{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T19:08:26Z","timestamp":1788894506302,"version":"build-2803163510"},"reference-count":23,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The aim of this study was to develop a novel Nasal Spine-Guided Classification for assessing the alveolar vertical extension of the maxillary sinus and to evaluate its anatomical relationship with the roots of the posterior teeth using CBCT in a Saudi subpopulation. Methods: Maxillary sinus pneumatization was measured using cone-beam computed tomography for 380 patients. The assessment was performed along a horizontal plane extending between anterior and posterior nasal spine. In addition, pneumatization was evaluated in edentulous areas, and between the roots of multi-rooted teeth. Maxillary sinus membrane thickness was also measured. The results were expressed as mean, median and interquartile range, and considered statistically significant at a p-value &lt; 0.05. Results: The mean maxillary sinus pneumatization on the left side was 8.8 \u00b1 4.32 mm, and 8.58 \u00b1 4.85 mm on the right side, with no statistically significant difference. The median of pneumatization in the edentulous area and between the roots on left side were 5.1 and 3.8 mm respectively, while on the right side, the median pneumatization was 5.03 and 3.04 mm. In addition, the proximity of the maxillary root apices to the sinus floor revealed a zero distance in 80.49% of the roots on the left side and in 79.48% on the right side. Furthermore, the results indicated no statistically significant association between maxillary sinus membrane thickness and pneumatization in the edentulous area. Conclusions: CBCT analysis revealed a predominance of advanced maxillary sinus pneumatization (Class III) and a high frequency of direct contact between posterior maxillary root apices and the sinus floor in the studied population. Additionally, no significant association was identified between maxillary sinus membrane thickness and sinus pneumatization in edentulous areas.<\/jats:p>","DOI":"10.3390\/jcm15062124","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T09:00:37Z","timestamp":1773219637000},"page":"2124","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Development and Application of Nasal Spine-Guided Classification for Maxillary Sinus Pneumatization"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6301-8557","authenticated-orcid":false,"given":"Ahmed M.","family":"Kabli","sequence":"first","affiliation":[{"name":"Department of Preventive Dental Sciences, College of Dentistry, Taibah University, Madinah 42353, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rawan K.","family":"Kamal","sequence":"additional","affiliation":[{"name":"Department of Preventive Dental Sciences, College of Dentistry, Taibah University, Madinah 42353, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3080-2775","authenticated-orcid":false,"given":"Rayan M.","family":"Meer","sequence":"additional","affiliation":[{"name":"Department of Preventive Dental Sciences, College of Dentistry, Taibah University, Madinah 42353, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6897-1565","authenticated-orcid":false,"given":"Albraa","family":"Alolayan","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Diagnostic Sciences, College of Dentistry, Taibah University, Madinah 42353, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Omar","family":"Elboraey","sequence":"additional","affiliation":[{"name":"Department of Preventive Dental Sciences, College of Dentistry, Taibah University, Madinah 42353, Saudi Arabia"},{"name":"Periodontology, Oral Diagnosis and Oral Radiology Department, Faculty of Dentistry, Tanta University, Tanta 31527, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"20190205","DOI":"10.1259\/dmfr.20190205","article-title":"The maxillary sinus: Physiology, development and imaging anatomy","volume":"48","author":"Whyte","year":"2019","journal-title":"Dentomaxillofac. Radiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1815","DOI":"10.1902\/jop.2009.090249","article-title":"Alveolar bone regeneration by transplantation of periodontal ligament stem cells and bone marrow stem cells in a canine peri-implant defect model: A pilot study","volume":"80","author":"Kim","year":"2009","journal-title":"J. Periodontol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s40729-018-0143-5","article-title":"Thickness of the Schneiderian membrane and its correlation with anatomical structures and demographic parameters using CBCT tomography: A retrospective study","volume":"4","author":"Kalyvas","year":"2018","journal-title":"Int. J. Implant Dent."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1055\/s-0036-1593834","article-title":"Evaluation of the prevalence of maxillary sinus abnormalities through spiral computed tomography","volume":"21","author":"Drumond","year":"2017","journal-title":"Int. Arch. Otorhinolaryngol."},{"key":"ref_5","first-page":"Doc08","article-title":"Comprehensive review on endonasal endoscopic sinus surgery","volume":"14","author":"Weber","year":"2015","journal-title":"GMS Curr. Top. Otorhinolaryngol. Head Neck Surg."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Yang, B., Wang, T., Wen, Y., and Liu, X. (2024). Association between sinus septa and lateral wall thickness with risk of perforation during maxillary sinus lift surgery: A systematic review and meta-analysis. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0308166"},{"key":"ref_7","first-page":"e47605","article-title":"Prevalence and characteristics of the maxillary sinus septa in a Saudi Arabian sub-population: A retrospective CBCT-based study","volume":"15","author":"Alassaf","year":"2023","journal-title":"Cureus"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Wu, X., Cai, Q., Huang, D., Xiong, P., and Shi, L. (2022). Cone-beam computed tomography-based analysis of maxillary sinus pneumatization extended into the alveolar process in different age groups. BMC Oral Health, 22.","DOI":"10.1186\/s12903-022-02445-2"},{"key":"ref_9","unstructured":"Misch, C.E., and Abbas, H.A. (2008). Contemporary Implant Dentistry, Mosby. [3rd ed.]."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.aanat.2018.01.008","article-title":"Three-dimensional CAD\/CAM imaging of the maxillary sinus in the ageing process","volume":"218","author":"Lovasova","year":"2018","journal-title":"Ann. Anat."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"20160043","DOI":"10.1259\/dmfr.20160043","article-title":"Comparison of panoramic radiography and CBCT to identify maxillary posterior roots invading the maxillary sinus","volume":"45","author":"Lopes","year":"2016","journal-title":"Dentomaxillofac. Radiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"20140238","DOI":"10.1259\/dmfr.20140238","article-title":"CBCT-based bone quality assessment: Are Hounsfield units applicable?","volume":"44","author":"Pauwels","year":"2015","journal-title":"Dentomaxillofac. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e12402","DOI":"10.1111\/jicd.12402","article-title":"Comparison of cone-beam computed tomography and panoramic imaging in assessing the relationship between posterior maxillary tooth roots and the maxillary sinus: A systematic review","volume":"10","author":"La","year":"2019","journal-title":"J. Investig. Clin. Dent."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1111\/cid.12606","article-title":"New classification of maxillary sinus contours and its relation to sinus floor elevation surgery","volume":"20","author":"Niu","year":"2018","journal-title":"Clin. Implant Dent. Relat. Res."},{"key":"ref_15","first-page":"113","article-title":"Extensive maxillary sinus pneumatization","volume":"41","author":"Kalavagunta","year":"2003","journal-title":"Rhinology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e64","DOI":"10.1590\/1807-3107bor-2018.vol32.0064","article-title":"Maxillary sinus floor pneumatization and alveolar ridge resorption after tooth loss: A cross-sectional study","volume":"32","author":"Cavalcanti","year":"2018","journal-title":"Braz. Oral Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1097\/00008505-199901000-00013","article-title":"Contemporary implant dentistry","volume":"8","author":"Misch","year":"1999","journal-title":"Implant Dent."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.tripleo.2005.09.031","article-title":"Correlation between maxillary sinus floor topography and related root position of posterior teeth using panoramic and cross-sectional computed tomography imaging","volume":"102","author":"Sharan","year":"2006","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"0300060520926896","DOI":"10.1177\/0300060520926896","article-title":"Relationship between maxillary posterior molar roots and the maxillary sinus floor: Cone-beam computed tomography analysis of a western Chinese population","volume":"48","author":"Pei","year":"2020","journal-title":"J. Int. Med. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.sdentj.2018.11.002","article-title":"Revisited maxillary sinus pneumatization narrative of observation in Al-Madinah Al-Munawwarah, Saudi Arabia: A retrospective cross-sectional study","volume":"31","author":"Elsayed","year":"2019","journal-title":"Saudi Dent. J."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Ji, X., He, J., Zhang, L., and Huang, D. (2025). Effect of the anatomical patterns of maxillary sinus floor on the endodontic microsurgery plan of maxillary sinusitis of endodontic origin. BMC Oral Health, 25.","DOI":"10.1186\/s12903-025-05442-3"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Dipalma, G., Inchingolo, A.M., Trilli, I., Ferrante, L., Noia, A.D., de Ruvo, E., Inchingolo, F., Mancini, A., Cocis, S., and Palermo, A. (2025). Management of oro-antral communication: A systematic review of diagnostic and therapeutic strategies. Diagnostics, 15.","DOI":"10.3390\/diagnostics15020194"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Saquib Abullais, S., AlQahtani, S.M., Alqahtani, S., Alaamri, A., Azhar Dawasaz, A., Alqahtani, A., and Dhadse, P.V. (2024). Radiographic assessment of maxillary sinus membrane and lateral wall thickness using cone-beam CT in different facial types in southwestern Saudi Arabia. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0298403"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2124\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T09:30:11Z","timestamp":1773221411000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2124"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,11]]},"references-count":23,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15062124"],"URL":"https:\/\/doi.org\/10.3390\/jcm15062124","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,11]]}}}