Study Explores Factors Influencing Membrane Perforation Risk in Maxillary Sinus Elevation

In a recent prospective cohort study, researchers delved into the complex factors that contribute to the risk of membrane perforation during maxillary sinus elevation procedures. 

This study aimed to provide valuable insights into the anatomical and patient-related elements that may increase the likelihood of membrane perforation. The findings could assist in improving the safety and success of sinus floor augmentation procedures performed through a lateral window approach.

Maxillary Sinus Augmentation

Restoring bone height in the posterior of the maxilla is often necessary for successful dental implant placement. Maxillary sinus augmentation has emerged as a reliable solution to address this issue. Among the techniques used for sinus augmentation, the lateral window approach is the most common, offering substantial membrane elevation and bone augmentation capabilities, outperforming transalveolar methods.

Common Challenge: Membrane Perforation

During sinus augmentation using the lateral window approach, membrane perforation represents a common intraoperative complication. Reports have indicated that membrane perforation prevalence can range from 10% to 60%. Various factors may contribute to membrane perforation, including the presence of sinus septa, maxillary sinus contours, thin sinus mucosa, and previous surgical interventions.

Despite several studies on membrane perforation risk factors, the findings have been inconsistent and at times contradictory. This research, therefore, aimed to address a fundamental question: “Among patients undergoing lateral window maxillary sinus elevation, which factors are linked to an increased risk of membrane perforation?” The study hypothesised that anatomical characteristics do not significantly impact the risk of perforation and, therefore, explored a range of anatomical and patient-related factors that could influence membrane perforation risk.

Unveiling Key Findings

The study enrolled 140 subjects (81 males and 59 females) with an average age of 54.66 years. These patients presented with edentulous areas at the posterior of the maxilla, characterised by insufficient bone height (<5 mm), making them candidates for sinus membrane elevation. Some noteworthy findings from the study include:

• The presence of septa was associated with a significant increase in membrane perforation risk, with a hazard ratio (HR) of 8.07.
• Patients with a single edentulous area spanning two or more teeth had an HR of 68.09 for perforation.
• Smoking was a substantial risk factor, with smokers having a 25 times higher likelihood of membrane perforation compared to non-smokers (HR 25).
• The presence of mucous retention cysts was linked to an HR of 27.75 for membrane perforation.

Over the course of the study, anatomical and patient-related factors were found to increase the risk of Schneiderian membrane perforation when utilizing the lateral window approach for sinus floor augmentation.

The study’s results underline the importance of identifying these risk factors and adopting strategies to mitigate the likelihood of membrane perforation, ultimately improving the safety and success of maxillary sinus elevation procedures.

Read the Full study: Which factors affect the risk of membrane perforation in lateral window maxillary sinus elevation? A prospective cohort study