Potential risk factors for maxillary sinus membrane perforation and treatment outcome analysis

Abstract

Background Most common complication of sinus floor elevation (SFE) is sinus membrane perforation (SMP). Purpose To investigate the correlation between SMP and potential risk factors and to evaluate SMP treatment outcomes. Materials and Methods This study included patients who had undergone a SFE at Division of Oral Surgery and Orthodontics, Medical University of Graz from 2013 to 2017. Analysis of patients' records and CBCT focused on patient‐related risk factors (sinus contours, thickness of membrane and lateral sinus wall, interfering septa, crossing vessels, former oroantral communication) and intervention‐related risk factors (surgical approach, sides, number of tooth units, and sites). The outcome of SMP treatment was analyzed in the recalls. Results In all, 121 patients underwent 137 SFE. There were 19 cases of SMP (13.9%). Two significant factors were identified: maxillary sinus contours (P = .001) and thickness of the sinus membrane (P = .005). The sinus membrane perforation rate was highest in narrow tapered sinus contours and when the sinus membrane was thinner than 1 mm. Among 19 cases with SMP, no complications were seen upon recall. Conclusions Maxillary sinus contours and sinus membrane thickness seem to be relevant factors for SMP. Sinus membrane perforations were successfully treated by coverage with collagen membrane.

Clinical and radiographic outcomes of reentry lateral sinus floor elevation after a complete membrane perforation

“…Sinus membrane perforations can occur due to thin membranes, 6,20 operator error, 8 maxillary sinus contours, 6 the presence of septum, 21 and a small residual bone height 4 . In this study, 22 patients underwent reentry LSFE.…”

“…Maxillary sinus mucosa perforations are the most common complication during LSFE, with a reported incidence of 7%‐56% 3 . Despite various updates in both the surgical technique and instruments, problems remain unavoidable 6,17 . Previous studies showed that when the perforation was small, or less than 10 mm, the perforation could be repaired by collagen membrane coverage or by suture delicately 5,7 .…”

“…Despite the various technological advances, sinus membrane perforation remains the most common complication during LSFE 3,4 . Previous studies have shown when the perforations are small, the membranes can be repaired with collagen membrane coverage 5‐7 . No significant differences were observed in terms of bone formation and implant survival rates post‐repair compared to the non‐perforation group 5,7 .…”

Factors influencing the sinus membrane thickness in edentulous regions: a cone-beam computed tomography study

“…Increased sinus mucosal thickness (SMT) could be caused by a variety of inflammatory symptoms, and the influencing factors include patient-related factors like age or smoking history; tooth-related factors such as the presence of periapical lesions, severity of periodontal diseases, and the extent of alveolar bone loss; and factors related to the morphology of the maxillary sinus, such as the measurement section and the sinus septa [8][9][10]. Reports have indicated ostium obstruction in 59.3% of patients with SMT > 5 mm [11].…”

Analysis of maxillary sinus septa by cone-beam computed tomography

“…A high percentage of maxillary sinuses have bone septa within them, with variable sizes, localizations and thicknesses, making it an even more difficult task to detach the sinus floor membrane from the bone and create space to place the graft 5,6 . Studies have demonstrated that the presence of sinus septa was a predominant risk factor for perforation of the membrane in maxillary sinus lift processes using a lateral approach [7][8][9] .…”