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Journal of Molecular and Clinical Medicine  2018, Vol. 1 Issue (2): 93-98    DOI: 10.31083/j.jmcm.2018.02.006
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Dimensional changes of the alveolar ridge in the posterior maxilla and sinus pneumatization following teeth extraction
Itay Levi1, Michal Halperin-Sternfeld1, 2, Hadar Zigdon-Giladi1, 3, Eli E. Machtei1, 3, Jacob Horwitz1, 3, *()
1 Department of periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa 31096, Israel
2 Department of Oral Biology, The Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
3 Bruce Rappaport Faculty of Medicine- Technion, Israel Institute of Technology, Haifa 31096, Israel
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Abstract  

Sinus pneumatization is a continuous physiological process that occurs naturally and causes an increase in the volume of paranasal sinuses. Pneumatization is also frequently observed following extraction of teeth in the posterior maxilla. This leads to an increase in the sinus volume and height at the expense of the edentulous alveolar ridge. These changes may affect treatment planning if dental implants are indicated to replace extracted teeth. Using a novel method to align and compare two panoramic radiographs taken before and after tooth extraction, we aimed to examine post-extraction dimensional changes in the maxillary sinus and alveolar ridge by superimposition of preand post-treatment panoramic radiographs. Twenty-two pairs of panoramic radiographs were analyzed retrospectively for changes in alveolar ridge and maxillary sinus dimensions following at least 6 months from tooth extraction. Pre- and post-extraction radiographs were matched and then superimposed using a fixed reference unit. Measurements included the distance from bone-crest to sinus-floor and to sinus-roof, as well as distance from sinus-floor to sinus-roof and maxillary-sinus sagittal circumference. The mean difference between pre- and post-extraction bone-crest to the sinus-floor radiographic measurements was statistically significant ($P =$ 0.001) with a mean change of 1.2 mm. The difference between pre- to post-extraction bone-crest to sinus-roof measurements was insignificant ($P =$ 0.094) with a mean change of 0.9 mm. The distance between pre- and post-extration sinus-floor to sinus-roof was significantly increased in an average of 1 mm ($P =$ 0.001) along with an increase in sinus sagittal circumference from 993.9 $\pm $ 295.7 mm to 1096.6 $\pm$ 312.5 mm ($P <$ 0.0001). In conclusion, a moderate increase in maxillary sinus dimensions concurrent with crestal resorption may be anticipated after extraction of maxillary posterior teeth, leading to an overall decrease in alveolar bone height.

Key words:  Sinus pneumatization      Tooth extraction      Dental implants      Vertical height      Bone augmentation     
Submitted:  11 January 2018      Revised:  24 January 2018      Accepted:  26 January 2018      Published:  20 April 2018     
*Corresponding Author(s):  Jacob Horwitz     E-mail:  j_horwitz@rambam.health.gov.il

Cite this article: 

Itay Levi, Michal Halperin-Sternfeld, Hadar Zigdon-Giladi, Eli E. Machtei, Jacob Horwitz. Dimensional changes of the alveolar ridge in the posterior maxilla and sinus pneumatization following teeth extraction. Journal of Molecular and Clinical Medicine, 2018, 1(2): 93-98.

URL: 

https://jmcm.imrpress.com/EN/10.31083/j.jmcm.2018.02.006     OR     https://jmcm.imrpress.com/EN/Y2018/V1/I2/93

Fig. 1.  Database flow chart.

Fig. 2.  Measurement technique: (A) Baseline radiograph of tooth #17. (B) Final radiograph of tooth #17, 6 months following extraction. (C) Landmark identification and definition. (D) Superimposition of the two radiographs. (E) Measurements; the distance BC-floor (1), BC-roof (2), floor-roof (3).

Fig. 3.  Maxillary sinus sagittal circumference.

Table 1  Maxillary sinus dimensions before and following tooth extraction.
Pre floor-roof Post floor-roof Pre BC-roof Post BC-roof Pre BC-floor Post BC-floor
Teeth (n) 32 32 32 32 32 32
Minimum (mm) 13.5 13.29 27.1 20.13 4.80 2.64
Maximum (mm) 35.9 37.2 43.7 44.1 20.0 17.8
Median (mm) 23.65 24.76 33.45 32.31 10.28 8.79
Mean 士 SD (mm) 23.6 士 5.4 24.6 士 5.5 34.2 士 4.4 33.3 士 5.5 10.6 士 4.2 9.3 士 4.3
p-value* 0.001 0.094 0.001
Table 2  Maxillary sinus dimensions before and following tooth extraction according to tooth types.
Pre floor-roof M1 23.5 5.5 10 0.95
M2 23.3 5.4 14
PM2 24.1 6.0 8
Post floor-roof M1 23.8 5.6 10 0.95
M2 24.9 5.5 14
PM2 25.0 6.2 8
Pre BC-roof M1 33.9 3.4 10 0.49
M2 33.8 4.9 14
PM2 35.4 士 5.0 8
Post BC-roof M1 32.6 4.9 10 0.49
M2 32.4 士 6.0 14
PM2 35.8 5.2 8
Pre BC-floor M1 10.6 4.3 10 0.48
M2 9.8 士 3.5 14
PM2 11.7 5.3 8
Post BC-floor M1 9.1 士 5.1 10 0.48
M2 8.4 士 3.7 14
PM2 11.1 4.4 8
Table 3  Maxillary sinus dimensions before and following tooth extraction dichotomized to extraction of single tooth versus multiple teeth.
Single/multiple Mean 士 SD (mm) Teeth
(n)
p-value*
Pre floor-roof Single 22.7 士 5.6 20 0.28
Multiple 24.9 士 5.0 12
Post floor-roof Single 24.4 士 6.1 20 0.79
Multiple 24.9 士 4.7 12
Pre BC-roof Single 33.7 士 4.6 20 0.35
Multiple 35.2 士 4.1 12
Post BC-roof Single 33.6 士 6.3 20 0.75
Multiple 32.9 士 3.9 12
Pre BC-floor Single 10.7 士 4.1 20 0.78
Multiple 10.3 士 4.4 12
Post BC-floor Single 9.8 士 4.2 20 0.45
Multiple 8.6 士 4.6 12
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