Emine Nur KAHRAMAN, Büşra TEKİN, Işıl YURDAIŞIK
Anatolian Current Medical Journal - 2026;8(5):1029-1039
Aims: To identify factors independently associated with extensive maxillary sinus alveolar crest pneumatization on computed tomography (CT) in a cross-sectional sample. Methods: We retrospectively analyzed 800 maxillary quadrants from 400 patients. Pneumatization was classified as normal or extensive, and its associations with demographic, dental, and sinonasal variables were tested by multivariable logistic regression with cluster-robust standard errors. Intra- and inter-observer agreement was quantified on a random subsample of 82 quadrants. Generalized estimating equations and penalized-likelihood (Firth) regression were used as sensitivity analyses. Results: Extensive pneumatization was present in 603 quadrants (75.4%) and was independently associated with age [odds ratio (OR) 0.932 per year; 95% confidence interval (CI) 0.908-0.957; p<0.001], maxillary septa (OR 2.235; 95% CI 1.257-3.975; p=0.006), and nasal septum deviation (OR 2.864; 95% CI 1.467-5.594; p=0.002). Tooth count, third molar presence, gender, and ostiomeatal complex patency were not. The model showed modest discrimination (area under the receiver operating characteristic curve 0.681; 95% CI 0.636-0.725). Where a root apex projected into the sinus, 88.8% of quadrants showed extensive pneumatization, compared with 58.3% where the roots were distant from the sinus floor. Conclusion: Extensive maxillary sinus pneumatization is more frequent in younger patients and is independently associated with maxillary septa and nasal septum deviation, rather than with tooth count; the association with maxillary septa was attenuated in a generalized estimating equations sensitivity analysis. Root-sinus proximity showed a strong unadjusted association.
