1.1MAXILLARY SINUS AND ITS DENTAL IMPLICATIONS By: Eman Al-Qahtani ID:42820089 January 14th Supervised By : Dr.Shereen Shokry

2. 2OUTLINE : 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. 3ANATOMY 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. 5FUNCTIONS 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. 6MAXILLARY SINUSITIS OF DENTAL ORIGIN Spread of infection from periapical or PDL abcess .Overextention of dental material sealers, cements ,Gp or silver conesIatrogenic cause like perforation of sinus membrane by an implant or left broken remaining root 7. 7HOW 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. 8OROANTRAL FISTULA most commonly complication of maxillary premolar molar tooth extraction. We treat this case surgically by Buccal Flap . 9. 9IMPLANTS IN THE MAXILLA : In the maxilla, 7 millimeters of bone height is sufficient to accommodate short implants. However, the use of 710 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 dont 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. 12MAXILLARY 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. 13RADIOGRAPHS : Radiography is the most important supplementary investigation to clinical examination of the sinuses Intra-Oral :Extra-Oral: PeriapicalPanoramic View OcclusalWaters view (Occipitomental view) Lateral OcclusalSubmentovertex viewFrontal View PA view 14. 14INTRA-ORAL RADIOGRAPHSPeriapical ViewOcclusal Intra-oral filmLateral Occlusal View 15. EXTRA-ORAL RADIOGRAPHSOccipitomental ViewLateral ViewSubmentovertex15 16. 16CT SCAN AND MRI : These have become increasingly important for the evaluation of sinus diseases . 17. 17ODONTOGENIC 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. 18RADICULAR 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. 19DENTIGEROUS CYST : Called by a (follicular cyst) too.2nd most common cyst , it usually appear on the impacted maxillary 3rd molar 20. 20MUCOUS RETENTION CYSTS : Mucous retention cysts in the sinuses are very common, they are expansile and potentially destructive lesions 21. 21ODONTOGENIC 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. 22PERIODONTAL 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. 23ODONTOGENIC TUMOR : Fibrous Dysplasia : Fibrous dysplasia is the most common disease of the jaws to manifest a ground-glass radiographic pattern. 24. 24MALIGNANT ODONTOGENIC TUMORS : They are Invasive and destructive lesions For Examples : Squamouse cell carcinoma 25. 25CAN 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 patients upper jaw and teeth, with tender cheeks, may mean the patients maxillary sinuses are involved. 26. 26REFERENCES : 1. Kilic C, Kamburoglu K, Yuksel SP, Ozen T. 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