{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T20:16:58Z","timestamp":1778530618474,"version":"3.51.4"},"reference-count":42,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background\/Objectives: A marked anteroposterior gradient of nasal fossa pneumatisation over the posterior maxillary alveolar base has been documented at the second premolar level, yet whether this gradient extends to the second upper molar (M2)\u2014the primary site for posterior implant rehabilitation\u2014remains uncharacterised. We aimed to quantify this gradient by classifying pneumatisation patterns above the maxillary alveolar base at M2 (Type 1: pure antral; Type 2: antral with palatine recess; Type 3: Big Nose pattern with combined antral and nasal involvement), assess bilateral symmetry and sex distribution, and compare findings with published second premolar data. Methods: A retrospective study was conducted on 165 cone-beam computed tomography scans (330 sides) from a Romanian population. Patterns were classified as Type 1 (pure antral), Type 2 (antral with palatine recess), or Type 3 (Big Nose pattern). Bilateral symmetry was assessed using Cohen\u2019s kappa, and sex differences using Fisher\u2019s exact test. Results: Type 1 was observed in 93.3% of sides, Type 2 in 4.2%, and Type 3 in 2.4%. Bilateral symmetry was 98.8% (kappa = 0.904), with all Type 3 cases occurring bilaterally. No significant sex difference was found (p = 0.363), although Type 3 showed a non-significant male predominance (OR = 4.55; p = 0.305). The Big Nose pattern was 6.8-fold less prevalent at M2 than at the second premolar level. Conclusions: A 6.8-fold reduction in Big Nose prevalence from the second premolar (16.2%) to M2 (2.4%) confirms a pronounced anteroposterior gradient in nasal fossa involvement over the posterior maxillary alveolar base\u2014the central finding of this study. At M2, the maxillary sinus dominates exclusively in 97.6% of sides, rendering standard sinus floor elevation highly predictable. The invariable bilaterality of the Big Nose pattern at M2 supports contralaterally symmetrical surgical planning. These findings provide a gradient-based clinical framework: nasal-floor-aware augmentation planning is essential anteriorly (premolar region), whereas standard sinus augmentation protocols are reliably applicable at M2.<\/jats:p>","DOI":"10.3390\/dj14050280","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T19:35:43Z","timestamp":1778528143000},"page":"280","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Big Nose Pattern at the Second Upper Molar\u2014A Retrospective CBCT Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Carol Antonio","family":"Dandoczi","sequence":"first","affiliation":[{"name":"Division of Anatomy, Department 1, Faculty of Dentistry, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8723-0540","authenticated-orcid":false,"given":"Mugurel Constantin","family":"Rusu","sequence":"additional","affiliation":[{"name":"Division of Anatomy, Department 1, Faculty of Dentistry, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4655-4574","authenticated-orcid":false,"given":"R\u0103zvan Costin","family":"Tudose","sequence":"additional","affiliation":[{"name":"Division of Anatomy, Department 1, Faculty of Dentistry, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Research Department, \u201cDr. Carol Davila\u201d Central Military Emergency Hospital, 010825 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7489-3505","authenticated-orcid":false,"given":"Mihail Silviu","family":"Tudosie","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1038\/s41368-023-00248-x","article-title":"Maxillary sinus floor augmentation: A review of current evidence on anatomical factors and a decision tree","volume":"15","author":"Lyu","year":"2023","journal-title":"Int. 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