| Objective:Exploring the relevant influencing factors of the changes of maxillary sinus mucosa and alveolar bone height before and after tooth extraction in patients with odontogenic maxillary sinus mucosa thickening by cone beam computed tomography(CBCT),so as to provide reference for risk assessment and operation design of oral implant surgery in maxillary posterior region.Methods:1.From June 2016 to December 2019,patients with chronic inflammation of maxillary posterior teeth who needed to be extracted in the Affiliated Stomatological Hospital of Zunyi Medical University were collected.Complete radiography data and medical records were available before extraction and 3-6 months after extraction.Tooth extraction was performed by 2 oral surgeons who were well trained and worked for more than 5 years in our hospital according to the minimally invasive extraction method,and the extraction operation was standardized.On the basis of the inclusion and exclusion criteria,In strict accordance with the inclusion and exclusion criteria,a total of 75 dental positions of 70 patients were included,corresponding to 75 maxillary sinuses.2.According to relevant measurement methods,the reconstructed images of the patients were calibrated,and the measurement level was selected.The schneiderian mucosa thickness(SMT)and alveolar bone height of the corresponding sites before and after tooth extraction were measured by the software of the equipment.According to SMT,it can be divided into odontogenic maxillary sinus mucosa thickened state(thickened,SMT≥2mm)and maxillary sinus mucosa normal state(normal,SMT<2mm).Based on this,the maxillary sinus mucosal state corresponding to the affected tooth site before tooth extraction was split into two groups,including the thickening group(the state of odontogenic maxillary sinus mucosa before extraction),a total of 58 cases,and the normal group(the normal state of maxillary sinus mucosa before extraction),a total of 17 cases.In the maxillary sinus mucosa progression after tooth extraction,21 cases were odontogenic maxillary sinus mucosa thickened and 54 cases were normal maxillary sinus mucosa.3.Grouping of factors affecting the thickening of odontogenic maxillary sinus mucosa:(1)According to the distance between the inflammation of the tooth and the maxillary sinus floor,it is classified into three groups:Group A had inflammation breaking through the maxillary sinus floor,group B had inflammation only touching the maxillary sinus floor but not breaking through,and group C had inflammation at a certain distance from the maxillary sinus floor;(2)According to the reason for tooth extraction,it is divided into three groups:periodontitis group,apical periodontitis group,and root fracture group;(3)Patients were divided into three groups according to age:youth group(18-40 years old),middle-aged group(41-60 years old),and elderly group(over 61 years old).3.All data measurements were statistically analyzed retrospectively by SPSS 18.0 software:(1)Chi-square test or Fisher’s exact probability test is used to analyze the relationship between the status of maxillary sinus mucosa before and after tooth extraction and the influencing factors;(2)Pairing Chi-square test is used to analyze the changes of maxillary sinus mucosa before and after tooth extraction;(3)Two or three independent samples were compared using Mann-Whitney U test and Kruskal-Wallis H test,respectively,to analyze the influencing factors of maxillary sinus mucosal thickness and alveolar bone height reconstruction degree.Results:1.The distance between inflammation of maxillary posterior teeth and maxillary sinus floor before tooth extraction affected the state of maxillary sinus mucosa,and there was significant difference in the proportion of normal maxillary sinus mucosa between group A and group C,and between group B and group C(Bonferroni correction,P<0.0167);and the distance between inflammation of maxillary posterior teeth and maxillary sinus floor affected the thickness of maxillary sinus mucosa,and in the thickness of maxillary sinus mucosa,group A and group B or group C comparison of maxillary sinus mucosal thickness difference was statistically significant(P<0.0167).2.Before tooth extraction,there was no statistical significance in the status and thickness of maxillary sinus mucosa of different extraction reasons and extraction ages(P>0.05).3.After tooth extraction,the state of maxillary sinus mucosa changed significantly,compared with that before tooth extraction,the proportion of normal maxillary sinus mucosa had significant difference(P<0.05);the state and thickness of maxillary sinus mucosa in normal group had no significant change compared with that before tooth extraction;the thickness of maxillary sinus mucosa in thickening group decreased significantly after tooth extraction compared with that before tooth extraction,the difference was statistically significant(P<0.05).In the thickening group,the proportion of normal maxillary sinus mucosa after tooth extraction accounted for 63.8%,the proportion of normal maxillary sinus mucosa after extraction due to periodontitis and apical periodontitis was lower than that of extraction due to root fracture(Bonferroni correction,P<0.0167).After tooth extraction,there was no significant difference in maxillary sinus mucosa status among different age groups(P>0.05).4.There was no significant difference in the change of alveolar bone height between the thickening group and the normal group after tooth extraction(P>0.05),and there was no statistically significant difference in the changes of alveolar bone height after extraction for different reasons(P>0.05).Conclusion:1.The distance between inflammation of maxillary posterior teeth and maxillary sinus floor affects the mucosal state of maxillary sinus.The smaller the distance between inflammation of maxillary posterior teeth and maxillary sinus floor,the higher the probability of thickening of maxillary sinus mucosa.When the inflammation breaks through the floor of maxillary sinus,the greater the degree of maxillary sinus mucosa thickening.2.After removing the source of odontogenic inflammation for 3-6 months,the thickness of thickened maxillary sinus mucosa decreased significantly or even returned to a normal state.However,affected by different reasons of tooth extraction,patients with periodontitis and apical periodontitis had a low probability of returning to the normal state of maxillary sinus mucosa.3.There was no correlation between alveolar bone height remodeling and odontogenic maxillary sinus mucosa thickening after maxillary posterior tooth extraction. |
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