Factors affecting maxillary sinus pneumatization following posterior maxillary tooth extraction

Purpose: The aims of the present study were 1) to quantitatively evaluate the extent of sinus pneumatization and 2) to determine the factors affecting sinus pneumatization. Methods: Based on implant treatment records, a list of patients who underwent implant placement on the posterior maxilla was obtained. Among them, patients with pre-extraction and post-extraction (before implant placement) panoramic radiographs were selected. After excluding radiographs with low resolution and image distortion, the radiographs before and after extraction were superimposed using computer software. Subsequently, the extent of sinus pneumatization (the vertical change of the sinus floor) was measured. Simple and multiple mixed models were used to determine the factors affecting sinus pneumatization. Results: A total of 145 patients were eligible for the present investigation. The average extent of sinus pneumatization was 1.56 +/- 3.93 mm at 176 tooth sites. Male sex, single tooth extraction, extraction of an endodontically compromised tooth, a class I root-sinus relationship, and sinus membrane thickening >10 mm favored pneumatization, but without statistical significance. The maxillary second molar presented the greatest pneumatization (2.25 +/- 4.39 mm) compared with other tooth types. This finding was confirmed in the multiple mixed model, which demonstrated a statistically significant impact of the extraction of a second molar compared with the extraction of a first premolar. Conclusions: Maxillary sinus pneumatization was 1.56 +/- 3.93 mm on average. The extraction of a second molar led to the greatest extent of pneumatization, which should be considered in the treatment plan for this tooth site.