Correlation of postoperative thickening of the sinus mucosa in cone beam computed tomography with decreased voxel brightness of the regenerated bone after sinus floor augmentation: a prospective study.

Although postoperative thickening of the sinus membrane is a risk in maxillary sinus floor augmentation (MSFA), the relationship between postoperative mucosal thickening (MT) and the quality of the augmented bone has not been clarified. The aim of this study was to evaluate the characteristics of the augmented bone after MSFA using cone beam computed tomography (CBCT) histograms, comparing patients with and without postoperative maxillary sinus MT. Patients who underwent MSFA with beta-tricalcium phosphate and simultaneous implantation between 2021 and 2023 were included (14 regions in 12 patients). CBCT images obtained pre-surgery (C1) and at 6 months post-surgery (C2) were used for comparisons between a No-MT group (≤2 mm) and an MT group (>2 mm). Three-dimensional bone subtraction (C2 - C1) was performed for the analysis of voxel brightness and quantification of the augmented bone volume. Histogram analysis showed that the MT group had a significantly lower mean brightness value (P = 0.004) and higher skewness (P = 0.003) and kurtosis (P = 0.006) values than the No-MT group. Thus, histogram-based assessment of bone quality in MSFA may be used as a prognostic marker for implant success by monitoring changes in brightness, skewness, and kurtosis during the augmented bone healing process.