|Year : 2015 | Volume
| Issue : 1 | Page : 16-18
Cross-sectional study estimating prevalence of maxillary sinus septum in South Indian population
J Kannaperuman1, Gowri Natarajarathinam2, Anusha V Rao1, Narasimman Muthusamy3
1 Department of Orthodontics, Nala Dental Hospital, Madurai, India
2 Department of Prosthodontics, Rajan Dental Institute, Chennai, Tamil Nadu, India
3 Department of Prosthodontics, Nala Dental Hospital, Madurai, India
|Date of Web Publication||2-Apr-2015|
No. 56, Dr. Radhakrishnan Salai, Mylapore, Chennai - 600004, Tamil Nadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Maxillary sinus septum is an anatomical variation in the maxillary sinus. Sinus septum is also an important anatomical structure that complicates sinus lift procedure.
Aim of the Study : This study evaluated the prevalence of maxillary sinus septa in the edentulous and dentate maxilla using digital orthopantomogram.
Materials and Method: This study was based on the analysis of digital orthopantomogram images for posterior maxilla that were obtained from patients who visited a Private Hospital. A retrospective analysis of 921 pairs of nonpathological maxillary sinuses was done. Patients who had pathological findings were excluded from the study.
Results: Sinus septum was present in 217 (23.6%) of the 921 pair of maxillary sinuses. Totally, 704 (76.4%) patients did not have maxillary sinus septum. Also, out of 527 male patients, 125 patients had the septum and out of 394 female patients, 92 patients had sinus septum.
Conclusion: This study gives an idea about the prevalence of sinus septum that would help a surgeon prevent a few possible complications during sinus lifting
Keywords: Dental implants, digital orthopantomogram, maxillary sinus, sinus septum
|How to cite this article:|
Kannaperuman J, Natarajarathinam G, Rao AV, Muthusamy N. Cross-sectional study estimating prevalence of maxillary sinus septum in South Indian population. J Dent Implant 2015;5:16-8
|How to cite this URL:|
Kannaperuman J, Natarajarathinam G, Rao AV, Muthusamy N. Cross-sectional study estimating prevalence of maxillary sinus septum in South Indian population. J Dent Implant [serial online] 2015 [cited 2019 Sep 22];5:16-8. Available from: http://www.jdionline.org/text.asp?2015/5/1/16/154423
| Introduction|| |
Osseointegrated implants are considered one of the modality to functionally restore partial and complete edentulism. Dental implant therapy has become a proven and safe treatment modality providing both a conservative and esthetic alternative compared to conventional fixed and removable prosthesis. However, implant therapy may not be possible if available bone is deficient at the surgical site. Implant placement in the posterior maxilla is especially complicated due to pneumatization of the maxillary sinus in the edentulous region. The alveolar process of the edentulous posterior maxillary bone height is reduced. This phenomenon is exacerbated by pneumatization of the maxillary sinus. The level of vertical bone height varies by person, ,,, so vertical bone height for implant placement may become deficient in certain individuals.
Maxillary sinus septa were first described by underwood in 1910.  They are walls of cortical bone present within the maxillary sinus; their shape has been described as an inverted gothic arch arising from the inferior or lateral walls of the sinus, and may even divide the sinus into two or more cavities. The risk of the membrane perforation increases when anatomical variations, such as a maxillary sinus septum, are present. ,
Therefore, it is important for septa to be accurately diagnosed on preoperative imaging. The occurrence and location of maxillary sinus septa have been evaluated using panoramic radiography and computed tomography (CT). The prevalence of sinus septa varies from 16% to 58% according to the literature. ,, Underwood found 30 septa in 45 skulls (90 maxillary sinuses), demonstrating a 33% prevalence. Krennmair et al.,  reported a prevalence ranging from 14% to 31.7%, depending on patient age and tooth loss. Recently, according to Kim et al.,  sinuses with septum or septa were found in 53 of 200 sinuses, demonstrating 26.5% prevalence.
The location of sinus septa also varies according to the literature. The most common location described by underwood was the posterior region. However, Krennmair et al.,  observed the majority of septa in the anterior/premolar region of edentulous maxillae and dentate maxillae (57.1%). According to Kim et al.,  the majority of septa are located in the middle/molar region (50%). The remaining septa, located in the anterior/premolar region and in the posterior/distal aspect of the second molar region, represent 25.4% and 23.7%, respectively.
Even though underwood  published a detailed description of maxillary sinus anatomy in 1910, for decades these septa were considered clinically-insignificant anatomical variations. Now, however, we must understand the maxillary sinus and anatomical variations because the lateral hinge door formation is a complicated procedure and the membrane is susceptible to perforation during elevation in the presence of a maxillary sinus with septa. ,,,,,,, Therefore, only when the prevalence, location and morphology of the sinus septa are understood, a precise surgical plan can be made and complications from sinus surgery prevented. ,
The aim of this study is to analyze the location and prevalence of maxillary sinus septum using digital orthopantomogram images for posterior maxilla that were obtained from the patients who visited Nala Dental Hospital, Madurai, India.
| Materials and methods|| |
This study was based on an analysis of digital orthopantomogram images of the posterior maxilla that were obtained from patients who visited Nala Dental Hospital, Madurai, India, during the period of June 2010 to June 2012. The images included in this study those who were not having pathological findings. The digital orthopantomogram that was made using orthopantomogram (Kodak 8000C Digital Panaromic and Cephalometric System , Carestream Dental LLC, USA).
Three examiners were trained individually, with calibration exercises to identify and locate the sinus septum in the digital images of the orthopantomogram [Figure 1]. Each orthopantomogram was analyzed by these three examiners to confirm the presence or absence of sinus septum. While analyzing maxillary sinuses of the 921 patients, it was considered that the sinus septum was present in a patient if either one of the two sinuses had a septum. Patients not having maxillary sinus septum on the both sides are considered absence of sinus septum.
| Results|| |
Nine hundred and twenty-one patients, excluding the patients with a pathologic appearance were analyzed. Out of 921 sinuses, 217 (23.6%) sinuses had maxillary sinus septum. In which 704 (76.4%) patients does not have the maxillary sinus septum. In terms of gender out of 527 males, 125 patients had the maxillary sinus septum and out of 394 females, 92 patients had the maxillary sinus septum. In terms of sinus location, 118 septum existed in right sinuses, and 99 septa existed in left sinuses.
| Discussion|| |
Several authors have studied the prevalence of maxillary sinus septum. ,,,,,, Underwood  found 30 septa in 90 sinuses, demonstrating 33% prevalence, and Ulm et al. found 15 septa in 82 sinuses, demonstrating a prevalence of 18.3%. Also, Krenmmair et al. reported 32 septa in 200 sinuses, demonstrating 16% prevalence, and Velasquez-Plata et al.  reported 75 septa in 312 sinuses, demonstrating a prevalence of 24%.
This study revealed 132 septa (23.6%) in 561 sinuses. The prevalence of the present study agrees with the results of the previous studies. Sinus septa can be divided into primary septa and secondary septa; the primary septa arise from the development of the maxilla, whereas the secondary septa are said to arise from the irregular pneumatization of the sinus floor following tooth loss. In other words, primary septa are congenital, and secondary septa are acquired.
The septa above the apical area of an edentulous ridge cannot be distinguished into primary or secondary septa without previous radiographic records. Therefore, it can be said that septa above teeth are primary, and septa above an edentulous ridge are primary or secondary. In terms of sinus location, from our observation, we found that 118 septum existed in right sinuses (23.6%), and 99 septa existed in left sinuses (25.4%). In spite of the limitation of not including septa size, the present study indicates that maxillary sinus septa can develop in all maxillary sinus regions whether they are atrophic/edentulous or nonatrophic/dentate.
Therefore, the presence/absence and the location of the septum need to be diagnosed using CT. Only then can a precise surgical plan be decided upon, and postoperative complications can be prevented. , For instance, opening 2 adjacent windows instead of one could be necessary to facilitate access to and elevation of the Schneiderian membrane. In other cases, the septum can be removed using an instrument, such as a hemostat.
| Conclusion|| |
In this study, the results point that whether the maxilla is atrophic or not or whether the ridge is edentulous or not, the prevalence and location of the maxillary sinus septa varied anatomically. Therefore, to prevent complications during surgery and postoperative complications, the clinician must have accurate information and a clear understanding of the patient's maxillary sinus. In the present study, only the result of the digital orthopantomogram image reading was presented, and actual clinical evidence and CT scan diagnosis is unexplored. Therefore, further study of the anatomical variation of the maxillary sinus is required.
| References|| |
Chanavaz M. Maxillary sinus: Anatomy, physiology, surgery, and bone grafting related to implantology - Eleven years of surgical experience (1979-1990). J Oral Implantol 1990;16:199-209.
Cawood JI, Howell RA. A classification of the edentulous jaws. Int J Oral Maxillofac Surg 1988;17:232-6.
Vinter I, Krmpotic-Nemanic J, Hat J, Jalsovec D. Does the alveolar process of the maxilla always disappear after tooth loss? Laryngorhinootologie 1993;72:605-7.
Underwood AS. An inquiry into the anatomy and pathology of the maxillary sinus. J Anat Physiol 1910;44:354-69.
Boyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg 1980;38:613-6.
Farmand M. Horse-shoe sandwich osteotomy of the edentulous maxilla as a preprosthetic procedure. J Maxillofac Surg 1986;14:238-44.
Sailer HF. A new method of inserting endosseous implants in totally atrophic maxillae. J Craniomaxillofac Surg 1989;17:299-305.
Beaumont C, Zafiropoulos GG, Rohmann K, Tatakis DN. Prevalence of maxillary sinus disease and abnormalities in patients scheduled for sinus lift procedures. J Periodontol 2005;76:461-7.
Kasabah S, Slezák R, Simunek A, Krug J, Lecaro MC. Evaluation of the accuracy of panoramic radiograph in the definition of maxillary sinus septa. Acta Medica (Hradec Kralove) 2002;45:173-5.
Maksoud MA. Complications after maxillary sinus augmentation: A case report. Implant Dent 2001;10:168-71.
Ueda M, Kaneda T. Maxillary sinusitis caused by dental implants: Report of two cases. J Oral Maxillofac Surg 1992;50:285-7.
Ulm CW, Solar P, Krennmair G, Matejka M, Watzek G. Incidence and suggested surgical management of septa in sinus-lift procedures. Int J Oral Maxillofac Implants 1995;10:462-5.
Tatum H Jr. Maxillary and sinus implant reconstructions. Dent Clin North Am 1986;30:207-29.
Van den Bergh JP, ten Bruggenkate CM, Disch FJ, Tuinzing DB. Anatomical aspects of sinus floor elevations. Clin Oral Implants Res 2000;11:256-65.
Betts NJ, Miloro M. Modification of the sinus lift procedure for septa in the maxillary antrum. J Oral Maxillofac Surg 1994;52:332-3.
Krennmair G, Ulm CW, Lugmayr H, Solar P. The incidence, location, and height of maxillary sinus septa in the edentulous and dentate maxilla. J Oral Maxillofac Surg 1999;57:667-71.
Neivert H. Symposium on maxillary sinus: Surgical anatomy of the maxillary sinus. Laryngoscope 1930;40:1-4.
Tidwell JK, Blijdorp PA, Stoelinga PJ, Brouns JB, Hinderks F. Composite grafting of the maxillary sinus for placement of endosteal implants. A preliminary report of 48 patients. Int J Oral Maxillofac Surg 1992;21:204-9.
Kim MJ, Jung UW, Kim CS, Kim KD, Choi SH, Kim CK, et al.
Maxillary sinus septa: Prevalence, height, location, and morphology. A reformatted computed tomography scan analysis. J Periodontol 2006;77:903-8.
Velásquez-Plata D, Hovey LR, Peach CC, Alder ME. Maxillary sinus septa: A 3-dimensional computerized tomographic scan analysis. Int J Oral Maxillofac Implants 2002;17:854-60.
Krennmair G, Ulm C, Lugmayr H. Maxillary sinus septa: Incidence, morphology and clinical implications. J Craniomaxillofac Surg 1997;25:261-5.
Lee WJ, Lee SJ, Kim HS. Analysis of location and prevalence of maxillary sinus septa. J Periodontal Implant Sci 2010;40:56-60.