Prevalence of Maxillary Sinus Pathology in Patients of the Misch International Implant Institute

Abstract

With the continuous evolution of sinus augmentation procedures in the field of implant dentistry it is imperative to have a comprehensive understanding of the maxillary sinus area. Both lateral wall and crestal approach sinus augmentation procedures have proven to be extremely successful for guided bone regeneration in the maxillary sinus. However, complications stemming from augmentation procedures are related to the presence of pre-existing maxillary sinus pathologies. The purpose of this study was to expand upon the current knowledge base in regards to the prevalence of maxillary sinus pathologies in patients presenting to an implant dentistry practice. To this end, computerized tomography (CT) scans of patients presenting to the Misch International Implant Institute (MIII) were analyzed for the existence of maxillary sinus pathology. Scans of 275 patients presenting to the MIII for maxillary sinus augmentation were evaluated by up-to three different examiners, all of whom were calibrated to the study design and well versed in the use of software to analyze CT scans. Age and gender were also evaluated to see if they had any relationship on the incidence of pathology. Scans were classified into one of five categories based upon the type of sinus pathology detected. The categories of sinus findings were: healthy, mucosal thickening > 5 mm, polypoidal mucosal thickening, partial opacification and/or air fluid level, and complete opacification. Overall, 54.9% of scans were classified as healthy, and 45.1% of scans were classified as exhibiting sinus pathology. Men were more likely to exhibit pathology compared to females (p<0.01). However, age did not appear to have any relation on the prevalence of sinus pathology. The prevalence of sinus pathology reported in this study appears to be within the range shown in previous medical and dental literature. However, due to the different populations studied in the literature and the varying definitions of what constitutes pathology, there is no consensus as to the exact prevalence of sinus pathology. Therefore, it may be more important for the dentist who is evaluating a CT scan prior to maxillary sinus augmentation to understand which patients will benefit from referral to another specialist (such as an otolaryngologist) for evaluation and co-management. It is proposed that based on the findings of this study, 45.1% of patients would require further consultation prior to proceeding with maxillary sinus augmentation surgery.