Short Implants

Placing an implant to replace missing teeth can be challenging because of lack of vertical and/or horizontal bone ridge, maxillary sinus pneumatization and inferior alveolar nerve position. Additional surgical procedures may be necessary, with varying predictability, where vertical augmentation being the least predictable. An alternative option is to place short implants and exclude the additional surgical grafting procedures. By reviewing studies, this paper explores the predictability of the short implants for use in the methods. Bicon SHORT® implants are available in 5 and 6 mm lengths and seem to be able to overcome such limits but more long-term studies are still needed to determine long-term prognosis and success of short implants in terms of them being comparable or equal to longer or standard length implants.