Vascular injury to the posterior superior alveolar artery (PSAA) during lateral sinus floor augmentation is a recognized surgical complication, yet data on PSAA anatomy in severely atrophic edentulous maxillae remain scarce. This study aimed to evaluate the prevalence, location patterns, and morphometric characteristics of the PSAA in this specific population using cone-beam computed tomography (CBCT). Preoperative CBCT scans of 121 patients (242 sinuses) with severely atrophic posterior maxillae (residual ridge height ≤ 5mm) were retrospectively analyzed. PSAA location was classified as intraosseous (Type I), submembranous (Type II), extraosseous (Type III), or transosseous (Type IV). PSAA diameter and vertical distances to the sinus floor (PSAA-SF) and alveolar crest (PSAA-ALV) were measured. Generalized estimating equations accounted for within-patient correlation from bilateral evaluations. The PSAA was identified in 99.17% of sinuses, predominantly Type II (56.67%), followed by Type I (37.50%), Type IV (3.33%), and Type III (2.50%). Mean PSAA diameter was 1.02 ± 0.56mm, mean PSAA-SF distance 8.89 ± 4.61mm, and mean residual ridge height 3.55 ± 1.37mm. Type II location was significantly associated with Schneiderian membrane thickening (p = 0.018). In severely atrophic edentulous maxillae planned for lateral sinus floor augmentation, the PSAA predominantly follows a submembranous course alongside a clinically critical transosseous variant. Preoperative CBCT assessment of the PSAA is essential to inform individualized surgical planning and minimize hemorrhagic risks.

The aim of this study is to evaluate maxillary sinus volume, the presence of sinus pathologies, and the location of the posterior superior alveolar artery (PSAA) in patients with periodontitis and periodontally healthy individuals using cone-beam computed tomography (CBCT). Periodontal examinations were performed on patients who applied to our department for CBCT for any reason and who agreed to participate in the study, and 188 adult patients were included in the study. CBCT scans were evaluated for maxillary sinus volume, sinus pathology, and (PSAA) localization. Maxillary sinus pathologies were classified as mucosal thickening, polypoidal mucosal thickening, mucus retention pseudocyst, partial opacification, and total opacification. The location of the PSAA was examined in three types: intraosseous, submembranous, and in the external cortex of the lateral wall of the sinus. Maxillary sinus volume was calculated using the IRYS software program. Measurements were performed on axial CBCT sections, and inter- and intraobserver reliability was assessed. Associations between periodontitis and CBCT parameters were analyzed using chi-square and Mann-Whitney U tests. A total of 376 maxillary sinuses from 188 individuals were evaluated. Maxillary sinus pathology was significantly more prevalent in patients with periodontitis compared with periodontally healthy individuals (39.2% vs. 25.3%, p = 0.004). In addition, maxillary sinus volume was significantly lower in the periodontitis group than in healthy controls (10.50 ± 6.52 vs. 12.33 ± 4.98, p = 0.009). The presence of pathology in the maxillary sinus was found to be statistically significantly higher in males (40.3%) than in females (27.7%) (p = 0.015). No significant association was observed between periodontitis and PSAA localization. Periodontitis is a disease that can lead to pathological and morphological changes in the maxillary sinus. PSAA localization does not differ significantly between groups, whereas maxillary sinus volume is influenced by periodontal health and sinus pathology. Therefore, three-dimensional evaluation of the region using CBCT is important prior to implant surgery and other maxillofacial surgical procedures involving the maxillary sinus.

Maxillary sinus (MS) floor elevation using the lateral window approach is a predictable technique for bone augmentation in the posterior maxilla. However, injury to the posterior superior alveolar artery (PSAA) during osteotomy can result in significant intraoperative bleeding and compromise surgical visibility. This study aimed to evaluate the presence, anatomical location, and vertical distance of the PSAA using cone-beam computed tomography (CBCT) and to analyze its relationship with the vertical position of the simulated lateral window relative to the sinus floor, relevant to sinus floor elevation procedures. A retrospective observational analysis was performed on 1152 MS assessed on CBCT scans obtained for various diagnostic purposes. Scans fully visualizing the MS and lateral wall were included. The PSAA was identified and classified according to its anatomical location: intraosseous, submucosal, or extraosseous. The vertical distance between the artery and the sinus floor was measured, and the vertical position of the simulated lateral window relative to the sinus floor was categorized into four classes (0–3 mm, 3–8 mm, 8–11 mm, and > 11 mm). Descriptive statistics were used to summarize the distribution of PSAA visibility, anatomical location, and lateral window height classes. Associations between PSAA anatomical location and vertical window position were examined using the Chi-square test for independence. The PSAA was identified in 68.1% of evaluated MS and was more frequently visible in males than in females. The artery was most commonly located beneath the Schneiderian membrane (48.6%), followed by intraosseous (17.6%) and extraosseous (1.8%) courses. The mean distance from the sinus floor was 8.3 ± 4.3 mm. Higher vertical positions of the simulated lateral window were significantly, although weakly, associated with an intraosseous arterial course. The PSAA is identifiable on CBCT in approximately two-thirds of MS, most commonly following a submucosal course, with a mean distance of 8.3 mm from the sinus floor. PSAA location was significantly associated with the vertical position of the simulated lateral window relative to the sinus floor, supporting the value of CBCT-based anatomical assessment for preoperative lateral window planning in MS floor elevation procedures.

Prevalence and location of posterior superior alveolar artery in Lebanese population. A retrospective tomography study.

In dentistry and maxillofacial surgery, detailed knowledge of maxillary sinus anatomy and its relationship to adjacent structures is essential to reduce the risk of intraoperative complications, particularly during implant placement and sinus floor elevation procedures. This study aimed to assess the prevalence, diameter, and anatomical course of the posterior superior alveolar artery (PSAA), as well as its spatial relationship to the alveolar crest and the maxillary sinus floor, using conebeam computed tomography (CBCT) to support preoperative surgical planning. This retrospective study evaluated 146 CBCT scans. The diameter of the PSAA and its spatial relationships with the maxillary sinus floor, alveolar crest, and medial sinus wall were assessed. Age and sex were included as covariates. Measurement reliability was evaluated using the intraclass correlation coefficient (ICC). Statistical analyses were performed with a significance level set at p < 0.05. The PSAA diameter was ≤ 2 mm in the vast majority of cases on both sides, accounting for 97.6% on the right and 97.5% on the left, while large-diameter PSAA ( > 2 mm), which may increase the risk of intraoperative bleeding, were uncommon on both sides. Although the PSAA is commonly characterized by a small diameter, larger-caliber arteries may be encountered and pose a potential risk during maxillary sinus surgeries. Therefore, accurate preoperative localization of the PSAA using CBCT is essential to minimize the risk of vascular injury and to support safe surgical planning.

Background/Objectives: Sinus elevation in the posterior maxilla carries a risk of hemorrhage due to injury of the posterior superior alveolar artery (PSAA). Accurate preoperative identification of the PSAA using cone-beam computed tomography (CBCT) can enhance surgical safety. This retrospective study evaluated the prevalence, location, diameter, and visibility of the PSAA in a Saudi population. Methods: A total of 117 CBCT scans (234 sinuses) obtained between 2022 and 2024 were analyzed. The PSAA's visibility, diameter, and distances from the alveolar crest, sinus floor, medial wall, and sinus septa were measured. Associations with age, sex, smoking status, and the presence of sinus septa were statistically assessed. Results: The PSAA was identified in 98.3% of sinuses. Intraosseous and submucosal locations predominated in premolar and molar regions, respectively. Class A arteries (≤1 mm) were most frequent. Significant differences were found between premolar and molar regions in arterial location and distances from the alveolar crest and sinus walls (p < 0.001). Older individuals exhibited medial displacement of the artery in the molar region, and smokers showed significantly smaller diameters (p < 0.05). Sinus septa were associated with increased PSAA distances from the sinus floor and medial wall. Conclusions: The PSAA demonstrates high detectability and marked variability in position and caliber within this Saudi cohort. Recognition of these anatomical variations is essential for reducing complications during sinus-augmentation procedures.

Calcium hydroxide is commonly used as a root canal disinfectant due to its high alkalinity and biocompatibility. However, excessive injection pressure may cause extrusion beyond the root apex, leading to complications such as nerve or vascular injury. This report showed a case of a 58-year-old woman who developed cutaneous necro-sis and sensory disturbance in the left midface and nasal alar region following endodontic treatment on the left maxillary second molar. Computed tomographic imaging revealed calcified occlusion of the posterior superior alveolar artery. The patient was treated with debridement, stromal vascular fraction injection, and split-thickness skin graft. This case demonstrates a rare but serious complication, known as Nicolau syndrome, resulting from intra-arterial injection of calcium hydroxide. Clinicians should be aware of this potential risk and exercise cau-tion during delivery of intracanal medicaments, especially in vascular-rich anatomical regions.

Reconsideration of the anatomical structure of the buccal fat pad.

Aim: This study aim was to assess the maxillary sinus anatomical variations and structures using cone beam computed tomography (CBCT), particularly for dental implant treatment planning. Materials and Methods: In this cross-sectional prevalence study, 200 CBCT images were examined. The assessments were conducted independently by two authors to evaluate the anatomical variations of the maxillary sinus. The anatomical variations assessed in the axial images included alveolar pneumatization, anterior pneumatization, exostosis, and hypoplasia. Additionally, the positioning of sinus septa and the posterior superior alveolar artery (PSAA) was also evaluated. Results: Among the 400 maxillary sinuses analyzed, alveolar pneumatization was the most commonly detected morphological abnormality. Anterior pneumatization was detected in 84 sinuses (% 21.0). Antral septa were found in 175 sinuses (% 43.7) and were mostly located in the middle region. Among 254 sinuses, the PSAA was most frequently detected intraosseously, accounting for 63.5% of cases. Conclusion: Maxillary sinus anatomical variations are significant findings in the context of dental implant planning. These variations are frequently observed in CBCT examinations conducted on the maxilla. Understanding the anatomical variations of the maxillary sinus enhances the effectiveness of preoperative dental implant planning and aids in the prevention of potential complications.

In this study, we investigated the anatomical location, dimensions, and relationships of the posterior superior alveolar artery (PSAA) and canalis sinuosus (CS) within the maxilla, aiming to enhance the safety and efficacy of surgical procedures. A retrospective analysis was performed on 323 individual cone beam computed tomography scans. The diameter of the PSAA and CS, the distance of the PSAA from the sinus floor, the distance of the PSAA and CS from the alveolar crest, the distance of the PSAA and CS from the nasal septum, and the distance from CS to the nasal cavity floor were measured. The distance between PSAA and the sinus floor showed no significant difference between the right and left sides nor between genders (p < 0.05). The distance between the alveolar crest of PSAA and the distance between PSAA and to nasal septum was significantly higher on the left than on the right side (p < 0.05). According to gender, female subjects exhibited a lower distance between PSAA and the nasal septum than males (p < 0.05). Variations in PSAA and CS anatomy highlight the need for individualized preoperative CBCT assessment to reduce complications like bleeding during maxillary surgeries, enhancing surgical planning and safety in dental and maxillofacial procedures.

Purpose: In this study, various anatomical structures of the maxillary sinus that should be considered for the selection of appropriate maxillary sinus floor augmentation (MSFA) were analyzed using cone beam computed tomography (CBCT).Materials and Methods: Among a total of 90 patients who visited Chonnam National University Dental Hospital and had dental implants placed with SFA, 146 implant sites surviving for more than 5 years were studied.Medical records were examined to know the performed method of MSFA (transcrestal approach (CA) versus lateral window approach (LA)), and preoperative CBCT images were analyzed sinus mucosa thickness (FT), height of the posterior superior alveolar artery (PSAA), residual bone height (RBH), lateral wall thickness (LT), and sinus contour, and statistically analyzed.Results: FT was 2.85 3.56 mm, LT was 1.41 0.99 mm, the PSAA height was 14.35 3.46 mm, and the width of the sinus was 13.13 4.29 mm.Narrow tapered type was the most common in the second premolar region.RBH had a significant negative correlation with the height of the PSAA and the width of the maxillary sinus, and a significant positive correlation with LT.Implant survival was 100% for both methods in sites with RBH of 4 mm or less.Comparing anatomical measurements between the two methods, FT was greater in CA and the height of the PSAA was greater in LA (P < 0.05).Conclusion: In cases where the residual bone height is less than 4 mm, it is difficult to form a lateral opening due to the low PSAA height, thin lateral wall thickness, and narrow contour, or when the maxillary sinus floor mucosa is thick, a good success rate can be expected by performing crestal approach.(

BACKGROUND &amp; OBJECTIVE: The posterior superior alveolar (PSAA) artery plays a crucial role in supplying blood to the lateral wall of the maxillary sinus. This artery is of particular significance while performing procedures that involve the maxillary sinus. Our current study aimed to localize this artery and record its distance from a particular landmark: the maxillary sinus floor in patients reporting to a dental teaching hospital. METHODOLOGY: This cross-sectional study was conducted in the Department of Periodontology at Lahore Medical &amp; Dental College. A total of 85 cone-beam computed tomography (CBCT) images were analyzed to document the presence and precise location of the posterior superior alveolar artery (PSAA). RESULTS: This study visualized 170 maxillary sinuses of 55 males and 30 females. The PSAA was visualized in 84.1 % of the sinuses. Further analysis revealed that in 54.1% of cases (n = 92), the artery was located intraosseously; in 21.2% (n = 36), it was situated below the sinus membrane; and in 8.8% (n = 15), it was found on the outer surface of the lateral wall of the maxillary sinus. The mean vertical distance from the lowest point of the sinus floor to the PSAA was 6.96 mm, with a range of 1.32 mm to 16.23 mm. CONCLUSIONS: Our study validates the diverse locations of the PSAA relative to the maxillary sinus's lateral wall, with no notable differences observed between genders. Additionally, it highlights the effectiveness of CBCT as a reliable method for pre-surgical evaluation of the maxillary sinus and its associated blood vessels.

AimThis study aimed to evaluate the prevalence, location and diameters of Posterior superior alveolar artery (PSAA) and Infraorbital foramen (IOF) to find out whether there is any relationship between PSAA and IOF, and to predict their location relative to each other in surgical procedures by using cone beam computed tomography (CBCT).Material and methodBilateral maxillary sinuses were analysed retrospectively in 170 patients with no missing teeth in the maxillary posterior region. The largest locations of PSAA and IOF in the maxillary sinus were determined and their size, shape, location in relation to the teeth and distances from anatomical points were evaluated. For statistical analysis, Kolmogorov-Smirnov, Shapiro-Wilk tests, Intraclass Correlation Coefficient, and Kappa Test were used.ResultsThe incidence rate of PSAA on CBCT was found as 56.2%. While the rate of those with a vertical diameter of ≥ 1 mm was 92.1%, the rate of those with a horizontal diameter of ≥ 1 mm was 65.4%. In terms of location, the highest rate was found in the distal of the second molar. Mean horizontal diameter of IOF was found as 3.47 mm, while its mean vertical diameter was found as 3.68 mm. In terms of location, the most common location was at the second premolar tooth level with a rate of 39.7%. While IOF was mostly seen at the first premolar tooth level in young participants, it was mostly seen at the distal of second premolar tooth in old age. No statistical correlation was found between PSAA and IOF (p > 0.05). However, the median values of diameters to the anatomical structures were found to be higher in males when compared to females.ConclusionIn the present study, our hypothesis of predicting the position of PSAA and IOF relative to each other in surgical procedures of the maxillary sinus was not confirmed. It may be useful to conduct more detailed studies with higher resolution CBCT devices in which more patients are included. In order to prevent a possible bleeding that can occur, clinicians are recommended to evaluate the size and location of these anatomical structures with CBCT before surgical procedures, especially in male patients and older patients.

ObjectiveThis study aims to determine the anatomical relationship between the posterior superior alveolar artery (PSAA) and the lateral wall of the maxillary sinus during preoperative radiological evaluations in the posterior maxillary dental region, as well as to evaluate the prevalence of PSAA and its potential associations with sinus pathologies.Materials and methodsThis retrospective study is based on the analysis of Cone-Beam Computed Tomography (CBCT) data from 510 sinuses of 255 patients. The visibility of the PSAA vascular canal, artery diameters, vertical distance between the alveolar crest and the artery, and the distance to the sinus floor were measured in coronal sections. Additionally, the relationships between sinus pathologies and septa within the sinuses and the PSAA were evaluated.ResultsPSAA was detected bilaterally in the majority of patients (70.2%). Sinus pathologies and the presence of septa were also examined, revealing that 36.9% of the sinus pathologies were bilateral. Chi-square analyses showed no statistically significant relationship between gender and the presence of PSAA. Female patients had a higher incidence of sinus pathologies compared to males (p = 0.002). No significant relationship was found between the presence of PSAA and septa.ConclusionsThis study highlights the importance of considering the anatomical position and prevalence of the PSAA during preoperative radiological evaluations in the posterior maxillary region. This study identified the PSAA as predominantly located in the lateral wall of the maxillary sinus, an anatomical feature of critical importance during preoperative radiological evaluations to minimize vascular complications.Clinical trial numberNot applicable.

Objective: The intimacy of the posterior superior alveolar artery (PSAA) with the lateral sinus wall makes it significant during sinus floor elevation for implant placement in the posterior maxilla. The objective of this study was to analyze crucial anatomical variations using cone beam computed tomography (CBCT). Materials and methods: 356 maxillary sinuses (178 CBCT scans—95 males and 83 females) were analyzed for the rate of detection of the PSAA, location relative to the lateral wall of the maxillary sinus, and distance of the PSAA to the sinus floor. The prevalence of any additional branches of the PSAA was recorded. Results: The PSAA was identified bilaterally in 150 cases (84.3%), unilaterally in 2 cases (1.12%,) and was undetectable in 26 cases (14.6%). The intraosseous course was most frequent in the molar region and a near-equal distribution between intraosseous and beneath the sinus membrane in the premolar region. The mean diameter of the PSAA was 1.67 ± 0.34 mm. The distance to the maxillary sinus floor measured 13.46 ± 4.24 mm, whereas the distance to the alveolar crest was 22.53 ± 2.32 mm. Two branches of the PSAA were observed in 27.34% (n = 82) of the cases. On average, the second branch was 12.34 ± 3.65 mm from the maxillary sinus floor and 21.89 ± 3.51 mm from the alveolar crest. Conclusion: Antrostomy preparation should be performed as mesial and as low as possible with a slight inferior curve around the area of the second premolar and first molar.

Background and Aim:The posterior superior alveolar artery (PSAA) is a branch of the maxillary artery.This study compared the anatomical position of the PSAA in the maxillary sinus between edentulous and dentate patients using cone-beam computed tomography (CBCT).Materials and Methods: This descriptive study evaluated 280 maxillary sinus CBCT scans of edentulous and dentate patients.Visibility, vertical diameter, location and type of artery, horizontal distance from the PSAA to the sinus internal wall, distance from the artery to the sinus floor, distance from the artery to the alveolar crest, and distance from the alveolar crest to the sinus floor were studied on coronal sections using SIDEXIS 3D software.Data were analyzed by the Chi-square, Spearman rank correlation coefficient, and independent t tests.Results: The artery type was mainly type I, with no difference between males and females or edentulous and dentate patients (P>0.05).PSAA was primarily located in the second molar area in dentate patients.The horizontal distance from the PSAA to the sinus internal wall, PSAA vertical diameter, distance from the alveolar crest to the sinus floor, and distance from PSAA to the maxillary sinus floor were not different in different age groups (P>0.05).Vertical diameter of PSAA and distance from PSAA to the maxillary sinus floor were not different between edentulous and dentate groups (P>0.05). Conclusion:The distance from the PSAA to the sinus internal wall and to the alveolar crest, and the distance from the alveolar crest to the sinus floor were smaller in edentulous patients.

Intraosseous posterior superior alveolar artery distribution relative to maxillary teeth

Abstract Aim: The aim of this study is to evaluate the prevalence, localization and diameters of Posterior superior alveolar artery (PSAA), one of the branches of maxillary artery, and Infraorbital foramen (IOF) through which the Infraorbital artery (IOA) passes, by using conic beam computed tomography (CBCT) in dentate patients. The study also aims to research whether there is any relationship between PSAA, which has a small diameter and which sometimes cannot be seen on CBCT, and IOF, which has relatively larger diameter, in terms of size, shape and localization and to predict their location relative to each other in surgical procedures involving the maxillary sinus in edentulous patients. Material and Method: Bilateral maxillary sinuses were analysed retrospectively in CBCT images taken for various reasons from 170 patients with no missing teeth in the maxillary posterior region. Demographic characteristics of patients such as age and gender and their radiological findings were recorded. The largest locations of PSAA and IOF in the maxillary sinus were determined and their size, shape, localization in relation to the teeth and their distances from anatomical points such as the midline, medial wall and base of the maxillary sinus and crest were evaluated. Results: While 49.42% of the participants were male, 50.58% were female and mean age was 28.88 ± 9.95. The incidence rate of PSAA on CBCT was found as 56.2%. While the rate of those with a vertical diameter of ≥1 mm was 92.1%, the rate of those with a horizontal diameter of ≥1 mm was 65.4%. When the relationship of PSAA with the maxillary sinus was examined, the most common location was intraosseous with 60.2%. In terms of localization, the highest rate was found in the distal of the second molar with 34.6%. IOF was observed in all CBCT images (100%). Mean horizontal diameter of IOF was found as 3.47 mm, while its mean vertical diameter was found as 3.68 mm. In terms of shape, the most common shape was semi-circular (49.4%). In terms of localization, the most common location was at the second premolar tooth level with a rate of 39.7%. While IOF was mostly seen at the first premolar tooth level in young participants, it was mostly seen at the distal of second premolar tooth in old age. No statistical correlation was found between the diameters, localizations and shapes of PSAA and IOF (p&gt;0.05). However, the median values of horizontal diameter, vertical diameter, distance to the midline, distance to the medial wall and base of the maxillary sinus and distance to the crest were found to be higher in men when compared to women in both anatomical structures. Conclusion: According to the results of this study, in order to prevent a possible bleeding that can occur since PSAA and IOF diameters are higher in men than women and since the vertical and horizontal diameters of PSAA are higher than 1 mm in a great majority of the patients, clinicians are recommended to evaluate the size and localization of these anatomical structures with CBCT before surgical procedures, especially in male patients and older patients. In the present study, no statistical correlation was found between PSAA, one of the branches of maxillary artery, and IOF, through which IOA passes, in terms of characteristics such as localization, distance to anatomical points and shape and our hypothesis of predicting their position relative to each other in surgical procedures of the maxillary sinus in edentulous patients was not confirmed. It may be useful to conduct more detailed studies with higher resolution CBCT devices in which more patients are included.

Anatomical variation of the course of posterior superior alveolar artery (PSAA) within maxillary bone are vital information for surgeons before any maxillary surgery. This study was designed to evaluate the variations of PSAA by determining the prevalence of intraosseous PSAA and assessing the anatomical reference points and diameter of the PSAA. Comparison between dentate and edentulous alveolus was also done. One hundred CBCT images were included in this study to enumerate the prevalence of intraosseous PSAA in maxilla. Anatomical reference points which include the horizontal position of the PSAA and the vertical distance from the PSAA to the maxillary sinus floor and alveolar crest were identified. The diameter and horizontal position of PSAA were also analysed. The results were tested using independent t-test and chi square test. The PSAA was seen in 73.5% of the cases and 70.1% were located intraosseously. There was no significant difference in the vertical distance between PSAA and alveolar crest, as well as between maxillary sinus floor and alveolar crest for dentate and edentulous patients. Meanwhile, there was a significantly greater vertical distance between the PSAA and the maxillary sinus floor in edentulous (9.24 ± 4.75 mm) than in dentate patients (6.78 ± 3.43 mm) with p-value of 0.002. Mean diameter of the canal was 1.09 ± 0.43 mm. In conclusion, this study provides useful information regarding the most prevalent location and diameter of the PSAA which indicates the importance of preoperative evaluation through CBCT to reduce the risk of intraoperative bleeding that may complicate the treatment.

Anatomical study on the posterior alveolar canal in maxillary tuberosity region using computed tomography