Evaluation of maxillary sinus anatomy, pathology, and variations in patients who admitted to Ege University Faculty of Dentistry using dental volumetric tomography

Objective: The objective of this thesis study is to determine pathologies and variations of the maxillary sinus in patients who admitted to Ege University Faculty of Dentistry, and had cone beam computed tomography (CBCT) of the upper jaw due to various indications. Also the effect of age, gender, and dental status on maxillary sinus mucosal thickening (MT), presence of septa and location of Posterior Superior Alveolar Artery (PSAA) was investigated. The second aim was to investigate the effect periapical lesions on maxillary sinus and evaluate the correlation between apical lesion (AL) diameter, alveolar bone height (ABH), MT of maxillary sinus. Material and Methods: Among the 2000 DVT images evaluated from archieves of Ege University Faculty of Dentistry, 500 maxillary sinuse images that fullfilled our inclusion criteria were included in the study. The pathology and the variations of the maxillary sinus were classified under 15 headings. Maxillary sinus mucosal thickening, septa height and location; localization of posterior superior alveolar artery (PSAA) was evaluated by one observer under standard conditions. The effect of periapical pathology on maxillary sinus was evaluated by comparing the periapical bone height and mucosal thickening of teeth with and without periapical lesions. Septa height, MT, diameter of PSAA, apical lesion diameter and periapical bone height was measured using the Care Stream 3D measuring tool, the imaging program of Kodak 9000 Flat Panel (FP) imaging software. Each measurement was repeated three times and the mean value was recorded. Results: Findings of the study revealed that 55.6% of CBCT images were obtained for implant planning indication. The most common maxillary sinus pathologies and variations were maxillary sinus mucosal thickening, presence of septa and pneumatization. Flat type mucosal thickening was found in 34.8% of the patients. Gender, age and state of dentiton was found to have statistically significant effect on MT. Pathological MT was seen more common, males, among 36-53 age group and in partially dentulous patients. Our results revealed that maxillary sinus septa are in the middle location. However gender, age and state of dentiton had no significant effect on the presence of septa. PSAA was mostly seen intraosseous localization and gender was had no effect on this.The visibility of PSAA was more frequent in partially edentulous teeth. The presence of septa had no effect on mucosal thicknening. Apical pathology had no effect on MT and ABH. Wilcoxon Signed Rank test showed that there were no differences between measurements made in sagittal and coronal planes [p=0.033 for sagittal and coronal bone height in the groups with and without lesions, and p=0.534 for sagittal and coronal mucosal thickness in the groups with and without lesions] Conclusion: The results of the study reveal that CBCT is an important diagnostic tool for the radiographic evaluation of maxillary sinus pathology and variations. Therefore preoperative CBCT imaging has a crucial role in the success of surgical procedures and avoids potential complications regarding the posterior maxillary region. Key words: Dental volumetric tomography, maxillary sinus pathology and variations, prevalance, septa, posterior superior alveolar artery