1

MAXILLARY SINUS AND
ITS DENTAL IMPLICATIONS
By: Eman Al-Qahtani
ID:42820089
January 14th
Supervised By : Dr.Shereen Sho...
2

OUTLINE :
• Anatomy and Development
• Relation between maxillary sinus and dental structures
• How maxillary sinus is a...
3

ANATOMY AND DEVELOPMENT :
The maxillary sinus is part of a
series of paranasal sinuses.
And it is the first of the para...
RELATIONSHIP BETWEEN THE ROOTS OF
THE MAXILLARY TEETH AND THE
MAXILLARY SINUS
• Many studies investigated the relationship...
5

FUNCTIONS OF MAXILLARY SINUS
• 1- Speech and voice resonance
• 2- reduce the weight of the skull
• 3- warmth inhaled ox...
6

MAXILLARY SINUSITIS OF DENTAL
ORIGIN
Spread of infection from
periapical or PDL
abcess .

Overextention of dental
mater...
7

HOW MAXILLARY SINUS IS AFFECTED
BY DENTAL PROCEDURES
• A- Proximity of The maxillary Teeth to the Maxillary Sinus :
• T...
8

OROANTRAL FISTULA
most commonly complication of maxillary
premolar molar tooth extraction.
We treat this case surgicall...
9

IMPLANTS IN THE MAXILLA :
• In the maxilla, 7 millimeters of bone height is sufficient to
accommodate short implants. H...
10
11
12

MAXILLARY SINUS
PNEUMATIZATION :
The expansion of the sinus was larger following
extraction of several adjacent poster...
13

RADIOGRAPHS :
• Radiography is the most important supplementary investigation to clinical
examination of the sinuses

...
14

INTRA-ORAL RADIOGRAPHS

Periapical View

Occlusal Intra-oral film

Lateral Occlusal View
EXTRA-ORAL RADIOGRAPHS

Occipitomental View

Lateral View

Submentovertex

15
16

CT SCAN AND MRI :
• These have become increasingly important for the evaluation of sinus
diseases .
17

ODONTOGENIC CYSTIC LESIONS
OF THE MAXILLA
Odontogenic cysts are the most common group of extrinsic lesions that
encroa...
18

RADICULAR CYST :
Maxillary sinusitis caused by an apical inflammatory
lesion (probably, a granuloma) at the root apice...
19

DENTIGEROUS CYST :
• Called by a (follicular cyst) too.2nd
most common cyst , it usually
appear on the impacted
maxill...
20

MUCOUS RETENTION CYSTS :
• Mucous retention cysts in the sinuses are very common, they are expansile
and potentially d...
21

ODONTOGENIC KERATOCYST :
• OKCs are derived from
the remnants of the
dental lamina. An OKC is
an odontogenic lesion ,
...
22

PERIODONTAL DISEASE :
• Maxillary sinusitis caused by apical infection
and extensive periodontal lesions involving the...
23

ODONTOGENIC TUMOR :
• Fibrous Dysplasia :

• Fibrous dysplasia is the most common disease of the jaws to
manifest a gr...
24

MALIGNANT ODONTOGENIC
TUMORS :
• They are Invasive and destructive lesions
• For Examples :
• Squamouse cell carcinoma
25

CAN SINUSITIS CAUSE DENTAL
PAIN
• One of the most common symptoms of any type of sinusitis is pain, and the
location d...
26

REFERENCES :
• 1. Kilic C, Kamburoglu K, Yuksel SP, Ozen T. An assessment of the relationship
between the maxillary si...
27

• 5- Hibberd CE, Nguyen TD. Brain abscess secondary to a dental infection in an 11year-old child: case report. J Can D...
28

10- McIvor J. Dental and Maxillofacial Radiology. London, UK: Churchill Livingstone 1986.
Dunfee BL, Sakai O, Pistey R...
29

• KILLEY HC. THE PROBLEM OF THE TOOTH OR ROOT IN THE MAXILLARY ANTRUM.
J Oral Surg Anesth Hosp Dent Serv. 1964 Sep;22:...
30
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Maxillary sinus

  1. 1. 1 MAXILLARY SINUS AND ITS DENTAL IMPLICATIONS By: Eman Al-Qahtani ID:42820089 January 14th Supervised By : Dr.Shereen Shokry
  2. 2. 2 OUTLINE : • Anatomy and Development • Relation between maxillary sinus and dental structures • How maxillary sinus is affected by dental procedures • Dental implants in Maxilla • Radiographs • Maxillary Sinus Infections • Cystic Lesions and Benign tumors • Malignant Tumors • How maxillary sinus affects the dental structures
  3. 3. 3 ANATOMY AND DEVELOPMENT : The maxillary sinus is part of a series of paranasal sinuses. And it is the first of the paranasal sinuses to develop in the 3rd month of fetal life .Final growth of the maxillary sinus takes place between 12 and 14 years of age and corresponds with the eruption of the permanent teeth and growth of the alveolar process of the upper jaw .
  4. 4. RELATIONSHIP BETWEEN THE ROOTS OF THE MAXILLARY TEETH AND THE MAXILLARY SINUS • Many studies investigated the relationship between the roots of the maxillary molars and the maxillary sinus using computed tomography , • They found that the apex of the mesiobuccal root of the maxillary 2nd molar was closest to the sinus floor (mean distance of 1.97 mm) • And the apex of the buccal root of the maxillary first premolar was furthest from the sinus floor (Mean distance of 7.5 mm) 4
  5. 5. 5 FUNCTIONS OF MAXILLARY SINUS • 1- Speech and voice resonance • 2- reduce the weight of the skull • 3- warmth inhaled oxygen • 4-filtration of the inspired air • 5- immunological barrier • 6- regulation of intra nasal pressure
  6. 6. 6 MAXILLARY SINUSITIS OF DENTAL ORIGIN Spread of infection from periapical or PDL abcess . Overextention of dental material sealers, cements ,Gp or silver cones Iatrogenic cause like perforation of sinus membrane by an implant or left broken remaining root
  7. 7. 7 HOW MAXILLARY SINUS IS AFFECTED BY DENTAL PROCEDURES • A- Proximity of The maxillary Teeth to the Maxillary Sinus : • The roots of the maxillary premolars and molars , are consistently located below the sinus floor , followed in frequency by the roots of the first molar ,third molar , second premolar , first premolar and canine . • Oro-maxillary sinus perforation occurs occasionally at the extraction of a maxillary tooth, and it may be a cause of maxillary sinusitis or antro-oral fistula
  8. 8. 8 OROANTRAL FISTULA most commonly complication of maxillary premolar molar tooth extraction. We treat this case surgically by Buccal Flap .
  9. 9. 9 IMPLANTS IN THE MAXILLA : • In the maxilla, 7 millimeters of bone height is sufficient to accommodate short implants. However, the use of 7–10 mm long implants is a greater concern in the maxilla than the mandible because the implant failure rate is higher in the maxilla. Therefore, 13 mm is the recommended minimum occlusocervical bone dimension in the maxilla. • In case we don’t have enough Bone height we go for sinus lift,which is a surgical procedure which aims to increase the amount of bone in the posterior maxilla
  10. 10. 10
  11. 11. 11
  12. 12. 12 MAXILLARY SINUS PNEUMATIZATION : The expansion of the sinus was larger following extraction of several adjacent posterior teeth, and extraction of 2nd molars ,If dental implant placement is planned in these cases, immediate implantation and/or immediate bone grafting should be considered to assist in preserving the 3-dimensional bony architecture of the sinus floor at the extraction site
  13. 13. 13 RADIOGRAPHS : • Radiography is the most important supplementary investigation to clinical examination of the sinuses • Intra-Oral : Extra-Oral: • Periapical Panoramic View • Occlusal Waters view (Occipitomental view) • Lateral Occlusal Submentovertex view • Frontal View PA view
  14. 14. 14 INTRA-ORAL RADIOGRAPHS Periapical View Occlusal Intra-oral film Lateral Occlusal View
  15. 15. EXTRA-ORAL RADIOGRAPHS Occipitomental View Lateral View Submentovertex 15
  16. 16. 16 CT SCAN AND MRI : • These have become increasingly important for the evaluation of sinus diseases .
  17. 17. 17 ODONTOGENIC CYSTIC LESIONS OF THE MAXILLA Odontogenic cysts are the most common group of extrinsic lesions that encroach on the maxillary sinuses. The cyst enlarges ,the sinus decrease in size .The result is radio-opaque line between the cyst and the air space of the sinus Cysts involving maxillary sinus : - Radicular cyst - Dentigerous cyst - Mucous retention cyst - Odontogenic Keratocyst
  18. 18. 18 RADICULAR CYST : Maxillary sinusitis caused by an apical inflammatory lesion (probably, a granuloma) at the root apices of the 2nd molar - NOTICE the cloudiness ( Radio-opacity) of the sinus
  19. 19. 19 DENTIGEROUS CYST : • Called by a (follicular cyst) too.2nd most common cyst , it usually appear on the impacted maxillary 3rd molar
  20. 20. 20 MUCOUS RETENTION CYSTS : • Mucous retention cysts in the sinuses are very common, they are expansile and potentially destructive lesions
  21. 21. 21 ODONTOGENIC KERATOCYST : • OKCs are derived from the remnants of the dental lamina. An OKC is an odontogenic lesion , which usually presents incidentally on a dental radiograph as a radiolucency associated with an impacted tooth.
  22. 22. 22 PERIODONTAL DISEASE : • Maxillary sinusitis caused by apical infection and extensive periodontal lesions involving the • Molars and premolars • NOTICE the cloudiness (Radio-opacity) of the sinus
  23. 23. 23 ODONTOGENIC TUMOR : • Fibrous Dysplasia : • Fibrous dysplasia is the most common disease of the jaws to manifest a ground-glass radiographic pattern.
  24. 24. 24 MALIGNANT ODONTOGENIC TUMORS : • They are Invasive and destructive lesions • For Examples : • Squamouse cell carcinoma
  25. 25. 25 CAN SINUSITIS CAUSE DENTAL PAIN • One of the most common symptoms of any type of sinusitis is pain, and the location depends on which sinus is affected. • If Pain is in the patient’s upper jaw and teeth, with tender cheeks, may mean the patient’s maxillary sinuses are involved.
  26. 26. 26 REFERENCES : • 1. Kilic C, Kamburoglu K, Yuksel SP, Ozen T. An assessment of the relationship between the maxillary sinus floor and the maxillary posterior teeth root tips using dental cone-beam computerized tomography. Eur J Dent. 2010;4:462– 467. • 2. Watzek G, Bernhart T, Ulm C. Complications of sinus perforations and their management in endodontics. Dent Clin North Am. 1997;41:563–583. • 3. Hauman CH, Chandler NP, Tong DC. Endodontic implications of the maxillary sinus: a review. Int Endod J. 2002;35:127–141. • 4. Fuhrmann R, Bücker A, Diedrich P. Radiological assessment of artificial bone defects in the floor of the maxillary sinus. Dentomaxillofac Radiol. 1997;26:112– 116. 5. Engström H, Chamberlain D, Kiger R, Egelberg J. Radiographic evaluation of the effect of initial periodontal therapy on thickness of the maxillary sinus mucosa. J Periodontol. 1988;59:604–608.
  27. 27. 27 • 5- Hibberd CE, Nguyen TD. Brain abscess secondary to a dental infection in an 11year-old child: case report. J Can Dent Assoc. 2012;78:c49 • 6-. Som PM, Bergeron. Head and Neck Imaging. 2nd Ed. Philadelphia, PA: Mosby, Inc. 1990: 215-221. 7-. Scholl RJ, et al. Cysts and Cystic Lesions of the Mandible: Clinical and RadiologicHistopathologic Review. Radiographics 1999; 19:1107-1124. 8-. Goh YH. Ectopic Eruption of Maxillary Molar Tooth- An Unusual Cause of Recurrent Sinusitis. Singapore Med J 2001; 42(2): 80-81. • 9-Kumamoto, H, et al. Clear cell odontogenic tumor in the mandible: report of a case with duct-like appearances and dentinoid induction. Journal of Oral Pathology & Medicine. 29(1): 43-47. 2000 •
  28. 28. 28 10- McIvor J. Dental and Maxillofacial Radiology. London, UK: Churchill Livingstone 1986. Dunfee BL, Sakai O, Pistey R, Gohel A. Radiologic and pathologic characteristics of benign and malignant lesions of the mandible. Radiographics 2006;26:1751-1768 11. Hafian H, Mauprivez C, Furon V, Pluot M, Lefevre B. Pindborg tumour: A poorly differentiated form without calcification. Rev Stomatol Chir Maxillofac. 2004;105:227–30. [PubMed] 12. Patiño B, Fernández-Alba J, Garcia-Rozado A, Martin R, López-Cedrún JL, Sanromán B. Calcifying epithelial odontogenic (pindborg) tumour: A series of 4 distinctive cases and a review of the literature. J Oral Maxillofac Surg. 2005;63:1361–8. [PubMed] 13. Maiorano E, Renne G, Tradati N, Viale G. Cytogical features of calcifying epithelial odontogenic tumor (Pindborg tumor) with abundant cementum-like material. Virchows Arch. 2003;442:107–10. [PubMed] 14. Timmenga N, Raghoebar GM, Boering G, Weissenbruch RV. Maxillary sinus function after sinus lifts for the insertion of dental implants. J Oral Maxillofac Surg 1997;55:936–9.[14]
  29. 29. 29 • KILLEY HC. THE PROBLEM OF THE TOOTH OR ROOT IN THE MAXILLARY ANTRUM. J Oral Surg Anesth Hosp Dent Serv. 1964 Sep;22:391–395. [PubMed] • Agarwal PN. An extensive dentigerous cyst with antro-cutaneous fistula. J Laryngol Otol. 1966 May;80(5):544–547. [PubMed] • SETIYA M. A DENTIGEROUS CYST WITH ANTRO-ORAL FISTULA. J Laryngol Otol. 1965 Jan;79:75–79. [PubMed
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