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Title CBCT and CT Allow Identification of the Posterior Superior Alveolar Artery (PSAA) Canal, but Whether This Identification Alters Dental Implant-Related Treatment Planning and/or Treatment Outcome Is Uncertain
Clinical Question In patients requiring maxillary sinus floor elevation for ridge augmentation prior to implant placement, does the pre-operative identification of the posterior superior alveolar artery using CBCT influence surgical treatment planning?
Clinical Bottom Line No published evidence has been reported that tested the assumption that identification of the PSAA significantly modifies the treatment plan or reduces the risk of complications. The studies summarized here demonstrate that the PSAA can be located by CBCT, but the missing link is a study that would actually show that this information helpfully influences treatment planning. The PSAA can be detected in more than 58.6% of edentulous cases, but the benefits of locating its position are still not directly addressed. Age, progressive atrophy, and teeth loss in that area can lead to variations in blood supply. The distance between the PSAA and the alveolar ridge varied between 7 and 20 mm, mainly depending on the degree of bone atrophy.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 26215383Centeles/201510 studies/1647 patients with sub-sinus edentulismMeta-Analysis
Key resultsIn the radiographic studies included in this meta-analysis, location of the PSAA was intra-osseous in 62.02% of the cases. CBCT showed a higher detection frequency than CT scans. A wide range of average distances from the artery to the osseous crest was reported among the studies that were analyzed: 11.2-18.3 mm.
#2) 21143535Rosano/201115 human cadavers; 100 CT scansCross-sectional study
Key resultsThe PSAA was detected using CT in 47% of the cases. The vertical distance between the lowest point of the vessel and the alveolar ridge was 11.25 mm +/- 2.99 mm. The alveolar artery anastomosis was found to be partially intra-osseous in 100% of the cases studied.
#3) 26133149Hayek/2015348 patientsCross-sectional study
Key resultsLocation of the PSAA in relation to the sinus wall was intraosseous in 69.2% of the cases, between the bone and the mucosa in 27.9% of the cases and 2.9% outside the bone. The distance between the PSAA and the alveolar crest was 10-20 mm in 79.4% of edentulous patients.
Evidence Search (posterior superior alveolar artery [All Fields] AND sinus ridge augmentation [All Fields]) AND (Meta-Analysis[ptyp] OR systematic[sb])
Comments on
The Evidence
Two articles were cross-sectional studies and one was a meta-analysis. The meta-analysis study only included articles reporting the location of the PSAA in patients with subsinus edentulism. The test subjects used in the other two cross-sectional studies varied between cadavers and dentulous and edentulous patients. All three articles appeared to have similar acceptable average results. Age and sex weren't identified as important variants. Evidence only showed a difference in location of the PSAA in relation to degree of bone atrophy. Our clinical question could be best answered if one or more studies had compared treatment planning, or treatment, with and without identification of the PSAA.
Applicability The patients included in these studies are representative of a typical patient population receiving implants and in need of sinus ridge augmentation. With the advent of CBCT and its almost limitless range of capabilities, many clinicians and practices use or own these new devices.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Periodontics)
Keywords Sinus ridge augmentation; external sinus lift; posterior superior alveolar artery; CBCT; Sinus Lift, Sinus Elevation, caldwell(-)luc, bone graft(ing), sinus, tap up, sinus tap
ID# 2941
Date of submission: 10/22/2015spacer
E-mail almatny@uthscsa.edu
Author Lea Al Matny, DDS
Co-author(s) e-mail
Faculty mentor/Co-author S. Thomas Deahl, II, DMD, PhD
Faculty mentor/Co-author e-mail deahl@uthscsa.edu
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