Radiographic Characterisation of Maxillary Sinus Pneumatization and Posterior Root Relationship – A Cone Beam Computed Tomographic Study

Abstract

Background: The anatomical relationship between the maxillary sinus and posterior maxillary teeth is of considerable clinical importance during implant placement, endodontic surgery, sinus augmentation procedures, and tooth extraction. Maxillary sinus pneumatization may alter available bone height and influence root proximity to the sinus floor. Cone Beam Computed Tomography (CBCT) provides accurate three-dimensional assessment of these anatomical relationships.

Material and Methods: A retrospective observational study was conducted using 423 CBCT scans obtained from subjects fulfilling the inclusion criteria. Maxillary sinus pneumatization was assessed using a Nasal Spine-Guided Classification system and categorized as Class I, Class II, or Class III. Root–sinus relationships were classified into Type I, Type II, and Type III categories. Associations between demographic variables and sinus classifications were analyzed using the Chi-square test. Correlations among continuous variables were evaluated using Spearman’s rank correlation coefficient. Statistical significance was set at p < 0.05.

Results: Class III pneumatization was the predominant pattern on both the left and right sides. No statistically significant association was observed between gender and maxillary sinus classification on either side (p > 0.05). Similarly, age group showed no significant association with sinus classification (p > 0.05). Type II root–sinus relationship was the most frequently observed pattern in both males and females. A weak positive correlation was observed between right edentulous height and Schneiderian membrane thickness (ρ = 0.133, p = 0.006). A second weak positive correlation was found between right pneumatization and right interradicular height (ρ = 0.108, p = 0.026).

Conclusion: Advanced maxillary sinus pneumatization was commonly observed in the study population. The anatomical relationship between posterior maxillary teeth and the sinus floor remained consistent across age and gender groups. CBCT provides valuable three-dimensional information that may assist clinicians in implant planning, endodontic surgery, and management of posterior maxillary pathologies.

Key words: Cone Beam Computed Tomography, Maxillary Sinus, Pneumatization, Root-Sinus Relationship, Schneiderian Membrane, Posterior Maxillary Teeth