Simone F. M. Janner Characteristics and dimensions of the Marco D. Caversaccio Patrick Dubach Schneiderian membrane: a radiographic Pedram Sendi analysis using cone beam computed Daniel Buser Michael M. Bornstein tomography in patients referred for dental implant surgery in the posterior maxilla
Authors’ affiliations: Key words: cone beam computed tomography, dental implants, mucosal thickness, posterior Simone F. M. Janner, Daniel Buser, Michael M. maxilla, Schneiderian membrane, sinus floor elevation, volume tomography Bornstein, Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland Abstract Marco D. Caversaccio, Patrick Dubach,ClinicforEar, Objectives: To determine the dimensions of the Schneiderian membrane using limited cone beam Nose and Throat Diseases, Head and Neck Surgery, Bern University Hospital, University of Bern, Bern, computed tomography (CBCT) in individuals referred for dental implant surgery, and to determine Switzerland factors influencing the mucosal thickness. Pedram Sendi, Institute for Clinical Epidemiology & Material and methods: The study included 143 consecutive patients referred for dental implant Biostatistics, Basel University Hospital, Basel, Switzerland placement in the posterior maxilla. A total of 168 CBCT images were taken using a limited field of view of 4 4cm,6 6 cm, or 8 8 cm. Reformatted coronal CBCT slices were analyzed with regard to the Corresponding author: thickness and characteristics of the Schneiderian membrane in nine standardized points of reference. PD Dr Michael M. Bornstein Department of Oral Surgery and Stomatology Factors such as age, gender, or status of the remaining dentition that could influence the dimensions School of Dental Medicine of the Schneiderian membrane were evaluated using univariate and multivariate linear regression University of Bern Freiburgstrasse 7 models. 3010 Bern Results: The thickness of the Schneiderian membrane exhibited a wide range, with a minimum value Switzerland of 0.16 mm and a maximum value of 34.61 mm. The highest mean values, ranging from 2.16 to Tel.: þ 41 31 632 25 45/66 Fax: þ 41 31 632 09 14 3.11 mm, were found for the mucosa located in the mid-sagittal regions of the maxillary sinus. The e-mail: [email protected] most frequent mucosal findings diagnosed were flat thickenings of the Schneiderian membrane (62 positive findings, 37%). For the multivariate linear regression model, only gender had a statistically significant influence on the mean overall and mid-sagittal thickness of the sinus mucosa. Conclusion: There is great interindividual variability in the thickness of the Schneiderian membrane. Gender seems to be the most important parameter influencing mucosal thickness in asymptomatic patients. Future studies are needed to assess the therapeutic and prognostic consequences of mucosal alterations in the maxillary sinus.
Since the first description in 1998 (Mozzo et al. pekar et al. 2008), CBCT imaging is becoming 1998), cone beam computed tomography (CBCT) more popular (Ziegler et al. 2002; Bremke et al. has become a popular and important technique 2008). for diagnosis and treatment planning in dental The placement of endosseous dental implants medicine (Ziegler et al. 2002; Bremke et al. has become an established and very common 2008). It has already become an established surgical procedure in dentistry over the past three diagnostic tool for some indications, such as decades. In the posterior maxilla, reduced bone endodontics (Lofthag-Hansen et al. 2007; Patel height and low bone density are the most com- 2009), dental traumatology (Bornstein et al. mon limitations for implant placement (Jemt & 2009), apical surgery (Rigolone et al. 2003; Low Lekholm 1995). Sinus floor elevation (SFE) pro- et al. 2008; Bornstein et al. 2010), challenging cedures have been documented as predictable Date: Accepted 7 December 2010 periodontal bone defects (Misch et al. 2006; Kasaj surgical options to overcome this obstacle (Born- & Willershausen 2007), preoperative planning of stein et al. 2008). Radiographic findings that To cite this article: Janner SFM, Caversaccio MD, Dubach P, Sendi P, Buser D, furcation surgery (Walter et al. 2009), and dental sometimes may pose problems for the surgeon Bornstein MM. Characteristics and dimensions of the implant surgery (Guerrero et al. 2006). Even for planning an SFE procedure with or without Schneiderian membrane: a radiographic analysis using cone beam computed tomography in patients referred for dental visualization of the paranasal sinuses, for which simultaneous dental implant placement are the implant surgery in the posterior maxilla. conventional computed tomography (CT) is con- presence of bony septa (Naitoh et al. 2009), Clin. Oral Impl. Res. xx, 2011; 000–000. doi: 10.1111/j.1600-0501.2010.02140.x sidered the diagnostic method of choice (Fatter- thickening of the Schneiderian membrane, prior