1074 D3000 new imprint Word template Vol 13, No 1 (2025) ISSN 2167-8677 (online) DOI 10.5195/d3000.2025.1074 http://dentistry3000.pitt.edu Variation in Maxillary Sinus Height and Length Among Skeletal Types I-III Maha Esam College of Den*stry, Tikrit University, Iraq Abstract Objec-ve: The purpose of this study was to evaluate the effect of malocclusion in skeletal class I, II, III on maxillary sinus dimensions. Materials and Methods: 30 cone-beam computed tomography (CBCT) images of 30 patients were analyzed. MSH (maxillary sinus height) and MSL (maxillary sinus length) were measured using the MIMICS 19.0 software (Materialise HQ Technologielaan, Leuven, Belgium). Skeletal patterns (Angle class I-II-III) were defined. Re- sults: The mean value of the MSH in class I was 23.27±4.01 mm for the right side and 23.03± 4.07 mm for the left side. For MSL, the values for class I were 29.20±3.26 for the right and 30.04± 3.13mm for the left. The mean value of the MSH in class II was 21.73±3.44 mm for the right and 19.61± 2.22 mm for the left. MSL in class II was 26.57±2.31 for the right and 26.96±3.41mm for the left. The average right MSH for class III was 22.90±0.62 mm, whereas the left side had a mean of 19.61±2.22 mm. Conclusion: Class I individuals exhibited the greatest MSH and MSL values bilaterally compared to Class II and III. Overall, maxillary sinus dimensions showed varia[on across skel- etal classes, with Class II presen[ng the lowest averages. Open Access Cita%on: Esam M. (2025) Varia%on in Maxillary Sinus Height and Length Among Skeletal Types I-III. Den%stry 3000. 1:a001 doi:10.5195/d3000.2025.1074 Received: October 12, 2025 Accepted: October 15, 2025 Published: November 10, 2025 Copyright: ©2025 Esam M. This is an open access ar%cle licensed under a Crea%ve Commons AWribu%on Work 4.0 United States License. Email: maha1974@tu.edu.iq Introduc)on Maxillary sinus is an air-filled, pyramidal- shaped structure present in the body of the maxilla [1]. it is the largest of the four prana- sal sinuses [2] it is a cavity or space filled with air in the body of maxilla [3]. Consisting of the maxillary, frontal, sphe- noid, and ethmoidal sinuses, which perform critical functions such as air filtration and providing immune barrier. For the sinuses, the inner surfaces are covered with a thin mucus layer, which ensures maintenance of moisture and health [4-5]. The maxillary sinus is a multifunctional bony cavity that begins at the ethmoidal infundib- ulum in the third month of fetal development [6,7]. After birth maxillary sinus continues to extend both laterally and inferiorly during the rapid growth period from birth to 3 years of age [8]. It measures approximately 144 mm3 at birth and grows pyramidally into adulthood. Anatomically, the maxillary sinus described as a quadrangular pyramid form with an internal base that formed by the lat- eral wall of the nasal cavity [9]. The size of the maxillary sinus is important in the Nield of dentistry during placement of implants, mini-screws, augmentation procedures, me- sialisation of second molars in place of Nirst molars, and intrusion of maxillary molars [10]. Craniofacial growth and development have a complex, multifactorial structure. According to the functional matrix theory, soft tissues affect the development of hard tissues [11]. The maxillary sinus can be affected by fac- tors such as head posture, functional ante- rior displacement, the vertical–sagittal skel- etal relationship, and surgical mandibular advancement [12]. Orthodontic treatment plan is affected by the size and position of the maxillary sinus. Like- wise, the maxillary sinus may be affected by different malocclusions either dental or skel- etal, anteroposterior or vertical in terms of size and position [13]. With the emergence of cone beam computed tomography (CBCT) and its advantages in the world of radiog- raphy appreciated, orthodontists are using it increasingly frequently. Studying the maxil- lary sinus becomes more accurate and with a 3D approach and the volume of the sinus could be evaluated [14]. Materials and Methods The sample of the study was collected from the patients treated at the Orthodontic Clinic of the Department of Orthodontic in College of Dentistry, Tikrit University, from Decem- ber 2023 to February 2024. Out of 50 Varia[on in Maxillary Sinus Height and Length Among Skeletal Types I-III Vol 13, No 1 (2025) DOI 10.5195/d3000.2025.1074 http://dentistry3000.pitt.edu 2 subjects, 30 patients were selected that ful- Nilled the following selection criteria: 1. The subjects were 18 to 25 years. 2. No history of abnormal habits (mouth breathing) and no apparent facial dishar- mony or cleft lip and palate. 3. No history of orthodontic, orthopedic or facial surgical treatment. 4. Fully erupted permanent dentition (in- cluding upper third molar). 5. Symmetrical faces. 6. No maxillary sinus pathology. 7.No pathologies like cysts or tumors. 8. No nasal or sinus polyposis. Ten patients for each Angle’s class were in- cluded [15]. In the Class II malocclusion group, individu- als were characterized by Class II molar-ca- nine relationship and convex proNile, In the creation of the Class III malocclusion group, attention was paid to the fact that the indi- viduals were characterized by Class III mo- lar-canine relationship, concave or Nlat pro- Nile [16]. Our study included CBCT images in which the boundaries of the maxillary sinus region were clearly observed in 3D within the Nield of view (FOV) area [17]. CBCT images were obtained in the standard sitting position us- ing the device (3D Accuitomo CBCT instru- ment (J Morita Manufacturing Corp, Kyoto, Japan 17.5-second exposure, 90 kV voltage, 5 mA current, and 140 x 100 mm FOV). Pa- tients were asked to bite with maximum in- tercuspation and not move their heads or tongues during scanning. All images had a full Nield of view so that the maxillary sinus was fully observed. To compute MSV, images were changed into DICOM format obtained from 0.25 mm thick axial slices [18]. Variables were deNined as follows (Figure 1): - Maxillary sinus length (MSL): this line ex- tends from An to Po. The maximum distance between the most lateral and medial points of each sinus was identiNied as the width [19]. - Maxillary sinus height (MSH): this line ex- tends from Su to In. The height was deNined as the maximum distance between the bot- tom and the highest points of the sinus on each side [20]. Figure 1. Cephalometric landmarks, planes and variables used in the study. Statistics consisted of descriptive statistics including mean values for merged sample were calculated. All the groups were sub- jected to one way ANOVA test to assess the signiNicance of association between maxil- lary size measurements and three malocclu- sion groups in male sample, female sample and merged sample (alpha of 0.05). Results/Discussion The mean value of right MSL for class I was 29.20±3.26 mm and was 30.04± 3.13 mm for the left side (Table 1). On the other hand, the mean value of right MSH for class I was 23.27±4.01 mm and for the left side the mean value was 23.03± 4.07 mm. Also, according to the present study the mean value of right MSL for class II was 26.57±2.31 mm and was 26.96±3.41mm for the left side. On the other hand, the mean value of right MSH for class I was 21.73±3.44 mm and for the left side the mean value was 19.61± 2.22 mm. On the other hand, the mean value of right MSL for class III was 23.96± 2.38mm and was 29.26±2.57 mm for the left side. While the mean value of right MSH for class III was 22.90±0.62 mm and for the left side the mean value was 19.61± 2.22 mm. Maxillary sinus dimensions vary signiNi- cantly across skeletal Classes I to III, with Class I showing the highest values. References 1. Mariya Qadir, Mohammad Mushtaq. Maxillary sinus size and malocclusion: Is there any relation? International Journal of Applied Dental Sciences 2017; 3(4): 333-337. 2. Blanton PL, Biggs NL. Eighteen hundred years of controversy: the paranasal sinuses. Am J Anat. 1969; 124(2):135-47. 3. Stammberger H. History of rhinology: anatomy of the paranasal sinuses. Rhinology. 1989; 27(3):197-210. 4. Chunduru R, Rachel P, Kailasam V, Pad- manabhan S. The Evaluation of Maxillary Sinus Di- mensions in Different Craniofacial Patterns: A Sys- tematic Review and Meta-Analysis. Turk J Orthod. 2023; 36(3): 208-215. 5. 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(Feb- ruary 01, 2024) Ingluence of Orthodontic Treat- ment on Changes in the Maxillary Sinus Dimen- sions. Cureus 16(2): e53363. DOI 10.7759/cu- reus.53363 12. Uchida Y, Goto M, Katsuki D, Akioshi T. A ca- daveric study of maxillary sinus size as an aid in bone grafting of maxillary sinus gloor. J Oral Maxil- lofac Surg 1998;56:1158-63. 13. Munhoz L, Abdala Júnior R, Abdala R, Arita ES: Diffusion-weighted magnetic resonance imaging of the paranasal sinuses: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018, 126:521-36. 10.1016/j.oooo.2018.07.004 14. Shah RK, Dhingra JK, Carter BL, Rebeiz EE: Pa- ranasal sinus development: a radiographic study. Laryngoscope. 2003, 113:205-9. 10.1097/00005537-200302000-00002 15. da Silva Y, Munhoz L, Filho JR, et al.: Maxillary sinus volumetric changes in jet aircraft pilots: a multislice computed tomography pilot study. Im- aging Sci Dent. 2023, 53:53-60. 10.5624/isd.20220173 16. Natheer H, Uthman BD, Canturk N. Evaluation of maxillary sinus dimensions in gender determi- nation using helical CT scanning. Forensic Sci- ences J 2011;56(2):403-8. 17. Sharan A, Madjar D. Maxillary sinus pneumati- zation following extractions: a radiographic study. Int J Oral Maxillofac Implants 2008;23(1):48-56. 18. Uchida Y, Goto M, Katsuki D, Akioshi T. A ca- daveric study of maxillary sinus size as an aid in bone grafting of maxillary sinus gloor. J Oral Maxil- lofac Surg 1998;56:1158-63. 19. Weir N. Otolaryngology an illustrated history. Boston: Butterworth-Heinemann; 2010. 20. Prabhat M, Rai S, Kaur M, Prabhat K, Bhatnagar P, Panjwani S. Computed tomography based foren- sic gender determination by measuring the size and volume of the maxillary sinuses. J Forensic Dent Sci 2016; 8:40-46. Varia[on in Maxillary Sinus Height and Length Among Skeletal Types I-III Vol 13, No 1 (2025) DOI 10.5195/d3000.2025.1074 http://dentistry3000.pitt.edu 3 Table 1. Descriptive statistics and ANOVA for overall sample. Groups R H R L L H L L Class I 23.27±4.01 ab 29.20±3.26 a 23.03± 4.07 a 30.04± 3.13 a Class II 21.73±3.44 b 26.57±2.31 b 19.61± 2.22 b 26.96±3.41 b Class III 24.64±3.50 a 23.96± 2.38 22.90±0.62 a 29.26±2.57 a P-value 0.05 0.01 0.01 0.05