Radiographic evaluation of the relationship between maxillary sinus pneumatization and tooth extraction

Aim: To assess maxillary sinus pneumatization radiographically after posterior tooth extraction and to compare the results based on both the post-extraction time interval and the tooth type. Material and Methods: This retrospective study included 54 patients who underwent extraction of at least one premolar or molar with roots close to the maxillary sinus floor. A total of 186 panoramic radiographs were assessed using standardized reference lines and points to measure sinus floor changes. Patients were categorized into five groups based on follow-up periods: 0–6, 7–12, 13–18, and 19–24 months. Magnification correction was applied, and mean pneumatization values were calculated by follow-up group and tooth type. Results: Maxillary sinus pneumatization demonstrated a progressive increase with longer post-extraction intervals. The mean pneumatization values were 1.1 mm in the 0–6 month group, 1.7 mm in the 7–12 month group, 2.1 mm in the 13–18 month group, and 3.9 mm in the 19–24 month group. Analysis by tooth type revealed mean values of 1.5 mm for premolar extractions, 2.0 mm for first molars, and 2.4 mm for both second and third molars. Greater pneumatization was observed in teeth with roots in close proximity to the sinus floor and in those extracted due to chronic periapical infection. Conclusion: Maxillary sinus pneumatization is a time-dependent process influenced by tooth type, root–sinus relationship, and pre-existing pathology. Early implant placement or ridge preservation techniques should be considered in high-risk cases to minimize bone loss and reduce the need for extensive sinus augmentation procedures.