Objective: The intimacy of the posterior superior alveolar artery (PSAA) with the lateral sinus wall makes it significant during sinus floor elevation for implant placement in the posterior maxilla. The objective of this study was to analyze crucial anatomical variations using cone beam computed tomography (CBCT). Materialsandmethods: 356 maxillary sinuses (178 CBCT scans—95 males and 83 females) were analyzed for the rate of detection of the PSAA, location relative to the lateral wall of the maxillary sinus, and distance of the PSAA to the sinus floor. The prevalence of any additional branches of the PSAA was recorded. Results: The PSAA was identified bilaterally in 150 cases (84.3%), unilaterally in 2 cases (1.12%,) and was undetectable in 26 cases (14.6%). The intraosseous course was most frequent in the molar region and a near-equal distribution between intraosseous and beneath the sinus membrane in the premolar region. The mean diameter of the PSAA was 1.67 ± 0.34 mm. The distance to the maxillary sinus floor measured 13.46 ± 4.24 mm, whereas the distance to the alveolar crest was 22.53 ± 2.32 mm. Two branches of the PSAA were observed in 27.34% (n = 82) of the cases. On average, the second branch was 12.34 ± 3.65 mm from the maxillary sinus floor and 21.89 ± 3.51 mm from the alveolar crest. Conclusion: Antrostomy preparation should be performed as mesial and as low as possible with a slight inferior curve around the area of the second premolar and first molar.
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