Clinical study and statistical analysis of intrabony location of posterior superior alveolar artery using cone-beam computed tomography

Abstract

The posterior superior alveolar artery (PSAA) is the branch of the maxillary artery that supplies the lateral sinus wall and overlying membrane. This artery has the potential to cause bleeding complications in approximately 20% of normally positioned lateral window osteotomies. The aim of this clinical study was to evaluate prevalence, diameter, and location of the PSAA before sinus augmentation using cone-beam computed tomography (CBCT). Sixty-nine CBCT scans from 18 patients undergoing lateral sinus augmentation and implant placement using a thin saw insert with a piezoelectric surgical device were included. Distance of the arterial inferior border from the alveolar crest, diameter, and horizontal position of the artery were statistically analyzed. Sinus membrane perforation and arterial damage were recorded at the creation of the lateral bony window. The artery was identified in 63.9% and was mostly intraosseous (53.62%). The average distance between the alveolar crest and the inferior border of the PSAA was 16.34±5.67 mm; the lowest border was located at maxillary first molar (p = .056). The mean diameter of the PSAA was 1.14±0.45 mm. Significant positive correlation between diameter and age was observed (p = .015*). The results from this study suggest that evaluation of the PSAA is needed before sinus augmentation, especially in elderly edentulous patients. Use of a piezoelectric surgical device can reduce the incidence of potential vascular damage and sinus membrane perforation due to micro-vibration. For these reasons, the creation of a lateral bony window during sinus augmentation is recommended.