Published Paper Details:

Background: The posterior superior alveolar artery (PSAA), a vital branch of the maxillary artery, supplies the lateral maxillary sinus wall and posterior maxilla. Anatomical variations in the PSAA are clinically significant, particularly during sinus lift procedures, implant placement, and maxillofacial surgeries, where inadvertent arterial injury may lead to hemorrhage and compromised surgical outcomes. Cone-beam computed tomography (CBCT) provides accurate three-dimensional visualization of maxillary sinus anatomy and is the preferred modality for pre-surgical planning. Understanding the PSAA's position relative to the sinus floor and alveolar crest in different dentition states is essential for improving surgical safety. Aim: To assess the anatomical location and distances of the intraosseous PSAA from the floor of the maxillary sinus and the alveolar crest in dentulous and partially edentulous patients, and to evaluate variations based on gender using CBCT. Materials and Methods: A cross-sectional retrospective analysis of 188 CBCT scans of patients aged 18-75 years was conducted. Scans were divided into two groups: dentulous (n = 94) and partially edentulous (n = 94). The PSAA was identified on coronal and sagittal CBCT sections, and linear measurements were made from its inferior border to (1) the maxillary sinus floor and (2) the alveolar crest in the first or second molar region. Scans with artifacts, pathology, impacted teeth, or prior surgical changes were excluded. Data were analyzed using SPSS version 22.0, with a significance level of p <= 0.05. Results: The mean distance of the PSAA to the sinus floor was 9.98 mm in dentulous patients and 9.67 mm in partially edentulous patients, showing no statistically significant difference (p = 0.450). The mean distance of the PSAA to the alveolar crest was 17.53 mm in dentulous patients and 15.51 mm in partially edentulous patients, indicating a statistically significant reduction in partially edentulous individuals (p = 0.001). Gender analysis revealed: o Dentulous group: No significant gender differences for PSAA distance to the sinus floor or alveolar crest (p > 0.05). o Partially edentulous group: A significant gender difference was found in PSAA distance to the sinus floor (greater in males; p = 0.022), while the distance to the alveolar crest showed no significant difference (p = 0.143). Conclusion: The PSAA's position relative to the sinus floor remains comparable between dentulous and partially edentulous patients; however, its distance to the alveolar crest is significantly reduced in partially edentulous individuals due to post-extraction alveolar bone resorption. Gender differences are minimal but become significant in partially edentulous patients regarding sinus floor measurements. CBCT provides high accuracy for PSAA localization and plays an essential role in pre-operative planning for implant placement and sinus augmentation procedures. This study offers valuable baseline data to enhance surgical safety and minimize vascular complications in the posterior maxilla.