Effects of maxillary sinus pneumatization on bone thickness of infrazygomatic crest for miniscrew implant placement

doi:10.3969/j.issn.1674-8115.2026.06.009

Abstract

Abstract:

Objective ·To investigate the effect of the degree of maxillary sinus pneumatization (MSP) on total bone thickness (BT) and cortical bone thickness (CBT) along the insertion path of miniscrew implants (MIs) placed in the infrazygomatic crest (IZC) region. Methods ·Young adult orthodontic patients aged 18‒34 years were included. Cone-beam computed tomography (CBCT) data collected at the initial visit were analyzed. Based on the distance from the apex of the mesiobuccal root of the maxillary first molar to the sinus floor (sinus floor-apex distance, SFA), the samples were divided into three groups: high sinus floor group (HS group, SFA≥3 mm), middle sinus floor group (MS group, 0 mm ≤ SFA < 3 mm), and low sinus floor group (LS group, SFA<0 mm). MIs were placed at angles of 50° or 60° relative to the palatal plane at the apex levels of the mesiobuccal root of the maxillary first molar (U6M), the distobuccal root of the maxillary first molar (U6D), and the mesiobuccal root of the maxillary second molar (U7M), as well as 2 mm cranial to these apex levels. BT and CBT along the insertion path were measured and compared. Results ·A total of 87 patients were included: HS group (n=33) with an SFA of (4.88±1.32) mm, MS group (n=27) with an SFA of (1.57±0.76) mm, and LS group (n=27) with an SFA of (-1.82±0.96) mm. At the U6M and U6D insertion sites, BT and CBT in all groups decreased as the degree of MSP increased. At U7M, no statistically significant differences in BT and CBT were found between the HS and MS groups, but both were greater than those in the LS group (all P<0.05). No statistically significant differences in BT were observed between the MS and LS groups at different sagittal sites. In the HS group, BT gradually decreased in the distal direction. All groups showed a trend toward thinner BT in the more cranial direction. In the HS group, at the apex level, a 50° insertion angle resulted in greater BT than a 60° insertion angle; at 2 mm cranial to the apex, no significant difference in BT was found between the 50° and 60° insertion angles. In the MS group, at both the apex level and 2 mm cranial to the apex, a 60° insertion angle provided greater BT than a 50° insertion angle. In the LS group, at 2 mm cranial to the apex, a 60° insertion angle provided greater BT than a 50° insertion angle; however, regardless of whether a 50° or 60° insertion angle was used, sufficient BT could not be obtained in the LS group. Conclusion ·BT and CBT decreased significantly with increasing MSP in the IZC region. For HS patients, MI placement in the IZC region is generally safe. For MS patients, MI placement at the apex level is relatively safe. For LS patients, MI placement in the IZC region is not recommended.

Key words: maxillary sinus pneumatization, adult, infrazygomatic crest, miniscrew implant, cone-beam computed tomography

CLC Number:

R783.5

Zhang Shuting, Yang Xin. Effects of maxillary sinus pneumatization on bone thickness of infrazygomatic crest for miniscrew implant placement[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(6): 770-777.

Figures/Tables 6

Fig 1 Insertion site measurements

Tab 1 Comparison of BT and CBT among different sinus floor height groups under various insertion paths （mm）

Insertion path	U6M		U6D		U7M
Insertion path	$x ¯$ ±s	P value	$x ¯$ ±s	P value	$x ¯$ ±s	P value
A50-BT		<0.001		<0.001		0.012
HS	6.79±2.21		5.67±1.71		4.05±1.69
MS	4.03±1.02		3.96±1.03		4.35±0.88
LS	2.28±0.82		2.27±0.81		2.64±1.54
A60-BT		<0.001		<0.001		0.002
HS	6.35±1.97		5.42±1.47		4.19±1.62
MS	4.13±1.06		3.96±1.06		4.47±1.00
LS	2.30±0.83		2.29±0.87		2.54±1.36
B50-BT		<0.001		<0.001		0.028
HS	4.91±1.38		4.19±1.34		3.08±1.29
MS	3.14±0.94		2.96±0.98		3.21±0.91
LS	1.87±0.64		1.84±0.65		2.09±1.01
B60-BT		<0.001		<0.001		0.017
HS	4.98±1.83		4.21±1.35		3.22±1.32
MS	3.27±1.04		2.99±1.00		3.35±1.01
LS	1.94±0.66		1.90±0.68		2.12±0.98
A50-CBT		<0.001		<0.001		0.002
HS	3.49±0.73		3.31±0.69		3.09±0.95
MS	3.12±0.77		2.97±0.67		3.43±0.87
LS	2.19±0.65		2.08±0.54		2.16±0.68
A60-CBT		<0.001		<0.001		<0.001
HS	3.62±0.88		3.52±0.78		3.37±0.91
MS	3.42±0.79		3.11±0.61		3.96±1.08
LS	2.23±0.70		2.09±0.59		2.28±0.74
B50-CBT		<0.001		<0.001		0.002
HS	3.42±0.82		2.99±0.65		2.73±0.81
MS	3.01±0.80		2.63±0.63		2.96±0.87
LS	1.84±0.66		1.78±0.55		1.89±0.50
B60-CBT		<0.001		<0.001		<0.001
HS	3.53±0.94		3.12±0.70		2.90±0.89
MS	3.14±0.86		2.72±0.68		3.13±0.88
LS	1.94±0.66		1.86±0.60		1.95±0.51

Tab 1 Comparison of BT and CBT among different sinus floor height groups under various insertion paths （mm）

Insertion path	U6M		U6D		U7M
Insertion path	$x ¯$ ±s	P value	$x ¯$ ±s	P value	$x ¯$ ±s	P value
A50-BT		<0.001		<0.001		0.012
HS	6.79±2.21		5.67±1.71		4.05±1.69
MS	4.03±1.02		3.96±1.03		4.35±0.88
LS	2.28±0.82		2.27±0.81		2.64±1.54
A60-BT		<0.001		<0.001		0.002
HS	6.35±1.97		5.42±1.47		4.19±1.62
MS	4.13±1.06		3.96±1.06		4.47±1.00
LS	2.30±0.83		2.29±0.87		2.54±1.36
B50-BT		<0.001		<0.001		0.028
HS	4.91±1.38		4.19±1.34		3.08±1.29
MS	3.14±0.94		2.96±0.98		3.21±0.91
LS	1.87±0.64		1.84±0.65		2.09±1.01
B60-BT		<0.001		<0.001		0.017
HS	4.98±1.83		4.21±1.35		3.22±1.32
MS	3.27±1.04		2.99±1.00		3.35±1.01
LS	1.94±0.66		1.90±0.68		2.12±0.98
A50-CBT		<0.001		<0.001		0.002
HS	3.49±0.73		3.31±0.69		3.09±0.95
MS	3.12±0.77		2.97±0.67		3.43±0.87
LS	2.19±0.65		2.08±0.54		2.16±0.68
A60-CBT		<0.001		<0.001		<0.001
HS	3.62±0.88		3.52±0.78		3.37±0.91
MS	3.42±0.79		3.11±0.61		3.96±1.08
LS	2.23±0.70		2.09±0.59		2.28±0.74
B50-CBT		<0.001		<0.001		0.002
HS	3.42±0.82		2.99±0.65		2.73±0.81
MS	3.01±0.80		2.63±0.63		2.96±0.87
LS	1.84±0.66		1.78±0.55		1.89±0.50
B60-CBT		<0.001		<0.001		<0.001
HS	3.53±0.94		3.12±0.70		2.90±0.89
MS	3.14±0.86		2.72±0.68		3.13±0.88
LS	1.94±0.66		1.86±0.60		1.95±0.51

Tab 2 Post-hoc tests for BT and CBT among different sinus floor height groups at the U7M site under various insertion paths （mm）

Insertion path		$x ¯$ ±s	P value	Insertion path		$x ¯$ ±s	P value
A50-BT				A50-CBT
HS	MS	-0.30±0.56	0.598	HS	MS	-0.34±0.32	0.305
HS	LS	1.41±0.53	0.012	HS	LS	0.93±0.31	0.005
MS	LS	1.71±0.61	0.008	MS	LS	1.27±0.35	<0.001
A60-BT				A60-CBT
HS	MS	-0.28±0.53	0.605	HS	MS	-0.60±0.35	0.093
HS	LS	1.66±0.51	0.002	HS	LS	1.09±0.33	0.002
MS	LS	1.93±0.58	0.002	MS	LS	1.69±0.37	<0.001
B50-BT				B50-CBT
HS	MS	-0.12±0.43	0.771	HS	MS	-0.24±0.28	0.407
HS	LS	0.99±0.40	0.019	HS	LS	0.83±0.27	0.004
MS	LS	1.12±0.46	0.020	MS	LS	1.07±0.31	<0.001
B60-BT				B60-CBT
HS	MS	-0.14±0.44	0.752	HS	MS	-0.23±0.30	0.454
HS	LS	1.09±0.41	0.012	HS	LS	0.95±0.29	0.002
MS	LS	1.23±0.47	0.013	MS	LS	1.18±0.33	<0.001

Tab 2 Post-hoc tests for BT and CBT among different sinus floor height groups at the U7M site under various insertion paths （mm）

Insertion path		$x ¯$ ±s	P value	Insertion path		$x ¯$ ±s	P value
A50-BT				A50-CBT
HS	MS	-0.30±0.56	0.598	HS	MS	-0.34±0.32	0.305
HS	LS	1.41±0.53	0.012	HS	LS	0.93±0.31	0.005
MS	LS	1.71±0.61	0.008	MS	LS	1.27±0.35	<0.001
A60-BT				A60-CBT
HS	MS	-0.28±0.53	0.605	HS	MS	-0.60±0.35	0.093
HS	LS	1.66±0.51	0.002	HS	LS	1.09±0.33	0.002
MS	LS	1.93±0.58	0.002	MS	LS	1.69±0.37	<0.001
B50-BT				B50-CBT
HS	MS	-0.12±0.43	0.771	HS	MS	-0.24±0.28	0.407
HS	LS	0.99±0.40	0.019	HS	LS	0.83±0.27	0.004
MS	LS	1.12±0.46	0.020	MS	LS	1.07±0.31	<0.001
B60-BT				B60-CBT
HS	MS	-0.14±0.44	0.752	HS	MS	-0.23±0.30	0.454
HS	LS	1.09±0.41	0.012	HS	LS	0.95±0.29	0.002
MS	LS	1.23±0.47	0.013	MS	LS	1.18±0.33	<0.001

Fig 2 Comparison of BT among sagittal insertion sites in the HS Group under the same insertion height and angulation

Fig 3 Comparison of BT between two insertion heights at 50°or 60° insertion angles

Tab 3 Comparison of BT between 50° and 60° insertion angles at two insertion heights （mm）

Insertion height	HS		MS		LS
Insertion height	$x ¯$ ±s	P value	$x ¯$ ±s	P value	$x ¯$ ±s	P value
A50-BT	6.79±2.21	0.036	4.03±1.02	0.037	2.28±0.82	0.244
A60-BT	6.35±1.97		4.13±1.06		2.30±0.83
B50-BT	4.91±1.38	0.749	3.14±0.94	<0.001	1.87±0.64	<0.001
B60-BT	4.98±1.83		3.27±1.04		1.94±0.66

Tab 3 Comparison of BT between 50° and 60° insertion angles at two insertion heights （mm）

Insertion height	HS		MS		LS
Insertion height	$x ¯$ ±s	P value	$x ¯$ ±s	P value	$x ¯$ ±s	P value
A50-BT	6.79±2.21	0.036	4.03±1.02	0.037	2.28±0.82	0.244
A60-BT	6.35±1.97		4.13±1.06		2.30±0.83
B50-BT	4.91±1.38	0.749	3.14±0.94	<0.001	1.87±0.64	<0.001
B60-BT	4.98±1.83		3.27±1.04		1.94±0.66

TrendMD

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