Skip to main content

Advertisement

SpringerLink
Log in

Objective computerised assessment of residual ridge resorption in the human maxilla and maxillary sinus pneumatisation

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

Atrophic resorption of the maxillary alveolar ridge is a complication that makes implantological rehabilitation critical. Our aim was to develop a novel computer aided procedure for the accurate quantitative assessment of maxillary residual ridge resorption including pneumatisation of the maxillary sinus that goes beyond previously described approaches and to apply it to a large dataset.

Materials and methods

To develop and refine the method, we performed a retrospective analysis using computed tomography data from 405 patients to generate segmented, three-dimensional models of zygomaticomaxillary bones and maxillary sinuses. Using anatomical landmarks and orientation lines or planes, all models were aligned automatically to subsequently generate cross-sectional images (n = 2835), enabling the classification of atrophy as well as the quantification of volumes and caudal extensions of the maxillary sinuses.

Results

We developed and implemented an accurate and reproducible workflow for the semi-automated analysis of volumetric maxillary images. Comprehensive statistical analysis of the large quantitative dataset revealed various correlations of maxillary process heights and sinus volumes with atrophy class, age and region and identified conjectural trends over the patient group.

Conclusions

The method was used successfully to process a large dataset to classify atrophy, to measure alveolar height parameters, and to quantify maxillary sinus volume, bottom volume and pneumatisation.

Clinical relevance

Apart from the anthropometric value of the generated dataset, the method could be applied to provide additional and more accurate data to assess the necessity of bone augmentation in the context of three-dimensional planning before implantation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Atwood DA, Coy WA (1971) Clinical, cephalometric, and densitometric study of reduction of residual ridges. J Prosthet Dent 26(3):280–295

    Article  Google Scholar 

  2. Atwood DA (1963) Postextraction changes in the adult mandible as illustrated by microradiographs of midsagittal sections and serial cephalometric roentgenograms. J Prosthet Dent 13(5):810–824. https://doi.org/10.1016/0022-3913(63)90225-7

    Article  Google Scholar 

  3. Tallgren A (1972) The continuing reduction of the residual alveolar ridges in complete denture wearers: a mixed-longitudinal study covering 25 years. J Prosthet Dent 27(2):120–132

    Article  Google Scholar 

  4. Cawood JI, Howell RA (1988) A classification of the edentulous jaws. Int J Oral Maxillofac Surg 17(4):232–236

    Article  Google Scholar 

  5. Cawood JI, Howell RA (1991) Reconstructive preprosthetic surgery. I. Anatomical considerations. Int J Oral Maxillofac Surg 20(2):75–82. https://doi.org/10.1016/S0901-5027(05)80711-8

    Article  PubMed  Google Scholar 

  6. Eufinger H, Gellrich NC, Sandmann D, Dieckmann J (1997) Descriptive and metric classification of jaw atrophy. An evaluation of 104 mandibles and 96 maxillae of dried skulls. Int J Oral Maxillofac Surg 26(1):23–28

    Article  Google Scholar 

  7. Atwood DA (1971) Reduction of residual ridges: a major oral disease entity. J Prosthet Dent 26(3):266–279

    Article  Google Scholar 

  8. Reich KM, Huber CD, Lippnig WR, Ulm C, Watzek G, Tangl S (2011) Atrophy of the residual alveolar ridge following tooth loss in an historical population. Oral Dis 17(1):33–44. https://doi.org/10.1111/j.1601-0825.2010.01699.x

    Article  PubMed  Google Scholar 

  9. Bodic F, Hamel L, Lerouxel E, Basle MF, Chappard D (2005) Bone loss and teeth. Joint Bone Spine 72(3):215–221. https://doi.org/10.1016/j.jbspin.2004.03.007

    Article  PubMed  Google Scholar 

  10. Atwood DA (2001) Some clinical factors related to rate of resorption of residual ridges. J Prosthet Dent 86(2):119–125. https://doi.org/10.1067/mpr.2001.117609

    Article  PubMed  Google Scholar 

  11. Carlsson GE (2004) Responses of jawbone to pressure. Gerodontology 21(2):65–70

    Article  Google Scholar 

  12. Ulm CW, Solar P, Krennmair G, Matejka M, Watzek G (1995) Incidence and suggested surgical management of septa in sinus-lift procedures. Int J Oral Maxillofac Implants 10(4):462–465

    PubMed  Google Scholar 

  13. Beretta M, Cicciu M, Bramanti E, Maiorana C (2012) Schneider membrane elevation in presence of sinus septa: anatomic features and surgical management. Int J Dent 2012:261905. https://doi.org/10.1155/2012/261905

    Article  PubMed  PubMed Central  Google Scholar 

  14. Pommer B, Ulm C, Lorenzoni M, Palmer R, Watzek G, Zechner W (2012) Prevalence, location and morphology of maxillary sinus septa: systematic review and meta-analysis. J Clin Periodontol 39(8):769–773. https://doi.org/10.1111/j.1600-051X.2012.01897.x

    Article  PubMed  Google Scholar 

  15. Underwood AS (1910) An inquiry into the anatomy and pathology of the maxillary sinus. J Anat Physiol 44(Pt 4):354–369

    PubMed  PubMed Central  Google Scholar 

  16. Haas OL Jr, Becker OE, de Oliveira RB (2015) Computer-aided planning in orthognathic surgery -systematic review. Int J Oral Maxillofac Surg 44(3):329–342. https://doi.org/10.1016/j.ijom.2014.10.025

    Article  Google Scholar 

  17. Kasai N, Kondo O, Suzuki K, Aoki Y, Ishii N, Goto M (2018) Quantitative evaluation of maxillary bone deformation by computed tomography in patients with leprosy. PLoS Negl Trop Dis 12(3):e0006341. https://doi.org/10.1371/journal.pntd.0006341

    Article  PubMed  PubMed Central  Google Scholar 

  18. Caloss R, Atkins K, Stella JP (2007) Three-dimensional imaging for virtual assessment and treatment simulation in orthognathic surgery. Oral Maxillofac Surg Clin North Am 19(3):287–309. https://doi.org/10.1016/j.coms.2007.04.006

    Article  PubMed  Google Scholar 

  19. Swennen GR, Mollemans W, Schutyser F (2009) Three-dimensional treatment planning of orthognathic surgery in the era of virtual imaging. J Oral Maxillofac Surg 67(10):2080–2092. https://doi.org/10.1016/j.joms.2009.06.007

    Article  PubMed  Google Scholar 

  20. Wagner F, Dvorak G, Nemec S, Pietschmann P, Traxler H, Schicho K, Seemann R (2017) Morphometric analysis of sinus depth in the posterior maxilla and proposal of a novel classification. Sci Rep 7:45397. https://doi.org/10.1038/srep45397

    Article  PubMed  PubMed Central  Google Scholar 

  21. Varga V, Raith S, Loberg C, Modabber A, Bartella AK, Holzle F, Fischer H, Steiner T (2017) Classification of the level of mandibular atrophy - a computer-assisted study based on 500 CT scans. J Craniomaxillofac Surg 45(12):2061–2067. https://doi.org/10.1016/j.jcms.2017.09.014

    Article  PubMed  Google Scholar 

  22. Raith S, Varga V, Steiner T, Hölzle F, Fischer H (2017) Computational geometry assessment for morphometric analysis of the mandible. Comput Methods Biomech Biomed Eng 20(1):27–34. https://doi.org/10.1080/10255842.2016.1196196

    Article  Google Scholar 

  23. Horn B (1987) Closed-form solution of absolute orientation using unit quaternions. J Otical Soc Am 4:629–642

    Google Scholar 

  24. Park HS, Lee YJ, Jeong SH, Kwon TG (2008) Density of the alveolar and basal bones of the maxilla and the mandible. Am J Orthod Dentofac Orthop 133(1):30–37. https://doi.org/10.1016/j.ajodo.2006.01.044

    Article  Google Scholar 

  25. Ali Hasan H, Khursheed Alam M, Yusof A, Matsuda S, Shoumura M, Osuga N (2016) Accuracy of three dimensional CT craniofacial measurements using mimics and Invesalius software programs. J Hard Tissue Biol 25(2):219–224. https://doi.org/10.2485/jhtb.25.219

    Article  Google Scholar 

  26. Terry BC, Zarb GA (1991) Report on the 4th international congress on preprosthetic surgery, Palm Springs, USA, 18-20 April, 1991. Int J Oral Maxillofac Surg 20(5):314–316. https://doi.org/10.1016/s0901-5027(05)80168-7

    Article  PubMed  Google Scholar 

  27. Muller F, Naharro M, Carlsson GE (2007) What are the prevalence and incidence of tooth loss in the adult and elderly population in Europe? Clin Oral Implants Res 18(Suppl 3):2–14. https://doi.org/10.1111/j.1600-0501.2007.01459.x

    Article  PubMed  Google Scholar 

  28. Azarpazhooh A, Dao T, Ungar WJ, Chaudry F, Figueiredo R, Krahn M, Friedman S (2014) Clinical decision making for a tooth with apical periodontitis: the patients; preferred level of participation. J Endod 40(6):784–789. https://doi.org/10.1016/j.joen.2014.01.045

    Article  PubMed  Google Scholar 

  29. Turkyilmaz I, Company AM, Mcglumphy EA (2010) Should edentulous patients be constrained to removable complete dentures? The use of dental implants to improve the quality of life for edentulous patients. Gerodontology 27(1):3–10. https://doi.org/10.1111/j.1741-2358.2009.00294.x

    Article  PubMed  Google Scholar 

  30. Azarpazhooh A, Dao T, Figueiredo R, Krahn M, Friedman S (2013) A survey of patients’ preferences for the treatment of teeth with apical periodontitis. J Endod 39(12):1534–1541. https://doi.org/10.1016/j.joen.2013.07.012

    Article  PubMed  Google Scholar 

  31. Schriber M, Bornstein MM, Suter VGA (2019) Is the pneumatisation of the maxillary sinus following tooth loss a reality? A retrospective analysis using cone beam computed tomography and a customised software program. Clin Oral Investig 23(3):1349–1358. https://doi.org/10.1007/s00784-018-2552-5

    Article  PubMed  Google Scholar 

  32. Cho SH, Kim TH, Kim KR, Lee JM, Lee DK, Kim JH, Im JJ, Park CJ, Hwang KG (2010) Factors for maxillary sinus volume and craniofacial anatomical features in adults with chronic rhinosinusitis. Arch Otolaryngol Head Neck Surg 136(6):610–615. https://doi.org/10.1001/archoto.2010.75

    Article  PubMed  Google Scholar 

  33. Sahlstrand-Johnson P, Jannert M, Strombeck A, Abul-Kasim K (2011) Computed tomography measurements of different dimensions of maxillary and frontal sinuses. BMC Med Imaging 11:8–7. https://doi.org/10.1186/1471-2342-11-8

    Article  PubMed  PubMed Central  Google Scholar 

  34. Mohlhenrich SC, Heussen N, Peters F, Steiner T, Holzle F, Modabber A (2015) Is the maxillary sinus really suitable in sex determination? A three-dimensional analysis of maxillary sinus volume and surface depending on sex and dentition. J Craniofac Surg 26(8):e723–e726. https://doi.org/10.1097/SCS.0000000000002226

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

On behalf of all authors of this manuscript, we declare that here is no personal relationship with other individuals or organisations that could inappropriately influence this work. The authors Stefan Raith and Timm Steiner contributed equally to this work. We thank Holger Spiegel for technical and language editing as well as proofreading.

Author information

Author notes

  1. Stefan Raith and Timm Steiner contributed equally to this work.

Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 62074, Aachen, Germany

    Ulrike Gerken, Stephan C. Möhlhenrich, Frank Hölzle, Stefan Raith & Timm Steiner

  2. Department of Dental Materials and Biomaterials Research, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany

    Felix Esser, Horst Fischer & Stefan Raith

  3. Department of Orthodontics, University Witten/Herdecke, Alfred-Herrhausen-Straße 45, 58448, Witten, Germany

    Stephan C. Möhlhenrich

  4. Department of Maxillofacial and Facial Plastic Surgery, University Leipzig, Liebigstraße 12, 04103, Leipzig, Germany

    Alexander K. Bartella

Authors
  1. Ulrike Gerken
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Felix Esser
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephan C. Möhlhenrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexander K. Bartella
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Frank Hölzle
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Horst Fischer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stefan Raith
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Timm Steiner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ulrike Gerken.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gerken, U., Esser, F., Möhlhenrich, S.C. et al. Objective computerised assessment of residual ridge resorption in the human maxilla and maxillary sinus pneumatisation. Clin Oral Invest 24, 3223–3235 (2020). https://doi.org/10.1007/s00784-020-03196-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-020-03196-6

Keywords

Search

Navigation