Imaging Analysis Of Risk Factors For Anatomical Structures Related To Complications Of Maxillary Sinus Lateral Elevation Based On CBCT

Ⅰ.BackgroundImplant restoration has become one of the main choices for patients with missing teeth.In clinical cases,dental implant restoration cases often encounter single or multiple tooth loss in the maxillary posterior tooth area.Due to the existence of the maxillary sinus air cavity adjacent to the anatomical structure,insufficient bone available in the missing tooth area often occurs,which affects the success rate of implant surgery.The maxillary sinus floor lift was first introduced by Tatum,and many scholars have improved the technique since then.Currently,maxillary sinus lift is an essential step for implantation in the maxillary posterior region with vertical alveolar bone defects.There are two methods for maxillary sinus lifting:percutaneous alveolar ridge top lift and lateral window outside lift.Both methods are safe and effective and can induce sufficient bone formation for implant placement.In addition,both methods show higher graft and implant survival.Maxillary sinus lateral wall elevation has been used in clinical practice for several years,but there is still a certain risk of complications,including perforation and bleeding.Understanding the important anatomical risk factors of the maxillary sinus related to complications is critical to the success of the operation.Preoperative evaluation of cone beam CT has become an important tool for diagnosis and surgical planning,including maxillary sinus floor elevation.Many anatomical features may affect the success rate of maxillary sinus lift surgery.The purpose of this article is to establish a systematic CBCT database of maxillary sinus anatomical risk factors related to complications of external elevation surgery,to promote communication between clinicians on the maxillary sinus structure,and to encourage surgeons to perform implant operations involving maxillary sinus elevation Perform in-depth analysis to reduce the risk of complications due to potentially underestimating important parameters.Ⅱ.ObjectiveObservation of maxillary sinus related anatomic risk factors by CBCT:1.Measurement of maxillary sinus mucoperiosteal thickness;2.Measurement of maxillary sinus angle;3.Incidence,shape and location distribution of maxillary sinus bone separation;4.Measurement of alveolar maxillary sinus artery detection rate,location distribution,and diameter;5.Measurement of anterolateral maxillary sinus bone wall thickness;6.Measurement of remaining alveolar ridge height;Ⅲ.Materials and methods1.Collect clinical data:The data of patients undergoing CBCT examination for implantation needs were collected from the Department of Implantation,Southern Medical University.2.Experimental equipment:Ka Vo 3D eXam cone beam CT machinePlanmeca Romexis(English version)professional measurement software3.Measurement method:Open the Dicom database,calibrate,open the observation window,and adjust layer by layer until the bone separation in the maxillary sinus is found,and record the separation position and walking direction.The thickness of the maxillary sinus membrane was measured at the mesial,distal,buccal,tongue,and bottom sites of the cross-section of the missing tooth site,and the mean value was recorded.The angle measuring tool measures the angle between the buccal and tongue walls.The thickness of the buccal bone wall was measured with the reference plane 15 mm higher than the crest level of the alveolar ridge;the distance between the lowest part of the sinus floor and the highest part of the remaining alveolar ridge was the remaining bone height.Screen the missing cases of maxillary first molar,observe the location of the alveolar maxillary sinus artery bone hole,record the CP-VP distance,and measure the bone hole diameter.4.Statistical methodsUsing IBM SPSS Statistics 23 software package for statistical processing of measurement data,in which measurement data is expressed by(X±S)for statistical description.The relationship between maxillary sinus bone separation,alveolar maxillary sinus arteries,and gender and age was analyzed by 2 tests and one-way analysis of variance.Maxillary sinus mucoperiosteal thickness,maxillary sinus floor angle,and other side-to-side comparisons were performed using paired t test.A single repeated measure factor analysis of variance was used to compare gender and age groups.P<0.05 was considered statistically significant.Ⅳ:ResultsA total of 496 valid data from this clinical trial were included in the study,including 273 males and 223 females.CBCT can be effectively applied to the preoperative diagnosis of maxillary posterior dental implant surgery.By measuring and analyzing the CBCT data of experimental subjects,we draw the following conclusions:1.In this study,the thickness of the maxillary sinus floor mucosa was(1.32±0.43)mm,with a minimum value of 0.67 mm and a maximum value of 2.79 mm.2.The average angle of maxillary sinus was 58.3°± 4.56 °.3.Maxillary sinus bone separation is the study object according to the number of patients,and the incidence rate is 25.81%(128/496).If the maxillary sinus side is the study object,the corresponding incidence rate is 27.47%(178/648).The coronal trend accounted for 85.02%(176/207),and 58.45%(121/207)of the bone separation was found in the middle.4.Of the 341 maxillary sinuses,195 were found in 195(57.18%),of which 65.13%were in the bone wall.The diameter of the arterial bone hole was(1.13 ± 0.86)mm.The difference between men and women was statistically significant(P<0.05).The distance of CP-VP is 4.38-31.41mm(average 15.72 ± 5.32mm).5.The thickness of the lateral wall of the maxillary sinus was(1.81±0.34)mm,and the diameter of the bone hole was significantly related to the thickness of the lateral wall of the maxillary sinus.Men are slightly thicker than women.6.The remaining alveolar ridge height is(9.75±0.323)mm,of which 67.86%are less than 10mm.(CP-VP)distance was significantly positively correlated with the height of the remaining alveolar crest.V.ConclusionIn this study,a total of 496 medical records were collected,and a total of 648 maxillary sinuses were observed and evaluated.Reading the literature to determine the objective evaluation criteria,obtaining more reliable large sample data,which can be compared horizontally with the data of previous researchers,expanding the relevant parameter database content with a view Provide more reliable theoretical data for clinical surgery.1.There is no significant difference in the thickness of mucoperiosteum between different genders,left and right,and RRH is significantly correlated with the thickness of mucoperiosteum.2.The maxillary sinus angle has no significant correlation with age and gender.The second premolar is narrower and the risk of complications is the highest.3.The maxillary sinus has more coronal tendencies,mainly in the middle.4.The alveolar maxillary sinus artery male has a larger diameter than female,which is statistically significant.5.The diameter of the arterial bone hole is significantly related to the thickness of the lateral wall of the maxillary sinus.