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| Title |
Sinus Septa Increase the Risk of Membrane Perforation During Lateral Window Sinus Augmentation |
| Clinical Question |
In patients requiring lateral window sinus augmentation, does the presence of a sinus septum compared to no septum increase the risk of membrane perforation? |
| Clinical Bottom Line |
In patients requiring lateral window sinus augmentation, the presence of a sinus septum increases the risk of membrane perforation. This is supported by three retrospective cohort studies in which sinus septa were significantly associated with membrane perforation. When a sinus septum is present, clinicians should be aware that there is an increased risk of perforation and be prepared to repair it. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 32724933 | Krennmair/2020 | 355 patients receiving 434 lateral window sinus augmentation surgeries | Retrospective Cohort Study | | Key results | Sinus perforation occurred in 103/434 (23.8%) of sinus augmentation procedures. A sinus septum was present 78 of the 103 perforated sinuses (75.7%) and 47 of the 331 non-perforated sinuses (14.2%). The presence of a sinus septa had an odds ratio of 31.992 (11.276-90.771) for sinus membrane perforation (P = 0.001). | | #2) 29655818 | Tukel/2018 | 120 patients receiving unilateral lateral sinus window augmentation | Retrospective Cohort Study | | Key results | Sinus perforation occurred in 22/120 (18.3%) of sinus augmentation procedures. A sinus septum was present in 10 out of the 22 perforated sinuses (43.5%) and in 12.4% of non-perforated sinuses. The presence of sinus septa had an odds ratio of 4.023 (1.180-13.607) for sinus membrane perforation (P=0.025). | | #3) 25921824 | Schwarz/2015 | 300 patients receiving 407 lateral window sinus augmentation surgeries | Retrospective Cohort Study | | Key results | Sinus septa were present in 110 out of 407 sinuses (27.1%). Sinus perforation occurred in 35/407 sinus augmentation procedures (8.6%). A sinus septum was present in 27 out of the 35 perforated sinuses (77.1%). Sinus septa had an odds ratio of 4.771 (1.777-12.807) for sinus membrane perforation (P = 0.002) | |
| Evidence Search |
("sinus"[All Fields] OR "sinus augmentation"[All Fields] OR "sinus lift"[All Fields] OR "sinus lift augmentation"[All Fields] OR "lateral window"[All Fields]) AND ("septa"[All Fields] OR "sinus septa"[All Fields] OR "sinus septum"[All Fields] OR "septum"[All Fields]) AND ("injury"[All Fields] OR "perforation"[All Fields])
Filters: in the last 5 years
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Comments on
The Evidence |
Validity: All three studies are retrospective cohort studies that address clearly focused issues. Cohorts were recruited in an acceptable way with specific inclusion and exclusion criteria; however, they may not be representative of the entire population since they were recruited within individual practices. Measurements were objective and reflective of the clinical questions. Only the Krennmair study had the same surgeon complete all the procedures. The Tukel study had surgeons of varying experience including junior residents, senior residents, and faculty, but surgeon experience was not statistically significant according to the results. Lastly, the odds ratio was much higher in the Krennmair study (OR = 31.992), while the Tukel (OR = 4.023) and Schwarz (OR = 4.771) studies reported lower odds ratios that were similar to each other.
Perspective: Sinus septa present a challenge clinically and require excellent surgical skills to carefully reflect the membrane around them. Surgical planning through CBCT analysis is essential to determine the best location of the lateral window(s) for optimal access during reflection of the sinus membrane.
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| Applicability |
Sinus septa are relatively common with an overall incidence of roughly 25%. According these studies, the odds ratio of perforating the sinus membrane during lateral window sinus elevation when a sinus septum is present varies from 4.023-31.992. Clinicians should carefully check CBCTs for sinus septa prior to lateral window sinus augmentation and be prepared to repair a perforation should it occur. |
| Specialty/Discipline |
(Oral Surgery) (Periodontics) |
| Keywords |
Lateral window sinus augmentation, sinus septa, perforation
|
| ID# |
3448 |
| Date of submission: |
11/25/2020 |
| E-mail |
dunegan@uthscsa.edu |
| Author |
Kara Dunegan, DDS |
| Co-author(s) |
Benjamin Neal, DMD |
| Co-author(s) e-mail |
nealb@uthscsa.edu |
| Faculty mentor/Co-author |
David Deas, DMD MS |
| Faculty mentor/Co-author e-mail |
deasd@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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