Relación entre el seno maxilar y ápices de dientes postero- superiores con tomografía computarizada de haz cónico / Relationship between the maxillary sinus and apices of posterior-superior teeth using cone beam computed tomography

El conocimiento de la relación entre el seno maxilar y los ápices de los dientes posterosuperiores es fundamental para evitar complicaciones frente a distintos tratamientos. Estudio descriptivo de corte transversal, con muestra por conveniencia de 383 imágenes de raíces de dientes posterosuperiores obtenidas por medio de tomografía computarizada de haz cónico (TCHC) de un centro radiológico en Viña del Mar, Chile. Cada raíz fue clasificada según su relación vertical con el seno en 4 categorías (0: ápice no se encuentra en contacto con contorno inferior del seno; 1: ápice en contacto con seno; 2: ápice lateralmente al seno; 3: ápice se protruye en seno). Además se midió su distancia en mm. Los datos fueron analizados con estadística descriptivas. El diente más lejano al seno maxilar fue el primer premolar superior (4.2 mm), seguido por el segundo premolar superior (1 mm). En el primer molar superior la raíz más lejana fue la mesio-vestibular (MV) 1mm, seguida por la raíz disto-vestibular (DV) 0.6mm y la raíz palatina (P) -1mm. En el segundo molar superior la raíz más lejana fue P 0.4mm, luego la DV 0.3mm, y MV -0,11mm. En cuanto a las categorías, se observó que la mayoría de las raíces se encuentran alejadas del seno siendo la raíz P del primer molar superior y la raíz MV del segundo molar superior las que se encuentran mayormente protruidas (42 % y 26 % respectivamente). El primer premolar es el diente posterosuperior que se encuentra más alejado del seno maxilar y a medida que se avanza hacia posterior hay tendencia a disminuir la distancia entre los ápices y el seno maxilar.

SUMMARY: Knowledge of the relationship between the maxillary sinus and the apices of the upper posterior teeth is crucial to avoid complications when considering different treatments. A descriptive cross-sectional study was carried out, with a convenience sample of 383 images of upper posterior teeth roots, obtained by means of cone beam computed tomography (CBCT) from a radiological center in Viña del Mar, Chile. Each root was classified according to its vertical relationship with the sinus into 4 categories (0: apex is not in contact with the lower contour of the sinus; 1: apex is in contact with the sinus; 2: apex laterally to the sinus; 3: apex protrudes in sinus). In addition, its distance was measured in mm. The data were analyzed with descriptive statistics. The tooth farthest from the maxillary sinus was the maxillary first premolar (4.2 mm), followed by the maxillary second premolar (1 mm). In the upper first molar, the most distant root was the mesiobuccal (MV) 1mm, followed by the distobuccal root (DV) 0.6mm and the palatal root (P) -1mm. In the upper second molar, the furthest root was P 0.4mm, then DV 0.3mm, and MV -0.11mm. In reference to the categories, it was observed that most of the roots are far from the sinus, with the P root of the first upper molar and the MV root of the second upper molar being the most protruding (42 % and 26 % respectively). The first premolar is the posterior maxillary tooth that is furthest from the maxillary sinus and as one advances posteriorly there is a tendency to decrease the distance between the apices and the maxillary sinus.

Análisis bidimensional de la permeabilidad de vías aéreas con el tamaño de senos maxilares y su relación con el desarrollo de la clase esqueletal en una población mexicana / Two-dimensional analysis of airway permeability with maxillary sinus size and its relationship with the development of skeletal class in a Mexican population

Comparar la permeabilidad de las vías aéreas y el tamaño de los senos maxilares en relación con la clase esqueletal. se midieron 90 radiografías lateral de cráneo, divididas en 3 grupos, comparando las 3 clases esqueletales, las cuales se determinaron con la medida ANB de Steiner, y estas a su vez en dos subgrupos que fueron hombres y mujeres, en las cuales se utilizó el análisis de McNamara para el análisis de vías aéreas y para el área del seno maxilar se tomaron dos medidas una antero-posterior y cefálica-caudal. Al comparar los hombres con las mujeres se identificó significancia estadística en vía área superior de clase II (p=≤0.017), vía aérea inferior de clase III (p=≤0.006). Al comparar las clases esqueletales en hombres se identificó diferencias en la vía aérea superior en las clases I vs III (p=≤0.05), inferior en la clase I vs III (p=≤0,001) y II vs III (p=≤0.044). Con respecto a mujeres se identificó significancia en la vía aérea superior al comparar la clase I vs II (p=≤0,043), vía aérea inferior en la clase II vs III (p=≤0.05), longitud del seno maxilar al comparar clase I vs II (p=≤0.017). Entre la clase I esqueletal y la clase II, el tamaño de los senos maxilares resulto menor en longitud en las mujeres de clase II esqueletal. Entre la clase I y clase III esqueletal en hombres, se encontró una longitud menor en la vía aérea superior e inferior en la clase I. Las vías aéreas resultaron en menor tamaño en sujetos de clase II.

SUMMARY: To compare the airway permeability and the size of the maxillary sinuses in relation to the skeletal class. 90 lateral skull radiographs were divided into 3 groups, comparing the 3 skeletal classes, which were determined with Steiner's ANB measurement, and these were once in two subgroups that were men and women, in any McNamara analysis was used for the analysis of airways and for the maxillary sinus area measurements were made an antero-posterior and cephalic-caudal. When comparing males with females, statistical significance was identified in the upper class II route (p=≤0,017), lower class III airway (p=≤0.006). At least skeletal classes in men, differences were identified in the upper airway in classes I vs III (p=≤0.05), lower in class I vs III (p=≤0.001) and II vs III (p=≤0.044). With respect to women, significance was identified in the upper airway when comparing class I vs II (p=≤0.043), lower airway in class II vs. III (p=≤0.05), maxillary sinus length to class I vs II (p=≤0.017). Between skeletal class I and class II, maxillary sinus size was shorter in length in skeletal class II women. Between class I and skeletal class III in men, a lower length was found in the upper and lower airways in class I. The airways were found to be smaller in class II subjects.

The pterygopalatine ganglion, palatine nerves and vessels: dissection and pathway / El ganglio pterigopalatino, nervios palatinos y vasos: disección y trayecto

SUMMARY: Background and Objectives: The palatine nerves and vessels cross the pterygopalatine fossa, the palatine canals, the palatine foramina and the submucosal space, at the level of the hard palate and the palatine recess of the maxillary sinus. Their trajectory is long, complicated and difficult to highlight on a single dissection piece. In the literature that we studied, we did not find clear images that fully highlight the real configuration of the pterygopalatine ganglion and nerves and of the palatine vessels. Our aim was to provide a clear and representative dissection of the pterygopalatine ganglion and of the palatine neurovascular bundle throughout its pathway in a simple, coherent and useful presentation for the practitioners interested in the regional pathology. We resected the posterior and inferomedial osseous walls of the maxillary sinus and highlighted the neurovascular structures in the pterygopalatine fossa and the wall of the maxillary sinus. We photographed the dissection fields and detailed the important relations. The images that we obtained are clear, simple and easy to interpret and use. We successfully highlighted the aspect and the main relations of the pterygopalatine ganglion and the pathway and distribution of the palatine nerves and vessels, from their origin to the terminal plexuses. There is a broad spectrum of clinical procedures or situations that require a proper knowledge and understanding of the anatomical pathway and relations of the palatine neurovascular elements. This includes the various types of regional anesthesia, tumor resection surgery, flaps of the palatine mucosa, the LeFort osteotomy etc. Demonstration of the pterygopalatine ganglion and its relations is useful in endoscopic interventions at the level of the pterygopalatine fossa.

RESUMEN: Los nervios y vasos palatinos atraviesan la fosa pterigopalatina, además de los canales palatinos, los forámenes palatinos y el espacio submucoso a nivel del paladar duro y el receso palatino del seno maxilar. Su trayectoria es larga, complicada y difícil de destacar en una sola pieza de disección. En la literatura que estudiamos, no encontramos imágenes claras que resalten completamente la configuración real del ganglio y los nervios pterigopalatinos y de los vasos palatinos. Nuestro objetivo fue proporcionar una disección clara y representativa del ganglio pterigopalatino y del haz neurovascular palatino a lo largo de su trayecto en una presentación simple, coherente y útil para los médicos interesados en la patología regional. Resecamos las paredes óseas posterior e inferomedial del seno maxilar y resaltamos las estructuras neurovasculares en la fosa pterigopalatina y la pared del seno maxilar. Fotografiamos los campos de disección y detallamos las relaciones importantes. Las imágenes que obtuvimos son claras, sencillas y de fácil interpretación. Resaltamos con éxito el aspecto y las principales relaciones del ganglio pterigopalatino y el trayecto y distribución de los nervios y vasos palatinos, desde su origen hasta los plexos terminales. En conclusion, existe un amplio espectro de procedimientos o situaciones clínicas que requieren un adecuado conocimiento y comprensión del trayecto anatómico y las relaciones de los elementos neurovasculares palatinos. Esto incluye los distintos tipos de anestesia regional, cirugía de resección tumoral, colgajos de mucosa palatina, osteotomía de LeFort, etc. La demostración del ganglio pterigopalatino y sus relaciones es útil en intervenciones endoscópicas a nivel de la fosa pterigopalatina.

Anatomical variations of the maxillary sinus septa of an Iranian population using cone-beam computed tomography: a retrospective study / Variaciones anatómicas de los tabiques del seno maxilar de una población iraní mediante tomografía computarizada de haz cónico: estudio retrospectivo

This study sought to assess the internal anatomy of the maxillary sinuses and their septa using cone-beam computed tomography (CBCT) in an Iranian population. Materials and Methods: Resorption of alveolar bone decreases the height of the maxillary alveolar ridge. This height reduction may be so severe that it warrants ridge augmentation by a sinus lift. Manipulation of the maxillary sinuses, as in sinus lift surgery, requires adequate knowledge about the sinus anatomy.Results: Maxillary sinus septum, as an anatomical variation, may complicate the surgical procedures and increase the risk of complications such as sinus membrane perforation. In this retrospective study, 366 sinuses, 190 from females and 176 from males, aged between 10 and 65 years old presenting to the Oral and Maxillofacial Radiology Department of School of Dentistry at Hamadan University of Medical Sciences were evaluated by two oral radiologists. The extension of the maxillary sinuses, presence of septa, number of septa and their location were determined. Data were analyzed using the chi square test (level of significance p≤0.001). The coefficient of agreement between the two oral radiologists was calculated based on Cohen kappa. Septa were present in 40.5% of the maxillary sinuses, out of which, 31.6% had one, 7.9% had two and 1% had three or more septa; 38% of the septa were horizontal while 62% had an oblique orientation. In total, 184 septa were found in 183 patients; out of which, 91 septa were 2mm to 5mm long while 93 septa were longer than 5mm. Conclusions: Comprehensive knowledge about the three-dimensional internal anatomy of the maxillary sinuses acquired by CBCT priorto surgical procedures can greatly help to prevent postoperative complications.

Este estudio buscó evaluar la anatomía interna de los senos maxilares y sus septos mediante tomografía computarizada de haz cónico (CBCT) en una población Iraní. Materiales y Métodos: . La resorción del hueso alveolar disminuye la altura de la cresta alveolar maxilar. Esta reducción de altura puede ser tan severa que justifique el aumento de la cresta mediante una elevación de seno. La manipulación de los senos maxilares, como en la cirugía de elevación del seno, requiere un conocimiento adecuado sobre la anatomía del seno. Resultado: El tabique del seno maxilar, como una variación anatómica, puede complicar los procedimientos quirúrgicos y aumentar el riesgo de complicaciones como la perforación de la membrana sinusal. En este estudio retrospectivo, dos radiólogos orales evaluaron 366 senos, 190 de mujeres y 176 de hombres, con edades comprendidas entre 10 y 65 años que se presentaron en el Departamento de Radiología Oral y Maxilofacial de la Facultad de Odontología de Hamadan University of Medical Sciences. Se determinó la extensión de los senos maxilares, la presencia de septos, el número de septos y su ubicación. Los datos se analizaron mediante la prueba de chi cuadrado (nivel de significación p?0.001). El coeficiente de concordancia entre los dos radiólogos orales se calculó en base a Cohen kappa. Los septos estaban presentes en el 40.5% de los senos maxilares, de los cuales, el 31.6% tenía uno, el 7.9% tenía dos y el 1% tenía tres o más septos; El 38% de los septos eran horizontales, mientras que el 62% tenía una orientación oblicua. En total, se encontraron 184 septos en 183 pacientes; de los cuales, 91 septos tenían de 2mm a 5mm de largo, mientras que 93 septos tenían más de 5mm. Conclusion: El conocimiento exhaustivo sobre la anatomía interna tridimensional de los senos maxilares adquiridos por CBCT antes de los procedimientos quirúrgicos puede ayudar en gran medida a prevenir complicaciones postoperatorias.

Estudio de la relación de los terceros molares superiores retenidos y el seno maxilar en radiografías panorámicas y tomografía (CBCT) / Study of the relationship of retained upper third molars and maxillary sinus in panoramic radiographs and tomography (CBCT)

Objetivo: Evaluar la eficacia de la radiografía panorámica para establecer la relación de los terceros molares superiores y la cortical inferior del seno maxilar, en comparación con la tomografía computarizada de haz cónico (CBCT). Material y métodos: El trabajo incluyó 72 pacientes, se estudiaron 34 terceros molares superiores retenidos izquierdos y 38 derechos. Se realizaron mediciones con el programa para establecer la distancia entre la cortical inferior del seno maxilar y el ápice del tercer molar superior a partir de la imagen de la radiografía panorámica en lo que se estableció como parámetros: «a distancia, en contacto y dentro del piso de seno maxilar¼. Luego, con los cortes oblicuos o paraaxiales de la tomografía computarizada (CBCT) se observó la verdadera ubicación en el plano bucopalatino. Resultados: Del total de los terceros molares superiores 34 fueron izquierdas (47.22%) y 38 derechas (52.78%). En la Rx. Panorámica, 18 casos (25%) se encontraron a distancia al seno maxilar, 12 en contacto (16.7%) y 42 por dentro (58.3%) del seno maxilar. En la tomografía se observaron 20 casos (27.8%) a distancia del conducto, 16 (22.2%) en contacto y 36 (50%) por dentro del seno maxilar. Se observaron diferencias estadísticamente significativas (p < 0.05) entre la Rx. panorámica y la tomografía (CBCT) de los terceros molares que se hallan por dentro del seno maxilar. Conclusión: A partir de los resultados obtenidos, podemos establecer que la radiografía panorámica no permite conocer la verdadera relación entre la cortical inferior del seno maxilar y los terceros molares superiores (AU)

Objective: To evaluate the effectiveness of panoramic radiography to establish the relationship of the upper third molars and the inferior cortical of the maxillary sinus, in comparison with the Cone Beam Computed Tomography (CBCT). Material and methods: The work included 72 patients, 34 upper left maxillary molars and 38 rights were studied. Measurements were made with the program to establish the distance between the lower cortex of the maxillary sinus and the apex of the upper third molar from the image of the panoramic radiograph in what was established as parameters: «at a distance, in contact and inside the floor of maxillary sinus¼. Then with the oblique or paraaxial slices of the computed tomography (CBCT) the true location in the bucco-palatal plane was observed. Results: Of the total upper third molars, 34 were left (47.22%) and 38 right (52.78%). In the panoramic X-ray 18 cases (25%) were found at distance to the maxillary sinus, 12 in contact (16.7%) and 42 inside (58.3%) of the maxillary sinus. The tomography showed 20 cases (27.8%) at a distance from the canal, 16 (22.2%) in contact and 36 (50%) inside the maxillary sinus. Statistically significant differences were observed (p < 0.05) between the Rx. panoramic and tomography (CBCT) of the third molars that are inside the maxillary sinus. Conclusion: From the results obtained, we can establish that the panoramic radiograph does not allow knowing the true relationship between the inferior cortical of the maxillary sinus and the upper third molars (AU)

Assessment of maxillary premolar region in relation to maxillary sinus floor and buccal bone plate: a cone beam computed tomography study / Evaluación de la región premolar maxilar en relación con el piso del seno maxilar y la tabla osea vestibular: estudio de tomografía computarizada de haz cónico

The maxillary sinus floor location and the buccal bone plate are factors to be considered in the long-term success with implant treatments mainly in the premolar region. the aim of this study was to establish morphometric characteristics of the buccal cortical bone (BCB) thickness of maxillary premolars and its relation to maxillary sinus floor through CBCT. In this study 350 first and second maxillary premolars were analyzed from 110 CBCT images and the buccal cortical bone (BCB) was measured in a coronal view at the major axis level of each premolar. In addition, in 200 first and second maxillary premolars CBCT images were measured the distance from premolar apex to maxillary sinus floor (MSF) in both frontal and sagittal plane. The type of relationship between the apex and MSF was classified according to Ok et al. (2014). The second premolar was observed with higher values of BCB (p<0.001). In first premolar, higher values were observed in the male sex (p>0.05). In second premolar, only significantly higher values were observed in the male sex in MA-MB-MC (p>0.05). Regarding to MSF and its relation to premolar roots, it was observed that 10 % of the sample was classified as type I, 19 % as type II, 55.5 % as type III and 15.5 % as type IV. The BCB of the upper premolar region is thicker in the apical region and decreases toward the coronal region. Almost 50 % of apex of second premolars are closely and risky related MSF (Type I and II).

La localización del piso del seno maxilar (PSM) y la tabla ósea vestibular (TOV) son factores a considerar en el éxito a largo plazo de los tratamientos de implante dental en la región premolar. El objetivo de este estudio fue establecer características morfométricas del grosor de la TOV en los premolares maxilares y su relación con el PSM a través de CBCT. Se analizaron 350 primeros y segundos premolares en 110 CBCT y la TOV fue medida en vista coronal en el eje axial mayor de cada premolar. Además en 200 primeros y segundos premolares maxilares se midió la distancia desde el ápice del diente hasta el PSM en el plano sagital y frontal. El tipo de relación entre el ápice y el PSM se clasificó según Ok et al. (2014). El Segundo premolar obtuvo los mayores valores de grosor de TOV (p<0.001). En primeros premolares se observaron valores altos en el género masculino (p>0.05). En segundos premolares solo se encontraron valores significativamente altos en el género masculino en MA-MB-MC (p>0.05). En la relación con el PSM y ápices de raíces de premolares, el 10% de la muestra se clasificó como tipo I, el 19% como tipo II, el 55,5% como tipo III y el 15.5% como tipo IV. En conclusión la TOV de la región premolares superior es más grueso en la zona apical, decreciendo hacia la zona coronal. Alrededor del 50% de los ápices de raíces de premolares maxilares están cercanas y en relación de riesgo con el PSM (tipo I y II).

Relación entre el piso del seno maxilar y las raíces de las piezas posteriores superiores, mediante tomografía computada / Relationship between maxillary sinus floor and the posterior upper teeth roots, by means of computed tomography

Objetivo: El objetivo de este estudio fue evaluar la frecuencia con que las raíces de premolares y molares superiores se encuentran dentro del seno maxilar. Conocer la relación entre dichas estructuras es importante para planificar los procedimientos endodónticos y quirúrgicos a ser realizados en esa región. Materiales y métodos: Se realizó el análisis cualitativo dinámico de 82 tomografías computadas de haz cónico (CBCT) unilaterales, analizándose 738 raíces correspondientes a premolares y molares de una sola hemiarcada superior. Se utilizó sala con iluminación controlada y la observación fue realizada por un solo examinador. El criterio de inclusión requería que la cortical inferior del seno maxilar debía ser visible para poder establecer la relación. Se utilizaron los tres planos tomográficos de visualización, permitiendo ajustes de brillo y contraste. La escala de clasificación de cada raíz consideró su relación como: dentro o fuera del seno maxilar. Los datos obtenidos fueron sometidos a las pruebas de Chi-cuadrado y Test Exacto de Fisher. Resultados: el primer premolar superior mostró una proyección hacia el interior del seno maxilar significativamente menor que las otras piezas dentarias posteriores (p>0.05), observándose su raíz vestibular sin proyección. La raíz palatina del primer premolar superior mostró la mayor incidencia dentro del seno maxilar, con un 39,02% del total de las raíces analizadas (p<0,05). El segundo molar superior mostró considerable proximidad con el seno maxilar, pero con menor incidencia con relación a la raíz palatina del primer molar. Conclusión: los procedimientos endodónticos o quirúrgicos a realizarse en cercanía al seno maxilar deben considerar siempre la relación raíz/seno, para evitar maniobras que lo invadan. La raíz palatina del primer molar superior mostró la mayor incidencia dentro del seno maxilar, con un 39,02% (AU)

Distancia entre la raíz palatina del primer molar superior permanente y el piso del seno maxilar, obtenida mediante tomografía computarizada cone beam / Distance between the palatal root of the first permanent upper molar to the floor of the maxillary sinus, obtained by cone beam computed tomography

El conocimiento de las relaciones anatómicas entre el piso del seno maxilar y los ápices de dientes maxilares posteriores, es muy importante al planificar una terapia endodóntica o cirugías en molares maxilares. Este estudio tiene por objetivo, establecer la distancia existente entre el ápice de la raíz palatina del primer molar superior y el piso del seno maxilar, obtenida de una muestra de 61 tomografías volumétricas Cone beam. Se realizó un estudio observacional transversal, donde se procedió a medir la distancia entre el ápice de la raíz palatina del primer molar superior y el piso del seno maxilar en 61 tomografías volumétricas Cone Beam, obteniendo medidas de un total de 107 raíces palatinas de molares maxilares. Las imágenes fueron almacenadas en formato DICOM y analizadas con el software Sky View Dental Plan en un computador HP Compaq LA1951g Z600 y en su análisis estadístico se utilizó el Programa Stata 11.0. El promedio de distancia registrado entre el ápice de la raíz palatina del primer molar superior y el piso del seno maxilar fue de 1,2 mm. La mayor distancia fue de 12,5 mm y la menor de 0 mm. La medida de 0 mm se presentó en 48 casos y alcanzó al 44,9 % de la muestra. Es frecuente que los ápices radiculares se encuentren dentro del seno maxilar, condición que debe ser de conocimiento clínico, con el objetivo de prevenir al máximo accidentes y complicaciones en las terapias endodónticas.

The knowledge of the anatomical relationships between the floor of the maxillary sinus and the apices of the posterior maxillary teeth is very important when planning an endodontic therapy or surgeries in the area. The objective of this study is to establish the distance between the apex of the palatal root of the first maxillary molar and the floor of the maxillary sinus, in a sample of 61 cone-beam computed tomography. A crosssectional observational study was carried out. We proceeded to measure the distance between the apex of the palatal root of the first upper molar and the floor of the maxillary sinus in 61 conebeam computed tomography, obtaining measurements of a total of 107 first maxillary molar palatal roots. The images were stored in DICOM format and analyzed with the Sky View software and the Stata 11.0. for statistical analysis. The average distance recorded between the apex of the palatal root of the first upper molar and the floor of the maxillary sinus was 1.2 mm. The greatest distance was 12.5 mm and the smallest was 0 mm. The measurement of 0 mm was presented in 48 cases and reached 44.9 % of the sample. It is common for radicular apices to be located within the maxillary sinus. The clinician must know this condition to prevent accidents and complications in the endodontic therapies as much as possible.

Evaluation of Maxillary Sinus Septa Prior to Dental Implant Therapy: A Cone Beam Computed Tomography Study / Evaluación del Septo del Seno Maxilar Antes del Tratamiento con Implantes Dentales: Un Estudio con Tomografía Computarizada de Haz Cónico

SUMMARY: The objective of this study was to investigate the prevalence and location of maxillary sinus septa prior to dental implant therapy in different age groups by cone beam computed tomography (CBCT) and identify the most helpful orthogonal plane for this purpose. CBCT scans of 200 patients were selected. The final sample was divided into four groups according to age: (1) 30-39 y.o.; (2) 40-49 y.o.; (3) 50-59 y.o.; (4) +60 y.o. Three calibrated examiners assessed the presence and location (anterior, middle, posterior) of sinus septa using all orthogonal slices. The prevalence of septa per region and plane was compared by chi-square test. Among 359 maxillary sinuses evaluated, it was observed at least one septum in 163 sinuses (45.4 %). Overall, the anterior region was the most prevalent. However, when the age groups were considered, the anterior region was only the most prevalent in groups 2 and 3. The middle and posterior regions were more prevalent in groups 4 and 1, respectively. In conclusion, the prevalence of maxillary sinus septa in patients who were candidate to dental implant therapy was notably high. It was observed that the anterior region of the sinus was the most prevalent and the axial slice was the most representative.

RESUMEN: El objetivo de este estudio fue investigar la prevalencia y localización del septo del seno maxilar antes del tratamiento con implantes dentales en diferentes grupos etarios, por medio de la Tomografía Computarizada de Haz Cónico (TCHC). Fueron seleccionadas TCHC de 200 pacientes. La muestra final fue dividida en cuatro grupos de acuerdo con la edad: (1) 30-39 años; (2) 40-49 años; (3) 50-59 años y (4) +60 años. Tres examinadores calibrados evaluaron la presencia y localización (anterior, media o posterior) del septo del seno maxilar usando todas las secciones ortogonales. La prevalencia del septo por región y plano fue comparada mediante el test x-cuadrado. Entre los 359 senos maxilares evaluados, fue observado por lo menos un septo en 163 senos (45,4 %). Generalmente la región anterior fue la más prevalente. Sin embargo, cuando fueron considerados los grupos etarios, solamente la región anterior fue la más prevalente en los grupos 2 y 3. Las regiones media y posterior fueron las más prevalente en los grupos 4 y 1, respectivamente. La prevalencia del septo del seno maxilar en pacientes que son candidatos a tratamiento con implantes dentales fue notablemente alta. Se observó que la región anterior fue la más prevalente siendo las secciones axiales las más representativas.

Análise volumétrica do septo no seio maxilar exibida por tomografia computadorizada feixe cônico na população peruana ­ estudo retrospectivo transversal / Volumetric analysis of the maxillary sinus septa by CBCT in a Peruvian population ­ cross-sectional retrospective study

Objetivos: avaliar a presença do septo sinusal na população peruana. Materiais e métodos: um estudo transversal foi realizado em 298 seios maxilares de pacientes encaminhados ao Serviço de Radiologia Oral e Maxilofacial do Hospital Nacional Arzobispo Loayza, em Lima, Peru. A presença do septo, o número, a localização, o comprimento e a orientação dos avaliados, bem como idade, sexo e tipo de dentulismo, foram quantificados nas imagens da tomografi a computadorizada feixe cônico (TCFC), usando o software CS 3D Imaging. O teste Qui-quadrado foi realizado para tentar identifi car associações entre a presença do septo, condição dentária, idade e sexo, com 5% de significância, usando-se o SPSS20. Resultados: o septo no seio maxilar foi visto em 36,2% dos casos e estava ausente em 63,8%. Quanto à localização, 49,4% dos septos estavam no lado direito e 50,6% no lado esquerdo. Houve septos completos em 22,9% e incompletos em 77,1% dos casos. A localização do septo em maior proporção foi encontrada na parede basal, com 48,2%, seguido pelo setor anterior e medial do seio maxilar. O comprimento médio foi de 6,86 mm. Houve associação entre a frequência do septo e o sexo dos pacientes (teste Qui-quadrado de Pearson, p=0,015, graus de liberdade 1, ᵪ2= 5,894). Conclusão: cada população apresentará variações na localização e tamanho do septo do seio maxilar que devem ser cuidadosamente estudadas por TCFC para evitar rompimento da membrana e outras intercorrências que levam ao insucesso das terapias regenerativas e restauradoras.

Objectives: to evaluate the presence of the sinus septa in a Peruvian population. Materials and methods: a cross-sectional study was performed on 298 maxillary sinuses of patients referred to the Oral and Maxillofacial Radiology Service of the Arzobispo Loayza National Hospital, Lima, Peru. The presence of the septum, the number, location, length and orientation of the evaluated, as well as age, gender, type of dentulism were quantified in conical beam computed tomography (CTT) images using CS 3D Imaging software. The Chi-square test was performed to try to identify associations between the presence of the septum, dental condition, age and sex, with 5% of signifi cance, using SPSS20. Results: the septum in the maxillary sinus was seen in 36.2% of the cases and absent in 63.8%. Regarding the location, 49.4% of the septa on the right side and 50.6% on the left side. There were complete septa in 22.9% and incomplete septa in 77.1% of the cases. The location of the septum in greater proportion was found in the basal wall with 48.2%, followed by the anterior and medial sector of the maxillary sinus. The average length was 6.86 mm. There was an association between septum frequency and patients' gender (Pearson's Chi-Square test, p=0.015, degrees of freedom 1, ᵪ2 = 5.894). Conclusions: each population will present variations in the location and size of the septum of the maxillary sinus that must be carefully studied by CBCT to avoid membrane rupture and other intercurrences that lead to the failure of regenerative and restorative therapies.

Importância do complexo osteomeatal no planejamento do levantamento de seio maxilar / Importance of the evaluation of the osteomeatal complex in the planning of maxillary sinus lift

O desvio de septo nasal, concha bolhosa e a obstrução do óstio são alterações do complexo osteomeatal, que podem interferir no volume dos seios maxilares, em sua oxigenação, drenagem adequada de fluidos e nos resultados de cirurgias nessa região. A adoção de um protocolo de avaliação do complexo osteomeatal envolvendo uma equipe multidisciplinar no planejamento de cirurgias de levantamento de seio maxilar pode proporcionar a diminuição do surgimento de complicações pós-operatórias relacionadas à drenagem e ventilação, prejudicadas pelo desvio de septo nasal, concha bolhosa e obstrução do óstio.

Nasal septum deviation, concha bullosa and ostium obstruction are alterations of the osteomeatal complex that may interfere with the volume of the maxillary sinuses, their oxygenation, adequate drainage of fluids and the results of surgeries in this region. The adoption of a protocol for evaluation of the osteomeatal complex involving a multidisciplinary team in the planning of surgeries of maxillary sinus can provide a reduction in the appearance of postoperative complications related to drainage and ventilation impaired by nasal septum deviation, concha bullosa and obstruction of the ostium.

Shape, septa and scalloping of the maxillary sinus / Forma, septo y festoneado del seno maxilar

The maxillary sinus varies according to age, however there are limited studies that have illustrated its 3D form over time. This study aimed to classify the maxillary sinus by the shape, number of septa and scallops in a 1 to 25 year age group, utilising computerized tomography (CT) scans and 3D reconstruction. CT scans (n=480) were reviewed from the picture archiving and communication system (PACS) of the state and private hospitals in Pietermaritzburg and Durban KwaZulu- Natal (KZN), South Africa. The sample consisted of 276 males and 204 females, 1-25 years and of two population groups, black African and white. SLICER 3D (www.slicer.org) was utilised in order to reconstruct a 3D model of the sinus. Morphological traits such as the presence of the sinus, scalloping and septa within the sinuses were categorised. In addition, the shape of the 3D model of the sinus was analysed anteriorly (coronal) and laterally (sagittal) adapting the classifications by Kim (1962) and Kim et al. (2002). The maxillary sinus was present bilaterally in n=477 individuals (99.4 %). Five different anterior shapes viz. Type 1 (triangular), Type 2 (upside down triangle), Type 3 (square), Type 4 (irregular) and Type 5 (rectangular) were identified in the anterior view. This shape was associated with age and population groups (p<0.05). In the lateral view, the maxillary sinus appeared to be quadrilateral with differences noted along the inferior wall. Intrasinus maxillary septa were more evident in the anterior region of the maxillary sinus (27.9 % right; 28.5 % left). The maxillary septa were commoner in females (37.9 % right; 39.4 % left) than in males (28.5 % right; 30.3 % left). They were also more commonly observed in the white cohort (63.8 % right; 68.1 % left) than in the black African cohort (29.1 % right; 30.5 % left). Scalloping in the axial plane from above along its anterior margin was also observed. An in-depth classification of the morphology of the 3D form of the maxillary sinus according to age (1 to 25 years) was established. Five different shapes in both the anterior and lateral view of the 3D model were observed. Anteriorly, it was noted that the main shape was Type 2 (upside down triangle). The shape of the sinus changed in the form according to age. Laterally, the shape was related to the development of the teeth, as the inferior wall of the sinus was classified. Maxillary septa and scalloping of the sinus were reported in all age groups. Surgically, the sinus morphology is essential for dental procedures such as sinus augmentation or dental implants, and anthropologically, in forensic identification.

El seno maxilar varía según la edad, sin embargo existen pocos estudios que hayan ilustrado su forma tridimensional. El objetivo de este estudio fue clasificar el seno maxilar por su forma, número de septos y las vieiras en un grupo de 1 a 25 años, utilizando tomografías computarizadas (TC) y reconstrucción 3D. Las tomografías computarizadas (n = 480) fueron revisadas del sistema de archivo y comunicación de imágenes (PACS) de los hospitales estatales y privados de Pietermaritzburg y Durban KwaZulu- Natal (KZN), Sudáfrica. La muestra consistió en 276 hombres y 204 mujeres, de 1 a 25 años y de dos grupos de población, negro africano y blanco. Se utilizó el software SLICER 3D (www.slicer.org) para reconstruir un modelo 3D del seno aéreo. Se clasificaron rasgos morfológicos como la presencia del seno aéreo, festoneado y septos dentro de los senos. Además, se analizó la forma del modelo 3D del seno anterior (coronal) y lateral (sagital) adaptando las clasificaciones de Kim (1962) y Kim et al. (2002). El seno maxilar estaba presente bilateralmente en n = 477 individuos (99,4 %). Se encontraron cinco diferentes formas anteriores: Tipo 1 (triangular), Tipo 2 (triángulo invertido), Tipo 3 (cuadrado), Tipo 4 (irregular) y Tipo 5 (rectangular) fueron identificados en la vista anterior. Esta forma se asoció con la edad y los grupos de población (p <0,05). En la vista lateral, el seno maxilar parecía cuadrilátero con diferencias observadas a lo largo de la pared inferior. Los septos maxilares fueron más evidentes en la región anterior del seno maxilar (27,9 % derecho y 28,5 % izquierdo). Los septos maxilares eran más frecuentes en las mujeres (37,9 % derecho, 39,4 % izquierdo) que en los varones (28,5 % derecho y 30,3 % izquierdo). También se observaron más comúnmente en la cohorte blanca (63,8 % derecho, 68,1 % izquierda) que en la cohorte africana negra (29,1 % derecho y 30,5 % izquierda). También se observó la festoneación en el plano axial desde arriba a lo largo de su margen anterior. Se estableció una clasificación en profundidad de la morfología de la forma tridimension del seno maxilar según la edad (1 a 25 años). Se observaron cinco formas diferentes tanto en la vista anterior como en la lateral del modelo 3D. Anteriormente, se observó que la forma principal era el Tipo 2 (triángulo invertido). La forma del seno cambia según la edad. Lateralmente, la forma estaba relacionada con el desarrollo de los dientes, ya que se clasificó la pared inferior del seno maxilar. Los septos maxilares y la festoneación del seno maxilar se encontraron en todos los grupos de edad. Desde el punto de vista quirúrgico, el conocimiento de la morfología del seno maxilar es esencial al momento de realizar procedimientos dentales como el aumento del seno o los implantes dentales, y antropológicamente, en la identificación forense.

3D print of the maxillary sinus for morphological study / Impresión 3D del seno maxilar para su estudio morfológico

The maxillary sinus (MS) is described as a pyramid-shaped cavity of the maxilla. Knowledge of its morphology makes it possible to define normality and abnormality so that its three-dimensional analysis can be a valuable preoperative tool during surgery in this anatomical area. The aim of this study is to present a strategy of morphological analysis of the MS using 3D printing acquired through computed cone beam tomography (CBCT) images. A cross-sectional descriptive study was conducted, including 15 subjects (8 women and 7 men). The 3D virtual reconstruction and modeling was done on the MSs bilaterally, and 30 physical models were produced on a 3D printer. The results revealed that the MSs obtained exhibited various morphologies. An individual analysis of each MS allowed the tripod nature of the MS to be defined. We also were able to observe anatomical repairs such as the MS ostium, as well as complex areas affecting important surgical decisions. This method for creating 3D models of MSs provides a new approach to understanding the precise anatomical characteristics in these structures, which cannot be assessed in the same way on a 2D screen. It may be concluded that 3D printouts of the MS are a suitable method of preoperative analysis that can be useful in educating the patient, however, less time-consuming strategies should be explored.

El seno maxilar (SM) es una cavidad piramidal en maxila. El objetivo de este estudio es presentar una estrategia de análisis morfológico del SM utilizando impresión 3D a través de la adquisición de imágenes provenientes de tomografías computadorizadas cone beam (TCCB). Se realizó un estudio descriptivo transversal incluyendo 15 sujetos (8 mujeres y 7 hombres). Se realizó la reconstrucción y modelado virtual 3D de los SMs bilateralmente y se obtuvieron 30 modelos físicos generados en una impresora 3D. Los resultados arrojaron que los SMs obtenidos presentaban morfologías variadas, el análisis individual de cada SM permitió definir la condición tripoidal del SM, reparos anatómicos como el ostium del SM, mientras que zonas complejas relacionadas a decisiones quirúrgicas importantes pudieron ser observadas. Este método de creación de modelos 3D de SMs entrega un nuevo enfoque que permite apreciar características anatómicas precisas de estas estructuras, que no se pueden evaluar de la misma forma en una pantalla 2D. Se puede concluir que la impresión 3D de SM entrega un método de analisis prequirúrgico adecuado y que puede ser útil en la educación del paciente; otras estrategias con menor consumo de tiempo deben ser exploradas.

The relationship of the medial roof and the posterior wall of the maxillary sinus to the sphenoid sinus: a radiologic study / Relação do teto medial e parede posterior do seio maxilar como o seio esfenoidal: estudo radiológico

Abstract Introduction: The medial maxillary sinus roof is a ridge formed by the superior margin of the maxillary sinus antrostomy. The posterior wall of the maxillary sinus is always included in operative fields. Objective: To perform a radiologic study assessing the utility of the medial maxillary sinus roof and the posterior wall of the maxillary sinus as fixed landmarks for providing a safe route of entry into the sphenoid sinus. Methods: We reviewed 115 consecutive paranasal sinus Computed Tomographic scans (230 sides) of Korean adult patients performed from January 2014 to December 2014. Using the nasal floor as a reference point, the vertical distances to the highest point of the medial maxillary sinus roof, the sphenoid ostium and anterior sphenoid roof and floor were measured. Then the vertical distances from the highest point of the medial maxillary sinus roof to the sphenoid ostium and anterior sphenoid roof and floor were calculated. The coronal distance from the posterior wall of the maxillary sinus to the sphenoid ostium was determined. Results: The average height of the highest point of the medial maxillary sinus roof relative to the nasal floor was measured to be 33.83 ± 3.40 mm. The average vertical distance from the highest point of the medial maxillary sinus roof to the sphenoid ostium and anterior sphenoid roof and floor was 1.79 ± 3.09 mm, 12.02 ± 2.93 mm, and 6.18 ± 2.88 mm respectively. The average coronal distance from the posterior wall of the maxillary sinus to the sphenoid ostium was 0.78 mm. The sphenoid ostium was behind the coronal plane of the posterior wall of the maxillary sinus most frequently in 103 sides (44.4%). It was in the same coronal plane in 68 sides (29.3%) and in front of the plane in 61 sides (26.3%). Conclusions: The medial maxillary sinus roof and the posterior wall of the maxillary sinus can be used as a reliable landmark to localize and to enable a safe entry into the sphenoid sinus.

Resumo Introdução: O teto medial do seio maxilar é uma crista formada pela margem superior da antrostomia do seio maxilar. A parede posterior do seio maxilar é sempre incluída em campos cirúrgicos. Objetivo: Fazer estudo radiológico para avaliar a utilidade do teto medial do seio maxilar e da parede posterior do seio maxilar como referências anatômicas fixas para fornecer uma via segura de abordagem ao seio esfenoidal. Método: Foram analisados 115 exames de tomografia computadorizada consecutivos dos seios paranasais (230 lados) de pacientes adultos coreanos feitos de janeiro de 2014 a dezembro de 2014. Com o uso do assoalho nasal como ponto de referência, as distâncias verticais entre o teto medial do seio maxilar e o óstio esfenoidal e entre o teto e o assoalho esfenoidal anterior foram medidos. Em seguida, as distâncias verticais do ponto mais alto do teto medial do seio maxilar e o óstio esfenoidal e entre o teto e ao assoalho esfenoidal anterior foram medidas. A distância coronal da parede posterior do seio maxilar ao óstio esfenoidal foi determinada. Resultados: A altura média do ponto mais alto do teto medial do seio maxilar em relação ao assoalho nasal foi medida como 33,83 ± 3,40 mm. A distância vertical média do ponto mais alto do teto medial do seio maxilar até o óstio esfenoidal e do teto ao assoalho esfenoidal anterior foi de 1,79 ± 3,09 mm, de 12,02 ± 2,93 mm e 6,18 ± 2,88 mm, respectivamente. A distância coronal média da parede posterior do seio maxilar ao óstio esfenoidal foi de 0,78 mm. O óstio esfenoidal estava por trás do plano coronal da parede posterior do seio maxilar com mais frequência em 103 lados (44,4%). O mesmo se encontrava no plano coronal em 68 lados (29,3%) e na frente do plano em 61 lados (26,3%). Conclusões: O teto medial do seio maxilar e a parede posterior do seio maxilar podem ser usados como pontos de referência confiáveis para localizar e possibilitar uma abordagem segura ao seio esfenoidal.

The implications of different lateral wall thicknesses on surgical access to the maxillary sinus

Abstract: The objective of this study was to measure the topographic thickness of the lateral wall of the maxillary sinus in selected Asian populations. Measurements were made on the lateral walls of maxillary sinuses recorded using CBCT in a convenient sample of patients attending an Asian teaching hospital. The points of measurement were the intersections between the axes along the apices of the canine, first premolar, and second premolar and along the mesiobuccal and distobuccal apices of the first and second molars and horizontal planes 10 mm, 20 mm, 30 mm and 40 mm beneath the orbital floor. The CBCT images of 109 patients were reviewed. The mean age of the patients was 33.0 (SD 14.8) years. Almost three quarters (71.8%) of the patients were male. The mean bone thickness decreased beginning at the 10-mm level and continuing to 40 mm below the orbital floor. Few canine regions showed encroachment of the maxillary sinus. The thickness of the buccal wall gradually increased from the canine region (where sinus encroachment of the canine region was present) to the first molar region, after which it decreased to the thickness observed at the canine region. The buccal wall of the maxillary sinus became thicker anteroposteriorly, except in the region of the second molar, and thinner superoinferiorly. These changes will affect the approach used to osteotomize the lateral sinus wall for oral surgery and for the sinus lift procedure.

Diagnóstico diferencial da sinusite de origem odontológica por meio da tomografia computadorizada / Differential diagnosis of dental sinusitis with the aid of computed tomography

O objetivo do presente artigo é apresentar três casos clínicos com diagnóstico de sinusite de origem odontológica, ou síndrome endo-antral, um quadro inflamatório infeccioso de origem endodôntica que acomete dos tecidos e mucosa do seio maxilar adjacentes aos ápices radiculares.Os casos apresentados chamam a atenção para a dificuldade do diagnóstico apenas coma radiografia periapical e a importância da tomografia computadorizada como recurso auxiliar.

The aim of the current article is to report three clinical cases diagnosed as sinusitis of dental origin, or endo-antral syndrome, an inflammatory condition of endodontic infection origin that affects the tissues and mucosa of the adjacent maxillary sinus up to the root apex. The presented cases draw attention to the difficulty of diagnosis only with periapical radiography and the importance of computed tomography as an auxiliary resource.

Instalação do implante dentário após levantamento do seio maxilar com ß-tricálcio fosfato: relato de caso com resultados histológicos / Dental implant placement after maxillary sinus floor elevation using ß-tricalcium phosphate: a case report with histological results

Este relato de caso clínico descreveu o uso do beta-tricálcio fosfato para levantamento do seio maxilar e instalação do implante dentário. Uma paciente de 38 anos de idade apresentou-se com ausência dos elementos 26 e 27. Após a remoção da parede vestibular e levantamento do assoalho sinusal, uma membrana de colágeno foi interposta antes da deposição do biomaterial (granulação 1-2 mm). Oito meses depois, uma trefina foi usada para biopsia, e dois implantes dentários foram instalados. Os resultados histológicos mostraram a formação de tecido ósseo sadio. Mais tarde, as coroas defi nitivas foram confeccionadas e instaladas. O beta-tricálcio fosfato (Cerasorb) mostrou-se satisfatório como material para enxerto, mesmo sem o uso de osso autógeno concomitante

This case report describes the use of beta-tricalcium phosphate for maxillary sinus lifting and dental implant placement. A 38 years-old patient presented with the absence of the elements 26 and 27. After removing the buccal bone wall for sinus floor lifting, a collagen membrane was adapted before the biomaterial (1-2 mm granules) being inserted. Eight months later, a trephine bur was used for biopsy, and two dental implants were installed. Histological results showed the formation of healthy bone tissue. Later, the definitive crowns were made and installed. The betatricalcium phosphate (Cerasorb) was satisfactory as a biomaterial for grafting, even that no concomitant use of autogenous bone has been performed

Study of Anatomical Relationship between Posterior Teeth and Maxillary Sinus Floor in a Subpopulation of the Brazilian Central Region Using Cone-Beam Computed Tomography - Part 2

Abstract This study evaluated the anatomical relationship between posterior teeth root apices and maxillary sinus floor (MSF) on 202 cone beam computed tomography (CBCT) exams. The distance between the root apices and the MSF, as well as the MSF thickness of the cortical bone closest to root apices and furcation regions were measured. The vertical and horizontal relationships of the MSF with the molar roots were classified into categories adapted from the criteria proposed by Kwak et al. (14). The shortest distances between MSF and the root apices were observed in the mesiobuccal root of the second molar (0.36±1.17 mm) and the palatal root of the first molar (0.45±1.10 mm) and the widest in buccal roots of the first premolars (5.47±4.43 mm). Significant differences were observed between the distance of MSF to the root apices of single-rooted first and second premolars. The cortical thickness ranged from 0.65±0.41 mm over the mesiobuccal root of the second molar to 1.28±0.42 mm over the buccal root of the first premolar. The most observed vertical and horizontal relationships were type II and 2H, respectively. The maxillary molar roots showed greater proximity to the MSF. The thickness of the MSF cortical bone closest to the apices and furcation regions was found to be similar only for premolars.

Resumo Avaliou-se a relação anatômica entre dentes posteriores e o soalho do seio maxilar (SSM) por meio da tomografia computadorizada de feixe cônico (TCFC) em 202 exames. A distância entre os ápices radiculares e o SSM, bem como a espessura do osso cortical do SSM próximo dos ápices radiculares e áreas de bifurcação foram medidas. As relações verticais e horizontais do SSM com as raízes dos molares foram classificados em categorias adaptadas a partir dos critérios propostos pelo Kwak et al. (14). A menor distância entre o SSM e os ápices dentários foi observada na raiz mesiovestibular do segundo molar (0,36±1,17 mm) e na raiz palatina do primeiro molar (0,45±1,10 mm), e a maior na raiz vestibular do primeiro pré-molar (5,47±4.43 mm). Diferenças significantes foram observadas entre a distância do SSM e os ápices dentários de primeiros e segundos pré-molares unirradiculares. A espessura da cortical óssea variou de 0,65±0,41 mm na região da raiz mesiovestibular do segundo molar a 1,28±0,42 na raiz vestibular do primeiro pré-molar. As relações vertical e horizontal mais prevalentes foram do tipo II e 2H, respectivamente. As raízes dos molares superiores apresentaram maior proximidade com o SSM. A espessura da cortical óssea do SSM nas regiões mais próximas dos ápices e área de furca foi similar apenas para os pré-molares.

Prevalência de septos sinusais maxilares em pacientes parcial e totalmente desdentados, baseada em 150 exames de tomografias feixe cônico (TCFC) / Prevalence of maxillary sinus septa for partial and totally edentulous patients based on 150 cone beam computerized tomographic (CBCT) exams

Objetivo: avaliar a prevalência, localização e o número dos septos sinusais através de tomografi as computadorizadas de feixe cônico (TCFC), correlacionando com o sexo, a idade e o lado acometido nos pacientes parcialmente ou totalmente desdentados. Material e métodos: cada seio maxilar foi dividido em três regiões: anterior, média e posterior, utilizando-se um gráfico de linhas verticais e horizontais, considerando-se a parede lateral da cavidade nasal com a parede posterior do seio maxilar, e os septos com altura igual ou superior a 2 mm. As imagens foram obtidas por meio do tomógrafo modelo 3D (i-CAT, Kavo, Gendex CB-500, OP 300; voxel = 0,125 mm). Resultados: 150 exames foram selecionados igualmente entre pacientes parcial ou totalmente desdentados. Os septos foram encontrados em 74 pacientes (49,3%), sendo 38 pacientes desdentados parciais (50,06%) e 36 desdentados totais (48%). 46,2% dos exames correspondiam ao sexo feminino, e 53,8% ao masculino. Com relação à localização, 48,65% dos septos foram localizados no terço médio do seio maxilar, e 25,68% nas regiões anterior e posterior. A altura média dos septos foi 7,4 mm nos pacientes desdentados parciais, e 6,18 mm nos desdentados totais. Não houve correlação estatisticamente significante entre a prevalência dos septos sinusais com o sexo, a idade e o lado acometido. Conclusão: os septos foram identificados em todos os terços da cavidade sinusal, mas com dimensões menores em pacientes totalmente desdentados. Desta forma, o plano tridimensional é fundamental para a eleição da melhor técnica cirúrgica e prevenir complicações transoperatórias, como a fenestração da membrana sinusal.

Objective: to evaluate the prevalence, number, and location of sinus septa through cone beam computerized tomograms (CBCT) according to gender, age, and site for partial and totally edentulous patients. Material and methods: each maxillary sinus was divided into three regions (anterior, middle, and posterior) using horizontal and vertical plotted lines, considering the lateral and posterior walls of the maxillary sinuses, and septa with > 2 mm in height. All images were obtained by volumetric 3D (i-CAT, Kavo, Gendex CB-500, OP 300; voxel = 0.125 mm). Results: 150 exams were selected for partial and totally edentulous patients. The septa were found in 74 patients (49.3%), being 38 partial (50.06%) and 36 completely edentulous (48%). From these, 46.2% of exams were from female and 53.8% from male patients. Regarding the site, 48.65% of septa were found at the middle and 25.68% at the anterior and posterior regions. The mean septal height was 7.4 mm for partial and 6.18 mm for totally edentulous. No statistically significant correlations were found between septa prevalence and gender, age, and affected site. Conclusion: the septa were found at all sinus cavity thirds, but with reduced dimensions in totally edentulous patients. In this way, a 3D planning is fundamental to elect the best surgical technique to avoid complications and prevent perioperative problems, such as the sinus membrane fenestration.

Maxillary sinus septa prevalence and morphology: computed tomography based analysis / Prevalencia y morfología del septo del seno maxilar: análisis basado en estudios de tomografía computadorizada

The aim of this study was to examine the prevalence, location and morphology of maxillary sinus septa, and in particular sagittally orientated forms, which cannot be visualized by classic 2D x-rays. Thereby authors would like to provide information about the potential patient group, to be referred for the computed tomography scan before sinus lift procedure. The analysis was based on 216 computed tomography archival images. The exclusion criterion was occurrence of any suspected pathology in the maxillary region. The septa prevalence that was investigated in computed tomography was high (49%) with the mean height of 5.44 mm. The incidence of sagittally orientated septa as a challenge in 2D x-rays was 10%, with the second molar region as the most frequent location. Based on the obtained results and radiation safety principles, the authors suggest that orthopantomogram x-ray may be a sufficient ancillary radiological examination before beginning preimplant surgical procedure in the area of the maxillary sinus.

El objetivo de este estudio fue determinar la prevalencia, ubicación y morfología del septo del seno maxilar, y en particular de las formas orientadas sagitalmente, que no pueden ser visualizadas con el uso de equipos convencionales de Rayos X en dos dimensiones. De esta manera, se busca ofrecer información sobre el grupo potencial de pacientes, que serán sometidos a estudios de tomografía computarizada antes de la elevación del seno maxilar. El análisis se basó en 216 imágenes de archivo de tomografía computarizada. El criterio de exclusión fue la presencia de cualquier sospecha de patología en la región maxilar. La prevalencia de septos hallados en tomografía computarizada fue alta (49%) con una altura media de 5,44 mm. La incidencia de septos orientados sagitalmente, encontrados en estudios de Rayos X 2D fue del 10%, siendo la localización más frecuente la región del segundo molar. De acuerdo a los resultados obtenidos y respetando los principios de seguridad radiológica, los autores sugieren que la ortopantomografía de rayos X puede ser un examen radiológico suficiente antes de comenzar el procedimiento quirúrgico de implante en el área del seno maxilar.