title: Dental implants and grafting success remain high despite large variations in maxillary sinus mucosal thickening.
abstract: BACKGROUND
  Although mucosal thickening is the most common radiographic finding observed regarding sinus pathology, the knowledge regarding its clinical significance on the outcomes of dental implants and grafting in the maxillary sinuses is still limited. We hypothesized that mucosal thickening would not alter the predictability for sinus floor augmentation and dental implant placement. The purpose of this retrospective study was to evaluate the outcomes of dental implant placement in sinus-augmented areas with preexisting sinus mucosal thickening.
  
  
  METHODS
  This study involved the review of cone-beam computed tomographic (CBCT) scans taken on patients that underwent both maxillary sinus elevation with grafting and implant placement at the University of Michigan School of Dentistry from 2004 to 2014. Cases with documented radiographic and clinical follow-up were included. The data analyses revealed the following.
  
  
  RESULTS
  A total of 29 CBCT scans met the inclusion criteria for evaluation, and 93.1% of them had maxillary sinus mucosal/tissue thickening. Specifically, 6.9% of cases exhibited no thickening, 6.9% had minimal thickening (1-2 mm), 20.7% of cases had moderate thickening (2-5 mm), and 65.5% had severe thickening (>5 mm). We propose these categorical measurements of tissue thickening as a new "mucosal thickening index." The tissue thickening did not vary based on gender, age, or smoking status, nor did it relate to the underlying alveolar ridge height. However, patients with a history of periodontal diseases demonstrated a significant association with mucosal thickening (p = 0.0043). These data indicate that there is high implant and grafting success rate (100%) in the maxillary sinus despite large and varied physiologic sinus mucosal/tissue thickening.
  
  
  CONCLUSIONS
  Based on study findings, this research will help guide dental practitioners regarding cases that exhibit mucosal thickening. These data support the concept that physiologic mucosal thickening in varied ranges is not associated with implant or grafting failure in the maxillary sinus.
authors.affiliation: Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, 1011 N University Ave, Ann Arbor, MI, USA.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Maska
authors.affiliation: Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, 1011 N University Ave, Ann Arbor, MI, USA.|Department of Surgical Sciences, School of Dentistry, Marquette University, 1801 W Wisconsin Ave, Milwaukee, WI, USA.
authors.forename: Guo-Hao
authors.initials: GH
authors.lastname: Lin
authors.affiliation: Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, 1011 N University Ave, Ann Arbor, MI, USA.|Department of Periodontology & Dental Hygiene, University of Detroit Mercy, 2700 Martin Luther King Jr. Blvd, Detroit, MI, USA.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Othman
authors.affiliation: Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, 1011 N University Ave, Ann Arbor, MI, USA.|Department of Periodontics, School of Dental Medicine, Case Western Reserve University, 2124 Cornell Rd, Cleveland, OH, USA.
authors.forename: Shabnam
authors.initials: S
authors.lastname: Behdin
authors.affiliation: Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, 1011 N University Ave, Ann Arbor, MI, USA.
authors.forename: Suncica
authors.initials: S
authors.lastname: Travan
authors.affiliation: Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, 1011 N University Ave, Ann Arbor, MI, USA.
authors.forename: Erika
authors.initials: E
authors.lastname: Benavides
authors.affiliation: Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, 1011 N University Ave, Ann Arbor, MI, USA. Yvonne.Kapila@ucsf.edu.|Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, 513 Parnassus Ave, S612D, Box 0422, San Francisco, 94143, CA, USA. Yvonne.Kapila@ucsf.edu.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Kapila
keywords: Cone-beam computed tomography; Dental implants; Maxillary sinus; Mucosal thickening; Periodontal diseases; Sinus floor augmentation