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Clinical Implant Dentistry and Related... Jun 2024Cone-beam computed tomography (CBCT) imaging of the maxillary sinus is indispensable for implantologists, offering three-dimensional anatomical visualization,... (Review)
Review
Cone-beam computed tomography (CBCT) imaging of the maxillary sinus is indispensable for implantologists, offering three-dimensional anatomical visualization, morphological variation detection, and abnormality identification, all critical for diagnostics and treatment planning in digital implant workflows. The following systematic review presented the current evidence pertaining to the use of artificial intelligence (AI) for CBCT-derived maxillary sinus imaging tasks. An electronic search was conducted on PubMed, Web of Science, and Cochrane up until January 2024. Based on the eligibility criteria, 14 articles were included that reported on the use of AI for the automation of CBCT-derived maxillary sinus assessment tasks. The QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool was used to evaluate the risk of bias and applicability concerns. The AI models used were designed to automate tasks such as segmentation, classification, and prediction. Most studies related to automated maxillary sinus segmentation demonstrated high performance. In terms of classification tasks, the highest accuracy was observed for diagnosing sinusitis (99.7%), whereas the lowest accuracy was detected for classifying abnormalities such as fungal balls and chronic rhinosinusitis (83.0%). Regarding implant treatment planning, the classification of automated surgical plans for maxillary sinus floor augmentation based on residual bone height showed high accuracy (97%). Additionally, AI demonstrated high performance in predicting gender and sinus volume. In conclusion, although AI shows promising potential in automating maxillary sinus imaging tasks which could be useful for diagnostic and planning tasks in implantology, there is a need for more diverse datasets to improve the generalizability and clinical relevance of AI models. Future studies are suggested to focus on expanding the datasets, making the AI model's source available, and adhering to standardized AI reporting guidelines.
PubMed: 38863306
DOI: 10.1111/cid.13352 -
Journal of Clinical Medicine Feb 2024The aim of the present systematic review was to investigate the clinical outcomes after the perforation of the maxillary sinus by dental implants, or after maxillary... (Review)
Review
The aim of the present systematic review was to investigate the clinical outcomes after the perforation of the maxillary sinus by dental implants, or after maxillary sinus membrane perforation during sinus lift procedure. Twenty-nine publications were included. Failure rates of implants in cases where perforation of sinus floor had happened (11 studies) was generally low, and only one case of transient sinusitis was reported. The estimated failure rate of these implants was 2.1% (SE 1.0%, = 0.035). There were 1817 implants (73 failures) placed in augmented sinuses in which the sinus membrane was perforated and 5043 implants (274 failures) placed in sinuses with no perforated membrane, from 18 studies. The odds of implant failure difference between the groups were not significant (OR 1.347, = 0.197). log OR of implant failure between perforated and non-perforated membrane groups did not significantly change with the follow-up time (-0.004/month; = 0.500). In conclusion, implant failure rate is generally low either for implants penetrating in the floor of the maxillary sinus or implants placed in augmented sinuses in which the sinus membrane was perforated. The prevalence of postoperative infection/sinusitis is low, and it may depend either on the dimensions of the perforation or on the anatomical predisposition.
PubMed: 38592698
DOI: 10.3390/jcm13051253 -
The International Journal of Oral &... Feb 2024To evaluate the impact of different approaches to sinus membrane perforation (SMP) repair on bone formation, postoperative complications, and implant loss risk. (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate the impact of different approaches to sinus membrane perforation (SMP) repair on bone formation, postoperative complications, and implant loss risk.
MATERIALS AND METHODS
Electronic searches on PubMed, Web of Science, Scopus, Embase, and Cochrane Library databases were conducted for publications up to February 2021. All included articles reported SMPs submitted for repair. The proportion of implant loss in repaired SMP sites was calculated using a random-effects model meta-analysis.
RESULTS
A total of 130 studies reporting SMP repair protocols were included in the systematic review, with 20 selected for meta-analysis. A total of 1,972 sinuses that were perforated and repaired during sinus elevation using different approaches were included in the qualitative analysis. The resorbable collagen membrane was the most commonly reported treatment. The presence of sinusitis was the most frequently described complication. Regarding bone parameters, the majority of studies described no differences between perforated and repaired sinuses and intact membranes. No difference in the implant loss proportion was observed between sites with repaired SMP compared to undetected SMP. The proportion of implant loss in repaired sinuses membrane sites (independent of the material or implant placement time) was 4% (95% CI: 2.0 to 8.0). In meta-regression analysis, no association was observed between the SMP size and implant loss proportion (P = .86).
CONCLUSIONS
The materials and techniques indicated for SMP management seem to securely seal the maxillary sinus, without a negative effect on the ultimate survival of the implants placed in the affected sinuses.
Topics: Humans; Maxillary Sinus; Membranes; Postoperative Complications; Osteogenesis
PubMed: 38416004
DOI: 10.11607/jomi.10180 -
Medicine Sep 2023The objective of this review is to investigate and analyze the anatomical variations present in the maxillary sinus (MS), through the examination of the prevalence of... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The objective of this review is to investigate and analyze the anatomical variations present in the maxillary sinus (MS), through the examination of the prevalence of these variations, as well as the corresponding prevalence of clinically significant pathologies and complications associated with them.
METHODS
The search process was carried out in the following databases; MEDLINE, SCIELO, WOS, CINHAL, SCOPUS, and GOOGLE SCHOLAR, using as search terms; "Maxillary bone," "Maxillary sinus," "Paranasal sinus," "Anatomical variations," "Sinusitis" and "Clinical anatomy."
RESULTS
A total of 26 articles and 12969 samples were included, from which 12,594 subjects had their sex recorded giving a total of 5802 males and 6792 females. The variants reported by the included were Haller cells, Concha Bullosa, Number of septa, Hypoplastic sinus, Agger Nasi, Thickening of the MS mucosa, Deviation of the nasal septum, Accessory ostium, and Onodi cells. Among the mentioned, the ones that presented the greatest number of studies (between 8 and 10 studies included) were: the Haller Cells, the Concha Bullosa, and the Number of septa, where prevalence was 0.30, 0.36, 0.39 respectively. These variations can lead to sinusitis, cause some types of tumors, or affect neighboring structures that could be compromised by this variation.
CONCLUSION
As a result, it is certainly complex to distinguish the presence of anatomical variations from pathological abnormalities. Therefore, knowledge of the different variations and their clinical relationships could be a useful asset for clinicians dedicated to this region.
Topics: Female; Male; Humans; Nose Diseases; Databases, Factual; Knowledge; MEDLINE; Maxillary Sinus
PubMed: 37747000
DOI: 10.1097/MD.0000000000034510 -
The Journal of Craniofacial SurgeryMaxillary osteotomies as a component of orthognathic surgery disrupt the normal anatomy and function of the sinus. The osteotomy with advancement of the inferior... (Meta-Analysis)
Meta-Analysis
Maxillary osteotomies as a component of orthognathic surgery disrupt the normal anatomy and function of the sinus. The osteotomy with advancement of the inferior component of the sinus leaves a bony and mucosal opening in the sinus. Immediately after surgery, nasal drainage is impeded because of intranasal swelling. Acute and chronic maxillary sinusitis would be expected; however, its incidence as an expected complication is not well documented. A systematic review and meta-analysis was completed using PubMed to determine the incidence of sinusitis after maxillary orthognathic surgery. Studies were reviewed by two authors, and incidence data were extracted. Two hundred six articles were identified with 24 meeting the criteria for analysis. The incidence of sinusitis was based on 4213 participants who had undergone orthognathic surgery. Twenty-three studies reported a total number of sinusitis cases, and the results demonstrated a pooled incidence of 3.3% (95% confidence interval: 1.77, 6.06). One study did not report a total number of cases but reported chronic sinusitis survey-duration-based and Lund-Mackay scores. These scores, respectively, worsened from 7.6 to 14.8 and from 1.58 to 2.90 postoperatively. Despite the variability of maxillary surgery, the surgical technique, and the postoperative management, the incidence is low but sinusitis does occur. Prospective studies with validated questionnaires within the context of a specific protocol may further elucidate the causality of sinusitis. Further, patients with sinonasal symptoms postsurgery should be encouraged to consult with an otolaryngologist to ensure prompt treatment.
Topics: Humans; Orthognathic Surgery; Prospective Studies; Incidence; Sinusitis; Maxillary Sinusitis; Osteotomy; Chronic Disease; Endoscopy
PubMed: 37681995
DOI: 10.1097/SCS.0000000000009738 -
Expert Review of Clinical Immunology 2023Chronic rhinosinusitis with nasal polyps (CRSwNP) has a high recurrence rate after surgery despite the availability of medical treatments. Multiple clinical and... (Review)
Review
INTRODUCTION
Chronic rhinosinusitis with nasal polyps (CRSwNP) has a high recurrence rate after surgery despite the availability of medical treatments. Multiple clinical and biological factors have been associated with poor post-operative outcomes in patients with CRSwNP. However, these factors and their prognostic values have not yet been extensively summarized.
AREAS COVERED
This systematic review included 49 cohort studies exploring the prognostic factors for post-operative outcomes in CRSwNP. A total of 7802 subjects and 174 factors were included. All investigated factors were classified into three categories according to their predictive value and evidence quality, of which 26 factors were considered plausible for post-operative outcome prediction. Previous nasal surgery, ethmoid-to-maxillary (E/M) ratio, fractional exhaled nitric oxide, tissue eosinophil count or percentage, tissue neutrophil count, tissue IL-5, tissue eosinophil cationic protein, and CLC or IgE in nasal secretion provided more reliable information for prognosis in at least two studies.
EXPERT OPINION
Exploring predictors through noninvasive or minimally invasive methods for specimen collection is recommended for future work. Models combining multiple factors must be established, as no single factor is effective for the whole population.
Topics: Humans; Prognosis; Nasal Polyps; Rhinitis; Sinusitis; Chronic Disease; Eosinophils
PubMed: 37225659
DOI: 10.1080/1744666X.2023.2218089 -
International Journal of Implant... May 2023To assess the outcome [zygomatic implant (ZI) survival] and complications of the original surgical technique (OST) and an Anatomy-Guided approach (AGA) in the placement... (Review)
Review
PURPOSE
To assess the outcome [zygomatic implant (ZI) survival] and complications of the original surgical technique (OST) and an Anatomy-Guided approach (AGA) in the placement of ZI in patients with severely atrophic maxillae.
METHODS
Two independent reviewers conducted an electronic literature search from January 2000 to August 2022. The inclusion criteria were articles reporting at least five patients with severely atrophic edentulous maxilla undergoing placement OST and/or AGA, with a minimum of 6 months of follow-up. Number of patients, defect characteristics, number of ZI, implant details, surgical technique, survival rate, loading protocol, prosthetic rehabilitation, complications, and follow-up period were compared.
RESULTS
Twenty-four studies comprised 2194 ZI in 918 patients with 41 failures. The ZI survival rate was 90.3-100% in OST and 90.4-100% in AGA. Probability of complications with ZI with OST was as follows: sinusitis, 9.53%; soft tissue infection, 7.50%; paresthesia, 10.78%; oroantral fistulas, 4.58%; and direct surgical complication, 6.91%. With AGA, the presenting complications were as follows: sinusitis, 4.39%; soft tissue infection, 4.35%; paresthesia, 0.55%; oroantral fistulas, 1.71%; and direct surgical complication, 1.60%. The prevalence of immediate loading protocol was 22.3% in OST and 89.6% in the AGA. Due to the heterogeneity of studies, statistical comparison was only possible after the descriptive analysis.
CONCLUSIONS
Based on the current systematic review, placing ZI in severely atrophic edentulous maxillae rehabilitation with the OST and AGA is associated with a high implant survival rate and surgical complications within a minimum of 6 months follow-up. Complications, including sinusitis and soft tissue infection around the implant, are the most common. The utilization of immediate loading protocol is more observed in AGA than in OST.
Topics: Humans; Dental Implants; Dental Implantation, Endosseous; Maxilla; Jaw, Edentulous; Survival Rate; Treatment Outcome; Postoperative Complications; Sinusitis; Soft Tissue Infections; Orthognathic Surgical Procedures; Male; Female; Child, Preschool; Child; Adult; Middle Aged; Aged
PubMed: 37198345
DOI: 10.1186/s40729-023-00478-y -
Journal of Endodontics Apr 2023The overall prevalence of maxillary sinusitis of odontogenic origin (MSOO) is still unknown. Therefore, this study aimed to determine the pooled prevalence of MSOO and... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The overall prevalence of maxillary sinusitis of odontogenic origin (MSOO) is still unknown. Therefore, this study aimed to determine the pooled prevalence of MSOO and verify associations between different odontogenic conditions and MSOO.
METHODS
Six electronic databases and the gray literature were searched on August 25, 2022. Two independent reviewers selected observational studies reporting the prevalence of MSOO and associated conditions in adults. Studies that did not use computed tomography for diagnosis were excluded. The methodological quality of the studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Cross-Sectional Studies. Data were analyzed by proportion and association meta-analyses. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.
RESULTS
Thirty-eight studies were included in the qualitative analysis and thirty-one in the meta-analyses. Only 12 studies (31.6%) fulfilled all items of the methodological quality checklist. Overall, the studies reported prevalence measures per maxillary sinus or patient. Thus, the pooled prevalence of MSOO was 51% per sinus (95% confidence interval [CI] [40%-61%]) and 50% per patient (95% CI [41%-59%]). Apical lesion (odds ratio [OR]: 4.03, 95% CI [2.26-7.19]), periodontitis (OR: 5.49, 95% CI [2.27-13.24]), moderate (OR: 2.57, 95% CI [1.85-3.57]) and severe bone loss (OR: 13.80, 95% CI [2.81-67.85] were significantly associated with MSOO. The certainty of the evidence for the associations was very low.
CONCLUSIONS
The pooled prevalence of MSOO on computed tomography assessment was 51% per maxillary sinus and 50% per patient. Therefore, half of the maxillary sinusitis may be of odontogenic origin. Apical lesion, periodontitis, and moderate and severe bone loss were significantly associated with MSOO.
Topics: Adult; Humans; Maxillary Sinusitis; Prevalence; Cross-Sectional Studies; Maxillary Sinus; Tomography, X-Ray Computed
PubMed: 36754253
DOI: 10.1016/j.joen.2023.01.010 -
The Journal of Oral Implantology Dec 2022To evaluate the available literature reporting the survival and complication rate of zygomatic implants, assessing factors (such as surgical technique,...
AIM
To evaluate the available literature reporting the survival and complication rate of zygomatic implants, assessing factors (such as surgical technique, surgical/restorative plan, population, study design and characteristics, etc.) associated with these outcomes.
MATERIALS AND METHODS
A comprehensive search was performed in three electronic databases, together with a manual search, to identify clinical studies reporting the survival and/or complication rates following zygomatic implant therapy, to quantify relative rates for both stated outcomes. Results: 101 articles were included: 69 were retrospective in nature, 29 were prospective non-randomized studies and 3 were randomized trials (RCTs). The mean survival rate among retrospective studies was 97.61%, while among prospective non-RCTs and RCTs was 98.53% and 95.92%, respectively. The survival rate was not associated with the surgical technique, nor with the surgical/restorative plan. A trend towards higher survival rate, although not statistically significant (p>0.05), was observed in more recent vs less recent studies. Forty-eight articles reported data on complications related to zygomatic implants, with labial laceration, orbital cavity penetration, hematoma, epistaxis, maxillary sinusitis, infection and oro-antral communication being among the most common adverse event. A lower incidence of maxillary sinusitis was observed for zygomatic implants placed using the extrasinus approach compared to the other surgical approaches (p<0.01). The incidence of maxillary sinusitis and oro-antral communications was found to be less likely in "recent" vs "less recent" studies (p<0.05).
CONCLUSIONS
Zygomatic implant therapy is a reliable treatment option for rehabilitating the severely atrophic maxilla, with high implant survival rate and relatively low complication rate. Several factors were found to be associated with the incidence of post-operative complications. Nevertheless, the evidence from the literature is mainly based on non-RCTs and therefore these findings have to be interpreted with cautions.
PubMed: 36473176
DOI: 10.1563/aaid-joi-D-22-00008 -
Clinical Implant Dentistry and Related... Feb 2023Zygomatic implants (ZI) have been frequently indicated to rehabilitate patients with extensive atrophies in alternatives to major bone reconstructions. It can be... (Meta-Analysis)
Meta-Analysis
Survival and complications of zygomatic implants compared to conventional implants reported in longitudinal studies with a follow-up period of at least 5 years: A systematic review and meta-analysis.
BACKGROUND
Zygomatic implants (ZI) have been frequently indicated to rehabilitate patients with extensive atrophies in alternatives to major bone reconstructions. It can be installed inside the maxillary sinus, called instrasinus zygomatic implant (IZI) or outside the maxillary sinus (EZI), depending on the surgery technique.
OBJECTIVE
To evaluate the survival and complication rates of ZI in longitudinal studies when compared with conventional implants (CI).
METHODS
An electronic search was performed in five databases and in Gray literature for articles published until April, 2022. The eligibility criteria comprised observational cohort studies (prospective or retrospective) and randomized clinical trials (RCTs) with at least 5 years of follow-up, reporting survival rate of ZI versus CI. A meta-analysis was conduct with 18 studies.
RESULTS
A total of 5434 implants (2972 ZI and 2462 CI) were analyzed in 1709 patients. The mean survival rate was 96.5% ± 5.02 and 95.8% ± 6.36 for ZI and CI, respectively (mean follow-up time of 78 months). There were observed no statistically significant between ZI and CI in prospective studies (risk ratio [RR] of 1.21; 95% confidence intervals [CIs]: 0.28 to 5.28; chi-squared [Chi ] = 11.37; I = 56%; degrees of freedom [df] = 5; z-score = 0.25; P = 0.80), retrospective studies IZI (RR of 1.29; 95% CIs: 0.52 to 3.23; Chi = 4.07; I = 2%; df = 4; z-score = 0.55; P = 0.58) and retrospective studies EZI (RR of 0.72; 95% CIs: 0.31 to 1.66; Chi = 1.99; I = 0%; df = 3; z-score = 0.78; P = 0.44). The biological complications most related to ZI was sinusitis, followed by infection and oroantral communication.
CONCLUSION
ZI have a high long-term survival rate (96.5% with a mean of 91.5 months of follow-up), showing no significant difference when compared with CI. The most prevalent biological complication is sinusitis, being most commonly to the IZI technique. This systematic review (SR) was registered in INPLASY under number INPLASY202280025.
Topics: Humans; Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis, Implant-Supported; Follow-Up Studies; Longitudinal Studies; Maxilla; Sinusitis; Zygoma
PubMed: 36373779
DOI: 10.1111/cid.13153