Do we Need 3D Imaging Prior to Sinus Augmentation? A Retrospective Study

Preoperative evaluation of the maxillary sinus is essential for planning sinus augmentation procedures. Chronic sinusitis and aspergillosis are considered contraindications, yet current guidelines recommend cone-beam computed tomography (CBCT) imaging only for symptomatic patients. This study aimed to determine the prevalence of sinus pathologies in patients scheduled for sinus augmentation and to evaluate the necessity of routine preoperative CBCT imaging.

The CBCT datasets of patients who presented to our academic private hospital between 2020 and 2023 for implant consultation requiring sinus augmentation were retrospectively analyzed. Sinus opacifications were classified according to Nair, and patency of the natural ostium was assessed. Patients with high-grade opacifications received treatment of potential foci, decongestant therapy, or sinus revision surgery depending on the etiology.

The datasets of 577 patients (287 men, 290 women; mean age: 61.7 ± 14.0 years) were evaluated. Among 1154 sinuses assessed, 11.4% exhibited high-grade opacifications, and 3.3% had a blocked ostium. Pathologies were frequently asymptomatic (77.8%). Odontogenic causes accounted for 7.8% of unilateral opacifications, while chronic polypoid sinusitis and aspergillosis were histopathologically confirmed in 4.0% and 1.4% of cases, respectively. Surgical interventions enabled subsequent sinus augmentation without complications.

High-grade sinus pathologies were common in this cohort and frequently asymptomatic. These findings support the routine use of preoperative CBCT imaging - including evaluation of both the maxillary sinus and the natural ostium - to improve surgical planning and minimize complications.