Maxillary Sinus Morphology: A Radiographic Retrospective Evaluation of the Posterior Superior Alveolar Artery in Caucasian and African-American Subjects

Abstract

Maxillary sinus floor augmentation using a lateral window approach is commonly used to increase the alveolar bone available in the edentulous maxilla for dental implant placement. Although this grafting procedure is generally considered safe and predictable, intra-operative complications can involve anatomic variations related to sinus septa and vasculature. Morphologic variations in the maxillary sinus have been documented in Caucasians but not African Americans. The purpose of this retrospective study was to compare the anatomic location and diameter of the posterior superior (PSAA) alveolar artery in African-Americans and Caucasians. Computerized tomographic images of 219 patients (108 African American and 111 Caucasian) permitted radiographic assessment and morphometric comparison of the PSAA. The primary dependent measure was radiographic diameter of the PSAA. Secondary dependent measures included the vertical distance of the PSAA to both the crest of the alveolar ridge and the inferior-most aspect of the maxillary sinus. The association of race and gender to the dependent measures was assessed using an analysis of covariance, adjusting for body mass index. The prevalence of the artery differed significantly between African-Americans (72.2%) and Caucasians (43.2%). Mean artery diameter did not differ significantly between African-Americans and Caucasians (1.29 mm ± 0.05, 1.24 mm ± 0.06, respectively), when adjusted for BMI. Diameter of the PSAA exhibited a significant positive association with BMI (p ≤ 0.05). The mean distance from the PSAA to alveolar crest was significantly lower for Caucasian females than Caucasian males (13.30mm ± 1.15, 17.79mm ± 1.05, respectively), whereas no gender difference was found in African Americans. The more prevalent and potentially larger caliber PSAA in African-Americans and the more inferior position of the artery seen in Caucasians women must be taken into consideration when attempting maxillary sinus floor augmentation via a lateral approach.