ORIGINAL ARTICLE

Retrospective study of maxillary sinus dimensions

and pneumatization in adult patients with
an anterior open bite
Jesung Ryu,a Sung-Hwan Choi,b Jung-Yul Cha,c Kee-Joon Lee,d and Chung-Ju Hwangd
Seoul, Korea

Introduction: The aim of this study was to evaluate differences in the maxillary sinus floor levels between adults
with an anterior open bite and those without. Methods: This retrospective study included 30 subjects: 15 adults
with an anterior open bite (mean age, 21.5 6 4.3 years) and 15 control subjects with normal occlusion (mean
age, 21.7 6 3.1 years). Cone-beam computed tomography and lateral cephalograms were analyzed before
treatment. Results: The open-bite group exhibited a significantly greater maxillary posterior alveolar height
(P \0.05). The craniocaudal heights of the maxillary sinus in the region between the first and second molars
and between the second premolar and first molar were significantly greater in the open bite group (40.5 and
39.0 mm, respectively) than in the control group (36.7 and 34.7 mm, respectively; P \0.05 for both). The
basal bone heights in the regions between the first and second molars, the second premolar and first molar,
and the first and second premolars were significantly smaller in the open-bite group than in the control group
(P \0.001 for all). Conclusions: Vertical pneumatization of the maxillary sinus floor in the region between
the first and second molars and between the second premolar and first molar is greater in adults with an anterior
open bite than in those without, whereas basal bone height in the maxillary posterior region is lower in the open-
bite patients. (Am J Orthod Dentofacial Orthop 2016;150:796-801)

O
pen bite is associated with a vertical skeletal
dysplasia in the jaws that arises below the cranial
base, and it often requires surgical treatment. The
etiology of open bite is associated with genetic and envi-
ronmental factors that influence craniofacial traits.1 The
skeletal and dentoalveolar characteristics of open bite
include a long face with a steep mandibular plane angle,
vertical growth with extrusion of posterior teeth in the
maxillary arch, and an obtuse gonial angle.2,3
The maxillary sinus floor comprises the maxillary
alveolar process and the hard palate. The growth and
development of the maxillary sinus are associated with
maxillary structures and the maxillary posterior teeth,
and are consequently influenced by any form of skeletal
From the Department of Orthodontics, College of Dentistry, Yonsei University,
Seoul, Korea.
a
Postgraduate student.
b
Fellow, The Institute of Cranio-Facial Deformity.
c
Associate professor, The Institute of Cranio-Facial Deformity.
d
Professor, The Institute of Cranio-Facial Deformity.
All authors have completed and submitted the ICMJE Form for Disclosure of
Potential Conflicts of Interest, and none were reported.
Address correspondence to: Chung-Ju Hwang, 50-1 Yonsei-ro, Seodaemun-gu,
Seoul 03722, Korea; e-mail, hwang@yuhs.ac.
Submitted, September 2015; revised and accepted, March 2016.
0889-5406/$36.00
Ó 2016 by the American Association of Orthodontists. All rights reserved.
http://dx.doi.org/10.1016/j.ajodo.2016.03.032
796
malocclusion.4,5 However, there are few reports on the
relationship between the development of the maxillary
sinus and malocclusion. Oktay5 compared differences
in the maxillary sinus area among various skeletal
profiles using panoramic radiography. Panoramic
radiography has low resolution, and vertical and hori-
zontal image magnifications and superimpositions of
anatomic structures are problems. Therefore, cone-
beam computed tomography (CBCT), which provides
multiplanar views with a uniform and low magnifica-
tion, should be used to overcome the limitations of
panoramic radiography.
In adults, the maxillary sinus floor extends between
adjacent teeth, creating elevations in the antral surface.6,7
This is considered an anatomic limitation that can
adversely affect orthodontic tooth movement including
intrusion or bodily movement.8 Oh et al9 reported that
tooth movement using light continuous forces is neces-
sary to move through the cortical bone of the maxillary
sinus wall in adults. Nevertheless, unpredicted complica-
tions such as root resorption, pulp ischemia, alveolar bone
loss, and perforation of the sinus membrane were found
to occur while moving the teeth through the maxillary si-
nus in an animal study and a human biopsy study.9-12
To our knowledge, no authors have investigated dif-
ferences in the sinus floor levels between adult patients
Ryu et al
with an anterior open bite and those with normal occlu-
sion using CBCT.
The aim of this study was to evaluate differences in
the maxillary sinus floor levels between adults with an
anterior open bite and those with a normal occlusion us-
ing CBCT. We tested the null hypothesis that there is no
significant difference in the sinus floor level between
subjects with and without an anterior open bite.
MATERIAL AND METHODS
The study sample comprised 30 subjects with or
without an anterior open bite whose dental records
were retrospectively reviewed at the Departments of
Oral and Maxillofacial Surgery and Orthodontics, Col-
lege of Dentistry, Yonsei University, Seoul, Korea.
The inclusion criteria for the open-bite group were
same ethnicity (Korean), age 18 years or older, anterior
open bite greater than 1 mm, and mandibular plane
angle (sella–nasion line to the mandibular plane) greater
than 38
. The exclusion criteria were loss of at least 1
permanent tooth, severe craniofacial deformities such
as cleft lip or palate, and a history of orthodontic treat-
ment or orthognathic surgery.
All participants were required to exhibit good overall
health conditions. Patients with serious medical condi-
tions requiring hospitalization in the past 3 months
were excluded to prevent any confounding effects of
these conditions or medications on the results.
Of the 30 subjects, 15 (7 men, 8 women; mean age,
21.5 6 4.3 years) fulfilled the abovementioned criteria
and were enrolled in the open-bite group. All patients
were scheduled for surgical correction of their anterior
open bite. CBCT images were already obtained to estab-
lish a surgical treatment plan.
The remaining 15 patients (7 men, 8 women; mean
age, 21.7 6 3.1 years) had a normal occlusion and
were a part of growth studies at The Institute of Cranio-
facial Deformity, College of Dentistry, Yonsei University,
Seoul, Korea (Table I). This study conformed to the te-
nets of the Declaration of Helsinki for medical protocols
and ethics and was approved by the institutional review
board of Yonsei Dental Hospital.
The lateral cephalograms were obtained (Cranex
31 ceph; Soredex, Helsinki, Finland) before treatment
and were digitized using V-ceph (version 5.5; Osstem,
Seoul, Korea) by an observer (J.R.) who was blinded to
the clinical status of the patients. In this study, we iden-
tified 4 anteroposterior and 11 vertical cephalometric
measurements.
CBCT images were obtained with the subjects in a
standard upright position (scanning time, 17 seconds;
field of view, 20 3 17.9 cm; 80 kV(p); 5 mA; 0.39 voxel
American Journal of Orthodontics and Dentofacial Orthopedics
797
Table I. Characteristics of subjects
Normal occlusion Anterior open bite
(7 men, 8 women) (7 men, 8 women)
Mean (SD) Mean (SD) P value
Age (y) 21.7 (3.1) 21.5 (4.3) 0.367*
Range (y) 19-28 18-31
ANB (
) 2.7 (1.7) 3.5 (4.1) 0.538y
SN-MP (
) 33.7 (3.9) 44.6 (3.8) \0.001y
SN-MP, Angle of sella-nasion line to the mandibular plane.
*P value calculated with the Mann-Whitney U test; yP value calcu-
lated with the Independent t test.
size) on the device (Alphard 3030h; Asahi Roentgen,
Kyoto, Japan). The acquired data were imported into In-
vivo software (version 5.2; Anatomage, San Jose, Calif)
in DICOM multifile format.
We selected the following reference planes on the
CBCT images: axial plane, which passed through the
anterior nasal spine in a direction parallel to the Frankfort
horizontal plane; sagittal plane, which passed through
the anterior nasal spine and the posterior nasal spine in
a direction perpendicular to the axial plane; and coronal
plane, which passed through the anterior nasal spine in
a direction perpendicular to the axial and sagittal planes.
Then, measurements of the maxillary sinus dimen-
sions were obtained, as described below, using previ-
ously reported methods on CBCT images.13
1. Linear measurements of the maxillary sinus height
(craniocaudal height). The axial cut was oriented
parallel to the maxillary posterior occlusal plane at
the alveolar crest level, and the sagittal cut was ori-
ented midway between the buccal and palatal
cortices. For the coronal cut, the axial image was
rotated until the orientation axis was perpendicular
to the buccal cortex (Fig 1).
The same adjustments were repeated for the regions
between the maxillary first and second molars, sec-
ond premolar and first molar, and first and second
premolars; the coronal cut was precisely oriented
in the interdental regions. The maxillary sinus
height was measured from the lowest point of the
cortical boundary of the orbital floor to the lowest
border of the cortical boundary of the sinus floor.
In each of the 3 interdental areas, the basal bone
height was measured from the lowest point of the
cortical boundary of the sinus floor to the lower
border of the alveolar crest. Eventually, 6 measure-
ments were acquired as follows: craniocaudal height
between the first and second molars, craniocaudal
height between the second premolar and first
molar, craniocaudal height between the first and
second premolars, basal bone height between
the first and second molars, basal height between
November 2016  Vol 150  Issue 5
798
Fig 1. CBCT measurements of craniocaudal dimensions. CC height, Craniocaudal height; BB height,
basal bone height.
the second premolar and first molar, and basal bone
height between the first and second premolars.
2. Linear measurements of the maxillary sinus depth (an-
teroposterior dimension) and width (mediolateral
dimension). These measurements were obtained along
the roots of the zygoma on each side. The orientation
axis for the coronal cut was adjusted so that it pre-
cisely passed along the inferior cortical boundary of
the zygoma root on both sides (Fig 2). Measurements
were repeated until the maximum anteroposterior and
mediolateral dimensions were obtained.
3. Cross-sectional area measurements. The cross-
sectional area of the maxillary sinus in the region
between the maxillary second premolar and first
molar was measured on a sagittal slice, because
the software had a problem in reproducibility with
regard to calculation of the total volume of the sinus
from 3-dimensional reconstructive images (Fig 3).
Reproducibility was evaluated by comparing mea-
surements obtained during the initial and repeated ex-
aminations of randomly collected cephalometric and
CBCT data from 20 patients over a 2-week interval by
the same examiner (J.R.). The method error was calcu-
lated using Dahlberg's formula.14 Errors ranged from
0.46 to 0.53 mm for linear measurements and from
0.81
to 0.89
for angular measurements; these values
were not significant.
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Ryu et al
Statistical analysis
There were no significant differences in the CBCT
measurements between the right and left sides; there-
fore, subsequent analyses were performed using the
average values of the data for both sides. All statistical
analyses were performed using SPSS software (version
21.0; IBM Korea, Seoul, Korea). The Shapiro-Wilk test
was used to verify the normality of data distribution. In-
dependent t tests and the Mann-Whitney U test were
applied to detect significant differences in lateral ceph-
alometric and CBCT measurements between the 2
groups. A P value of \0.05 was considered statistically
significant.
RESULTS
There were no significant differences in anteroposte-
rior cephalometric measurements between the groups
(P .0.05 for all; Table II). On the other hand, the
open-bite group exhibited significantly greater clock-
wise rotation of the mandibular planes (SN-MP and
FMA; P \0.001 for both) and greater maxillary posterior
alveolar height (U6-PP; P 5 0.013; Table II).
In the sagittal plane, the craniocaudal height of the
maxillary sinus between the first and second premo-
lars could not be measured in 2 patients from the
open-bite group and 1 patient from the control group
because the anterior boundary of the maxillary sinus
Ryu et al 799

Fig 2. CBCT measurements of the anteroposterior (AP) depth and mediolateral (ML) width. Dotted
line, measured axial section line.

Table II. Overall comparisons of lateral cephalometric

measurements between the normal occlusion and
open-bite groups
Normal occlusion Anterior open bite P
Measurement Mean (SD) Mean (SD) value
Anteroposterior
ANB (
) 2.7 (1.7) 3.5 (4.1) 0.536
Wits (mm) 3.0 (2.2) 3.7 (6.9) 0.684
Go-Me (mm) 83.3 (6.0) 80.2 (5.0) 0.139
Overjet (mm) 2.5 (0.7) 2.8 (3.9) 0.798
Vertical
SN-MP (
) 33.7 (3.9) 44.6 (3.8) \0.001
FMA (
) 24.4 (3.9) 35.4 (3.7) \0.001
SN-PP (
) 11.2 (3.1) 10.2 (3.0) 0.393
FH-PP (
) 1.9 (2.3) 1.0 (2.7) 0.304
PP-MP (
) 22.5 (3.8) 34.4 (4.1) \0.001
SN-OP (
) 19.1 (5.3) 23.4 (3.5) 0.057
AFH (mm) 136.4 (6.4) 140.4 (9.4) 0.330*
PFH (mm) 91.3 (7.0) 82.6 (7.9) 0.004
Facial height 66.8 (2.9) 58.8 (2.5) \0.001
ratio (%)
Overbite (mm) 2.3 (1.0) 2.0 (1.5) \0.001*
Fig 3. CBCT measurements of the cross-sectional area. U6-PP (mm) 25.9 (2.4) 28.3 (2.5) 0.013

P values were calculated with the independent t test unless other-

was located posterior to the second premolar in these
patients.
The heights of the maxillary sinus in the regions be-
tween the first and second molars, second premolar and
first molar, and first and second premolars in the open-
bite group were 40.5, 39.0, and 32.1 mm, respectively;
heights in the control group were 36.7, 34.7, and
29.2 mm, respectively. The craniocaudal heights of the
maxillary sinus in the region between the first and
second molars and between the second premolar and
first molar were significantly greater in the open-bite
group than in the control group (P 5 0.040 and
P 5 0.023, respectively; Table III).
The basal bone heights in the regions between the first
and second molars, second premolar and first molar, and
wise noted.
SN-MP, Angle of sella-nasion line to the mandibular plane; FMA,
angle of the Frankfort line to the mandibular plane; SN-PP, angle
of sella-nasion line to the palatal plane; FH-PP, angle of the
Frankfort line to the palatal plane; PP-MP, angle of the palatal
plane to the mandibular plane; SN-OP, angle of sella-nasion line
to the occlusal plane; AFH, anterior facial height; PFH, posterior
facial height; Facial height ratio, the ratio of posterior facial
height to anterior facial height; U6-PP, maxillary posterior alveolar
height.
*P value calculated with the Mann-Whitney U test.
first and second premolars were significantly smaller in
the open-bite group than in the control group
(P \0.001 for all; Table III). The basal bone height was
the shortest in the region between the maxillary first and
second molars, increasing gradually in the mesial direction.

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800 Ryu et al

In this study, there was no significant difference in the

Table III. Overall comparison of CBCT measurements
anterior facial height, which could have affected mea-
between the normal occlusion and open-bite groups
surements of vertical sinus height and basal bone height
Normal Anterior between the groups. However, the maxillary posterior
occlusion open bite P alveolar height (U6-PP) was significantly greater in the
Measurement Mean (SD) Mean (SD)value
open-bite group than in the control group (Table II).
Craniocaudal height
M1-M2 height (mm) 36.7 (5.0) 40.5 (4.7) 0.040 We speculate that the increased maxillary posterior alve-
PM2-M1 height (mm) 34.7 (4.3) 39.0 (5.3) 0.023 olar height in patients with an open bite may be associ-
PM1-PM2 height (mm) 29.2 (4.5) 32.1 (5.1) 0.122 ated with an inferiorly located sinus floor, consistent
Basal bone height with the opinions in previous studies.21,22 Arriola-
M1-M2 bone 11.5 (2.5) 7.0 (1.9) \0.001
Guillen and Flores-Mir22 reported that the molar height
height (mm)
PM2-M1 bone 12.0 (2.6) 8.3 (2.5) \0.001 was 4 mm greater in their open-bite group than in their
height (mm) control group, and Kucera et al21 reported that extrusion
PM1-PM2 bone 16.4 (2.8) 12.2 (2.4) \0.001 of the maxillary posterior teeth is a common finding in
height (mm) adults with a skeletal open bite. From a clinical perspec-
Anteroposterior 37.9 (4.9) 38.4 (3.0) 0.713*
tive, orthodontic treatment for patients with an anterior
depth (mm)
Mediolateral width (mm) 29.3 (3.3) 29.0 (3.5) 0.822 open bite should be primarily aimed at limiting or correct-
Cross-sectional 1187.6 (212.8) 1390.0 (251.4) 0.026* ing excessive dentoalveolar height in the posterior re-
area (mm2) gions. For the correction of a severe skeletal open bite,
The craniocaudal height between PM1 and PM2 of 2 patients in the
orthognathic surgery is generally necessary. However, or-
open-bite group and that of 1 patient in the control group could not thodontic camouflage treatment involving clinically
be measured because the anterior boundary of the maxillary sinus achievable molar intrusion using temporary anchorage
was located posterior to the second premolar in these patients. devices is an alternative that can improve this condition
P values were calculated with the independent t test unless otherwise and provide relatively acceptable esthetics without the
noted.
M1, First molar; M2, second molar; PM1, first premolar; PM2, sec-
risks and burdens of orthognathic surgery. To achieve
ond premolar. meaningful molar intrusion, a study on the anatomic lim-
*P value calculated with the Mann-Whitney U test. itations of orthodontic tooth movement, including a
maxillary sinus floor comprising cortical bone, is required.
There were no significant differences in anteroposte- Daimaruya et al10 performed histologic evaluations and
rior and mediolateral CBCT measurements between the confirmed that the alveolar bone around the root apices
groups (P 5 0.713, P 5 0.822, respectively; Table III). was remodeled when the maxillary premolars were
The cross-sectional area of the maxillary sinus on the im- intruded using a skeletal anchorage system in the bony
ages was significantly greater in the open-bite group nasal floor. The nasal floor membrane and a thin layer of
than in the control group (1390.0 and 1187.6 mm2, newly formed bone, which was intranasally elevated,
respectively; P 5 0.026; Table III). covered the intruded molar root. Nevertheless, external
apical root resorption without the formation of reparative
DISCUSSION cementum was observed. Therefore, because excessive
The maxillary sinus is the largest of the paranasal si- force can cause root resorption, the patients in the open-
nuses and exhibits a pyramidal shape, with the lowest point bite group in our study required careful treatment.23
lying in the region of the maxillary first and second molars. According to our results, we rejected the null hypoth-
With increasing age, the sinus floor tends to resorb, esis. There was a significant difference in pneumatiza-
creating dehiscences around the tooth roots.15-17 tion of the maxillary sinus floor between groups (Table
Pneumatization is a physiologic process that occurs in III), with more vertical pneumatization in the region be-
all paranasal sinuses during the growth period, resulting tween the first and second molars and between the sec-
in increases in the sinus volumes.18 The extent of pneu- ond premolar and first molar in the open-bite group
matization varies among subjects and between the right compared with that in the control group. Moreover,
and left sides. Although the precise mechanisms underly- the basal bone height was smaller in the open-bite group
ing pneumatization remain poorly understood, factors than in the control group, considering the inverse rela-
associated with variability in pneumatization include tionship between maxillary sinus pneumatization and
ethnicity, bone density, palatal height and width, and remaining basal bone.18
body size.7,19 The process of pneumatization is more Endo et al24 found no significant relationship between
significant after posterior tooth extraction and is maxillary sinus size and the sagittal relationship between
associated with atrophy of the adjacent alveolar bone.7,20 the maxilla and mandible. However, sinus pneumatization

November 2016  Vol 150  Issue 5 American Journal of Orthodontics and Dentofacial Orthopedics
Ryu et al
is more of a vertical phenomenon than a sagittal phenom-
enon. Therefore, it can be inferred that sinus pneumatiza-
tion is related to vertical malocclusion, not sagittal
malocclusion. In the previous study, patients with larger
cranial bases and nasomaxillary complexes tended to
exhibit larger maxillary sinuses.24 These results suggest
that dentofacial morphologic features can influence the
size and dimensions of the maxillary sinus.
To the best of our knowledge, this is the first study to
determine differences in the maxillary sinus floor levels
between adults with an anterior open bite and those
without. However, the nonrandomized, retrospective
design and small sample size may have limited the results,
with the retrospective design increasing the susceptibility
to bias in data selection and analysis. Mainly, the small
sample size restricted the ability to extrapolate these find-
ings to the general population, regardless of whether the
results of this study are statistically significant. Addition-
ally, our patients had a limited skeletal Class I or weak
Class II sagittal malocclusion. Evaluation of the different
skeletal patterns in patients with open bite will be helpful,
particularly for Class III patterns, which can cause
morphometric differences in posterior regions. Future
prospective studies with large sample sizes are warranted
to evaluate the sinus floor levels before and after intrusion
of the maxillary posterior teeth in patients with different
sagittal skeletal malocclusion patterns accompanied by
an anterior open bite.
CONCLUSIONS
Our results suggest that vertical pneumatization of the
maxillary sinus floor between the first and second molars
and between the second premolar and first molar is
greater in adult patients with an anterior open bite than
in those without, whereas the basal bone height in the
maxillary posterior region is lower in the open-bite pa-
tients. These factors must be considered before establish-
ing a treatment plan involving maxillary molar intrusion
in patients with an anterior open bite.
REFERENCES
1. Schudy FF. The rotation of the mandible resulting from growth: its
implications in orthodontic treatment. Angle Orthod 1965;35:36-50.
2. Fields HW, Proffit WR, Nixon WL, Phillips C, Stanek E. Facial
pattern differences in long-faced children and adults. Am J Orthod
1984;85:217-23.
3. Choi SH, Cha JY, Kang DY, Hwang CJ. Surgical-orthodontic treat-
ment for skeletal class II malocclusion with vertical maxillary
excess, anterior open bite, and transverse maxillary deficiency. J
Craniofac Surg 2012;23:e531-5.
4. van den Bergh JP, ten Bruggenkate CM, Disch FJ, Tuinzing DB.
Anatomical aspects of sinus floor elevations. Clin Oral Implants
Res 2000;11:256-65.
American Journal of Orthodontics and Dentofacial Orthopedics
801
5. Oktay H. The study of the maxillary sinus areas in different ortho-
dontic malocclusions. Am J Orthod Dentofacial Orthop 1992;102:
143-5.
6. Park JH, Tai K, Kanao A, Takagi M. Space closure in the maxillary
posterior area through the maxillary sinus. Am J Orthod Dentofa-
cial Orthop 2014;145:95-102.
7. Sharan A, Madjar D. Maxillary sinus pneumatization following ex-
tractions: a radiographic study. Int J Oral Maxillofac Implants
2008;23:48-56.
8. Sharan A, Madjar D. Correlation between maxillary sinus floor
topography and related root position of posterior teeth using
panoramic and cross-sectional computed tomography imaging.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:
375-81.
9. Oh H, Herchold K, Hannon S, Heetland K, Ashraf G, Nguyen V, et al.
Orthodontic tooth movement through the maxillary sinus in an
adult with multiple missing teeth. Am J Orthod Dentofacial Orthop
2014;146:493-505.
10. Daimaruya T, Takahashi I, Nagasaka H, Umemori M, Sugawara J,
Mitani H. Effects of maxillary molar intrusion on the nasal floor
and tooth root using the skeletal anchorage system in dogs. Angle
Orthod 2003;73:158-66.
11. Wehrbein H, Bauer W, Wessing G, Diedrich P. The effect of the
maxillary sinus floor on orthodontic tooth movement. Fortschr
Kieferorthop 1990;51:345-51.
12. Wehrbein H, Fuhrmann RA, Diedrich PR. Human histologic tissue
response after long-term orthodontic tooth movement. Am J Or-
thod Dentofacial Orthop 1995;107:360-71.
13. Hamdy RM, Abdel-Wahed N. Three-dimensional linear and volu-
metric analysis of maxillary sinus pneumatization. J Adv Res
2014;5:387-95.
14. Dahlberg G. Statistical methods for medical and biological stu-
dents. New York: Interscience Publications; 1940.
15. Bell GW, Joshi BB, Macleod RI. Maxillary sinus disease: diagnosis
and treatment. Br Dent J 2011;210:113-8.
16. Lee JE, Jin SH, Ko Y, Park JB. Evaluation of anatomical consider-
ations in the posterior maxillae for sinus augmentation. World J
Clin Cases 2014;2:683-8.
17. Woo I, Le BT. Maxillary sinus floor elevation: review of anatomy
and two techniques. Implant Dent 2004;13:28-32.
18. Nimigean V, Nimigean VR, Maru N, Salavastru DI, Badita D,
Tuculina MJ. The maxillary sinus floor in the oral implantology.
Rom J Morphol Embryol 2008;49:485-9.
19. Koppe T, Rohrer-Ertl O, Hahn D, Reike R, Nagai H. The relationship
between the palatal form and the maxillary sinus in orang-utan.
Okajimas Folia Anat Jpn 1996;72:297-306.
20. Wehrbein H, Diedrich P. Progressive pneumatization of the basal
maxillary sinus after extraction and space closure. Fortschr Kiefer-
orthop 1992;53:77-83.
21. Kucera J, Marek I, Tycova H, Baccetti T. Molar height and dentoal-
veolar compensation in adult subjects with skeletal open bite.
Angle Orthod 2011;81:564-9.
22. Arriola-Guillen LE, Flores-Mir C. Molar heights and incisor inclina-
tions in adults with Class II and Class III skeletal open-bite maloc-
clusions. Am J Orthod Dentofacial Orthop 2014;145:325-32.
23. Maeda Y, Kuroda S, Ganzorig K, Wazen R, Nanci A, Tanaka E. His-
tomorphometric analysis of overloading on palatal tooth move-
ment into the maxillary sinus. Am J Orthod Dentofacial Orthop
2015;148:423-30.
24. Endo T, Abe R, Kuroki H, Kojima K, Oka K, Shimooka S. Cephalo-
metric evaluation of maxillary sinus sizes in different malocclusion
classes. Odontology 2010;98:65-72.
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