Morphological assessment of the posterior superior alveolar artery using cone-beam computed tomography

In dentistry and maxillofacial surgery, detailed knowledge of maxillary sinus anatomy and its relationship to adjacent structures is essential to reduce the risk of intraoperative complications, particularly during implant placement and sinus floor elevation procedures. This study aimed to assess the prevalence, diameter, and anatomical course of the posterior superior alveolar artery (PSAA), as well as its spatial relationship to the alveolar crest and the maxillary sinus floor, using conebeam computed tomography (CBCT) to support preoperative surgical planning.

This retrospective study evaluated 146 CBCT scans. The diameter of the PSAA and its spatial relationships with the maxillary sinus floor, alveolar crest, and medial sinus wall were assessed. Age and sex were included as covariates. Measurement reliability was evaluated using the intraclass correlation coefficient (ICC). Statistical analyses were performed with a significance level set at p < 0.05.

The PSAA diameter was ≤ 2 mm in the vast majority of cases on both sides, accounting for 97.6% on the right and 97.5% on the left, while large-diameter PSAA ( > 2 mm), which may increase the risk of intraoperative bleeding, were uncommon on both sides.

Although the PSAA is commonly characterized by a small diameter, larger-caliber arteries may be encountered and pose a potential risk during maxillary sinus surgeries. Therefore, accurate preoperative localization of the PSAA using CBCT is essential to minimize the risk of vascular injury and to support safe surgical planning.