The influence of the relationship between the root apex of the posterior teeth and the maxillary sinus floor on the thickness of the maxillary sinus mucosa

doi:10.19439/j.sjos.2025.02.015

Abstract

Abstract: PURPOSE: To measure and analyze the thickness of the maxillary sinus mucosa under different relationships between the maxillary posterior teeth apex and the maxillary sinus floor on cone beam CT (CBCT). METHODS: A total of 987 patients requiring implant surgery due to dentition defect or loss were selected from Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2020 to December 2022. The maxillary posterior teeth most closely related to the maxillary sinus were observed on CBCT, the tooth position and root apex were recorded, and the vertical distance between the apex of the posterior tooth and the base of the maxillary sinus was measured. According to the distance between the root apex and the maxillary sinus floor, the posterior teeth were divided into three categories: Class Ⅰ: the distance between the root apex and the maxillary sinus floor (d >0 mm); Class Ⅱ : the root apex was attached to the maxillary sinus floor and the cortical bone of the maxillary sinus floor was continuous (d=0 mm); Class Ⅲ : apical protrusion into the maxillary sinus floor(d<0 mm). The thickness of the thickest part of the maxillary sinus floor mucosa was measured. The distance between the root and the maxillary sinus floor and the thickness of the maxillary sinus mucosa were compared under different root-sinus floor relationship, and the correlation analysis was performed. SPSS 26.0 software package was used to analyze the data. RESULTS: Among the 1974 maxillary sinuses of 987 patients, there were 450 maxillary sinuses with Class I relationship between the posterior root apex and the maxillary sinus floor, while 126 (28%) of the maxillary second molar proximal root and the maxillary sinus floor were the most closely related. In ClassⅠrelationship, the average distance from root to the maxillary sinus floor was (2.9±2.7) mm, and the average thickness of the maxillary sinus mucosa was (2.9±4.0) mm. There was no correlation between the distance from root to the maxillary sinus floor and the thickness of the maxillary sinus mucosa. There were 808 maxillary sinuses with ClassⅡ relationship between the posterior root apex and the maxillary sinus floor, among which 132 (16.3%) maxillary first molars had the closest relationship with the maxillary sinus floor. In Class Ⅱ relationship, the average thickness of the maxillary sinus mucosa was (3.0±4.6) mm. There were 249 maxillary sinuses with Class Ⅲ relationship between the posterior tooth root apex and the maxillary sinus floor, among which 87 (34.9%) palatal roots of the maxillary first molar were the most closely related to the maxillary sinus floor. The average distance from the root to the maxillary sinus floor was (-1.9±-1.4) mm, and the average thickness of maxillary sinus mucosa was (2.4±4.9) mm. There was a positive correlation between them (r=0.18, P=0.004). CONCLUSIONS: The most common relationship between the posterior maxillary tooth apex and the maxillary sinus floor is Class Ⅱ. The palatal root of the first molar is most closely related to the maxillary sinus floor, the mesiobuccal root of the second molar ranks second. The thickness of the maxillary sinus mucosa varies on the relationship between the different maxillary posterior teeth apex and the maxillary sinus floor. The average thickness of the maxillary sinus mucosa in Class Ⅲ is thicker than Class Ⅱ and Class I. In Class Ⅲ, as the distance from the apices to the maxillary sinus floor increases, the thickness of maxillary sinus mucosa increases.

Key words: Maxillary sinus mucosa, Maxillary sinus floor, Apex of posterior teeth, CBCT, Maxillary sinus floor elevation

CLC Number:

R782.1

Wu Jiongrui, Gao Yiming, Chen Liang. The influence of the relationship between the root apex of the posterior teeth and the maxillary sinus floor on the thickness of the maxillary sinus mucosa[J]. Shanghai Journal of Stomatology, 2025, 34(2): 196-201.

References

[1] Kato S, Omori Y, Kanayama M, et al.Sinus Mucosa thickness changes and ostium involvement after maxillary sinus floor elevation in sinus with septa. a cone beam computed tomography study[J]. Dent J (Basel), 2021, 9(8):82.
[2] Moreno Vazquez JC, Gonzalez de Rivera AS, Gil HS, et al. Complication rate in 200 consecutive sinus lift procedures: guidelines for prevention and treatment[J]. J Oral Maxilloface Surg, 2014, 72(5): 892-901.
[3] Tavelli L, Borgonovo AE, Re D, et al.Sinus presurgical evaluation: a literature review and a new classification proposal[J]. Minerva Stomatol, 2017, 66(3): 115-131.
[4] Al-Dajani M.Incidence, risk factors, and complications of schneiderian membrane perforation in sinus lift surgery: a meta-analysis[J]. Implant Dent, 2016, 25(3): 409-415.
[5] Paik JW, Cha JK, Song YW, et al.Effect of Schneiderian membrane integrity on bone formation in sinus augmentation: an experimental study in rabbits[J]. J Clin Periodontol, 2022, 49(1): 76-83.
[6] Monje A, Diaz KT, Aranda L, et al.Schneiderian membrane thickness and clinical implications for sinus augmentation: a systematic review and meta- regression analyses[J]. J Periodontol, 2016, 87(8): 888-899.
[7] Zimmo N,Insua A,Sinjab K,et al.Impact of sex, age, and season on sinus membrane thickness[J]. Int J Oral Maxillofac Implants, 2018, 33(1): 175-180.
[8] Rancitelli D, Borgonovo AE, Cicciù M, et al.Maxillary sinus septa and anatomic correlation with the schneiderian membrane[J]. J Craniofac Surg, 2015, 26(4): 1394-1398.
[9] Apparaju V, Velamati SC, Karnati L, et al.Does residual bone thickness apical to periodontal defect play a major role in maxillary sinus mucous membrane thickness?: a cone-beam computed tomography-assisted retrospective study[J]. Dent Res J (Isfahan), 2019, 16(4): 251-256.
[10] Lin YH, Yang YC, Wen SC, et al.The influence of sinus membrane thickness upon membrane perforation during lateral window sinus augmentation[J]. Clin Oral Implants Res, 2016, 27(5): 612-617.
[11] Wen SC, Lin YH, Yang YC, et al.The influence of sinus?membrane thickness upon membrane perforation during transcrestal sinus lift procedure[J]. Clin Oral Implants Res, 2015, 26(10): 1158-1164.
[12] Yildirim TT, Güncü GN, Goksülük D, et al.The relationship of demographic and disease variables on schneiderian membrane thickness and appearance[J].Oral Surg Oral Med Oral Pathol Oral Radiol, 2017, 124(6): 568-576.
[13] Shanbhag S, Karnik P, Shirke P, et al.Association between periapical lesions and maxillary sinus mucosal thickening: a retrospective cone-beam computed tomographic study[J]. J Endod, 2013, 39(7): 853-857.
[14] Lu Y, Liu Z, Zhang L, et al.Associations between maxillary sinus mucosal thickening and apical periodontitis using cone-beam computed tomography scanning: a retrospective study[J].J Endod, 2012, 38(8): 1069-1074.
[15] Kumar MPS, Harshitha C.Relationship between maxillary sinus floor and the apices of maxillary posterior teeth-a cone beam computed tomography study[J]. Drug Invent Today, 2018, 10(8): 1374-1376.
[16] Kang SH, Kim BS, Kim Y.Proximity of posterior teeth to the maxillary sinus and buccal bone thickness: a biometric assessment using cone-beam computed tomography[J]. J Endod, 2015, 41(11): 1839-1846.
[17] 张智勇, 张晓, 宋辉. 上颌窦底与上颌磨牙牙根关系的锥形束CT研究[J]. 口腔医学研究, 2010, 26(5): 690-692.
[18] Shahbazian M, Vandewoude C, Wyatt J, et al.Comparative assesment of panoramic radiography and CBCT imaging for radiodiagnostics in the posterior maxilla[J].Clin Oral Investig, 2014, 18(1): 293-300.
[19] Pagin O, Centurion BS, Rubira-Bullen IR, et al.Maxillary sinus and posterior teeth: accessing close relationship by cone-beam computed tomographic scanning in a Brazilian population[J].J Endod, 2013, 39(7): 748-751.
[20] von Arx T, Fodich I, Bornstein MM. Proximity of premolar roots to maxillary sinus: a radiographic survey using cone-beam computed tomography[J].J Endod, 2014, 40(10): 1541-1548.