Location of maxillary intraosseous vascular anastomosis based on the tooth position and height of the residual alveolar bone: computed tomographic analysis

Abstract

Purpose: The aims of this study were to measure the distance of the intraosseous vascular anastomosis in the anterolateral wall of the maxillary sinus from different reference points, and to correlate the location of the intraosseous vascular anastomosis with the tooth position and the residual bone height of the maxilla.

Methods: Computed tomography (CT) images were taken from 283 patients undergoing dental implants placement in the posterior maxilla. Three horizontal lines were drawn at the ridge crest, maxillary sinus floor, and the position of the anastomosis. A vertical second line at the center of each tooth was drawn perpendicular to the horizontal lines. The distance from the ridge crest to the maxillary sinus floor and the distance from the maxillary sinus floor to the bony canal were measured from the intersections of the horizontal and vertical lines. The residual alveolar bone height was used to categorize three groups: group 1,<4 mm; group 2, between 4 and 8 mm; and group 3, >8 mm.

Results: The residual bone height values of different tooth positions were significantly different (P=0.0002). The distance from the maxillary sinus floor to the intraosseous vascular anastomosis was significantly different between groups 1 and 3 (P=0.0039). At the molar sites, a moderate negative correlation was found between the residual bone height and the distance from the maxillary sinus floor to the intraosseous anastomosis. The distances of the alveolar ridge crest and the maxillary sinus from the intraosseous vascular anastomosis were not significantly different between sexes.

Conclusions: Within the limitations of this study, sites with a higher residual bone height in the molar regions were at a relatively high risk of artery damage during window osteotomy preparation; therefore, we recommend taking more precautions when using a lateral approach for sinus elevation.

Keywords: Alveolar bone loss; Edentulous mouth; Maxillary artery; Sinus floor augmentation; X-ray computed tomography.

Figure 1

Measurement of the anastomosis position of posterior superior alveolar artery and infraorbital artery. (A) Group 1: The residual bony ridge height is less than 4 mm. (B) Group 2: The residual bony ridge height is between 4 and 8 mm. (C) Group 3: The residual bony ridge height is more than 8 mm. A: distance from the ridge crest to the maxillary sinus floor, B: distance from the maxillary sinus floor to the bony canal.

Figure 2

Scatter plot of the correlation between the remaining alveolar bony ridge height and the distance from the maxillary sinus floor to the bony canal position based on the tooth position: (A) first premolar, (B) second premolar, (C) first molar, and (D) second molar site.