Title Maxillary Sinus Membrane Perforation May Affect Implant Survival
Clinical Question In patients who undergo maxillary sinus augmentation, does perforation of the sinus membrane increase the risk for implant failure?
Clinical Bottom Line For patients who undergo maxillary sinus augmentation, there is conflicting data as to whether or not membrane perforation has an effect on future implant survival.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
30168884Al-Moraissi/201858 studies/2947 patients Systematic review and meta regression analysis
Key resultsImplant loss was higher when sinus membrane perforation was present (RR = 2.17, CI: 1.52-3.10, P = 0.001). There was also a positive correlation between the number of intraoperative sinus membrane perforations and implant failure (P = 0.005).
34250560Diaz-Olivares/20217 studies/1162 patientsSystematic review and meta-analysis
Key resultsThere was no significant difference between the survival rate of implants placed in perforated sites (97.68%) and non-perforated sites (98.88%) (p=0.229). The most frequent post-op complication after sinus membrane perforations was infection.
Evidence Search (sinus membrane perforation) AND (implants)
Comments on
The Evidence
Both studies are systematic reviews and meta-analyses, which represent the highest level of available evidence. However, different outcomes were observed. Both studies had well designed and clearly defined search and selection strategy. Al-Moraissi et al. (2018) included RCTs and non-randomized studies, of which 17 showed an unknown or high risk of bias. Included studies had data from both lateral and vertical sinus augmentation procedures, and procedures using piezoelectric and/or rotary instruments. Possible confounding factors were present including surgeon experience, size of membrane perforation, etc. and there was no discussion about perforation repair. The regression model also showed that sinus membrane perforation could only account for 52% of variation, meaning that 48% of implant failure may be due to other reasons. Diaz-Oliveras et al. (2021) included seven retrospective cohort studies (lower level of evidence), of which only 1 showed increased risk of bias. The cohort studies examined only lateral sinus augmentation procedures and presented data on membrane repair methods and post-op complications.
Applicability Sinus augmentation is a common procedure that is performed to allow for implant placement in the posterior maxilla. Perforation of the sinus membrane is the most common complication of this procedure. Although there are conflicting conclusions about the effect of intraoperative maxillary sinus membrane perforation on implant failure, it is important to note several key trends. Based on these two studies, both size (Diaz-Olivares et al., 2021) and number of perforations (Al-Moraissi et al., 2018) may have a significant effect on future implant survival. It is crucial that surgeons performing maxillary sinus lifts begin with thorough planning and use careful surgical technique to avoid intraoperative complications. However, when complications do arise, appropriate management and repair may minimize adverse future outcomes.
Specialty (Oral Surgery) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords Maxillary Sinus, Sinus Lift, Sinus Augmentation, Sinus Membrane Perforations, Implant
ID# 3497
Date of submission 11/19/2022
E-mail milesc@uthscsa.edu
Author Claire Miles, DMD
Co-author(s) Jason Nguyen, DDS
Co-author(s) e-mail nguyenj16@livemail.uthscsa.edu
Faculty mentor Angela Palaiologou-Gallis, DMD, MS
Faculty mentor e-mail palaiologoua@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?)
None available
Comments and Evidence-Based Updates on the CAT
None available