1. 1
MAXILLARY SINUS AND
ITS DENTAL IMPLICATIONS
By: Eman Al-Qahtani
ID:42820089
January 14th
Supervised By : Dr.Shereen Shokry

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
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. 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
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
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
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
OROANTRAL FISTULA
most commonly complication of maxillary
premolar molar tooth extraction.
We treat this case surgically by Buccal Flap .

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

11. 11

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
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
INTRA-ORAL RADIOGRAPHS
Periapical View
Occlusal Intra-oral film
Lateral Occlusal View

15. EXTRA-ORAL RADIOGRAPHS
Occipitomental View
Lateral View
Submentovertex
15

16. 16
CT SCAN AND MRI :
• These have become increasingly important for the evaluation of sinus
diseases .

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
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
DENTIGEROUS CYST :
• Called by a (follicular cyst) too.2nd
most common cyst , it usually
appear on the impacted
maxillary 3rd molar

20. 20
MUCOUS RETENTION CYSTS :
• Mucous retention cysts in the sinuses are very common, they are expansile
and potentially destructive lesions

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
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
ODONTOGENIC TUMOR :
• Fibrous Dysplasia :
• Fibrous dysplasia is the most common disease of the jaws to
manifest a ground-glass radiographic pattern.

24. 24
MALIGNANT ODONTOGENIC
TUMORS :
• They are Invasive and destructive lesions
• For Examples :
• Squamouse cell carcinoma

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
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
• 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
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
• 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

30. 30