The influence of different forms of sinus membrane perforation on the prevalence of postoperative complications in lateral window sinus floor elevation: A retrospective study

Abstract

Background Maxillary sinus membrane perforation (SMP) during lateral window sinus floor elevation (SFE) might be associated with postoperative complications (PC). Objectives To evaluate the prevalence of PC and clinical implant outcome for different forms of SMP with lateral window SFE. Material and Methods The prevalence of PC such as maxillary sinusitis, graft necrosis and wound infection was retrospectively evaluated for 434 lateral window SFE (334 patients) with 331 SFE (241 patients) without and 103 SFE (93 patients) with SMP. SMP was additionally classified into four subgroups regarding to membrane perforation size (small‐moderate [<10 mm] vs. large [>10 mm]) and membrane biotype ([BT] thin vs. thick). Additionally, patient‐ and surgery‐related risk factors affecting PC and the 1‐year implant survival rate were evaluated for SFE without and with SMP and subgroups. Results A significantly higher prevalence including significant odds ratios of PC such as maxillary sinusitis (10/103 [9.7%] vs. 4/331 [1.2%]; p < 0.021; OR: 8.85; p < 0.021) and graft necrosis (7/103[6.8%] vs. 1/103[0.3%]; p < 0.017; OR:7.43; p < 0.017) was found for SFE with than without SMP. The SMP subgroup with large size and thin BT involved significantly (p < 0.005) more PC (15/20[75%]) than all other SMP subgroups (5/20[25%]). For the risk factors evaluated the univariate analysis demonstrated differences of PC for the presence versus absence of SMP (p < 0.001) and for thin versus thick sinus mucosa (p < 0.038; p < 0.006) but not for sex, smoking, sinus septa and surgical stage. In the multivariate risk factors analysis, PC were significantly related to risk factors such as large size with thin BT (OR:18.049; p < 0.007). The 1‐year implant survival rate did not differ between SFE without (99.5%) and with SMP (99.1%), regardless of successfully repaired subtype of SMP. Conclusion The synopsis of perforation size and membrane biotype is crucial in differentiating different forms of SMP assessing and anticipating different prevalences of PC in lateral window SFE.

Maxillary bone augmentation with calvarial bone graft for immediate full‐arch rehabilitation: Insights from a 10‐year proof‐of‐concept retrospective analysis

“…Despite thorough preoperative evaluation, antibiotic prescription before and after surgery, proper surgical technique, appropriate postoperative care, and patient education, sinusitis remained a concern. Similar to our study, Kahnberg and Vannas-Löfqvist (2008) and Krennmair et al (2022) reported a high incidence of sinusitis (9.7%-22%) in patients undergoing maxillary sinus augmentation.…”

Association between smoking and Schneiderian membrane perforation during maxillary sinus floor augmentation: A systematic review and meta‐analysis

“…Thus, the Schneiderian membrane biotype and the size of perforation were essential to evaluate the risk of postoperative complications in maxillary sinus floor elevation. 36 Lining in the inner part of the maxillary sinus cavities, the blood supply of Schneiderian membrane is derived from the anastomoses of the infraorbital artery and the posterior superior alveolar artery. 37 The sinus membrane is characterized by a periosteum overlaid with a layer of pseudostratified ciliated epithelium and the underlying highly vascularized connective tissue.…”

“…Not only as a physical barrier and maintains the normal function of the sinus, the integrity of the sinus membrane but also provides blood supply and osteogenic potential to enhance the graft maturation. Thus, the Schneiderian membrane biotype and the size of perforation were essential to evaluate the risk of postoperative complications in maxillary sinus floor elevation 36 . Lining in the inner part of the maxillary sinus cavities, the blood supply of Schneiderian membrane is derived from the anastomoses of the infraorbital artery and the posterior superior alveolar artery 37 .…”

Volumetric changes and graft stability after lateral window sinus floor augmentation: A randomized clinical trial

“…Krennmair and colleagues showed no differences regarding implant survival rates between LWSFA sites with (99.1%) and without (99.5%) perforations. 28 As a matter of fact, the reported prevalence of postoperative complications (e.g., maxillary sinusitis, graft necrosis) was highly correlated to presence of large sinus perforations within a thin SMT (OR = 18.04) but not to sex, smoking, presence of sinus septa and/or surgical stage. This is in accordance with the findings of this study as sinus perforations were observed (5 out of 24 LWSFA sites) and had no impact upon implant survival rates or onset of postoperative complications.…”