Prevalence of intraoperative complications with open sinus lift and underwood septa

   The loss of maxillary masticatory teeth is associated with a decrease in both the height and width of the alveolar bone mass. In addition to the bone limits, implant placement to replace the missing tooth is complicated by the close proximity of the maxillary sinus floor. The above can negatively affect the success of the patient’s surgical rehabilitation. The maxillary sinus lift (MS), or sinus lift, can optimize the procedure and the results of dental implantation. Maxillary sinus floor lift surgery is a procedure with predictable results and a low complication rate, with an expected success rate of over 90 % in the long term. However, like any surgical procedure, a sinus lift comes with some complications. One of the most common complications is Schneider’s membrane perforation, which occurs either for iatrogenic reasons related to improper surgical actions or due to anatomical features of a particular patient that may complicate the procedure. A particularly interesting fact is the association of the incidence of MS membrane perforation with individual patient anatomy, particularly the presence of frontal or sagittal bony septa.

   The purpose of this study is to determine the relationship of the incidence of Schneider’s membrane perforation during sinus lift surgery in patients with and without bony septa in the MS.

   Materials and Methods. The present study included 100 patients who underwent open sinus lift surgery with subsequent implant placement. The participants were divided into 2 groups after studying the data of preoperative CBCT: group 1 – patients without septum in the MS (control group – 30 patients), group 2 – patients with septum in the MS (experimental group – 70 patients). Postoperative follow-up of the patients of both groups to monitor the presence of complications from Schneider’s membrane was performed on the 3^rd,5^th,7^th day according to clinical symptoms. Results. For group 1 patients (MS without septum), the rate of Schneider’s membrane perforation during sinus lift was 20 %, whereas for group 2 patients (MS with septum), the rate of perforation was 77.2 %.

   Conclusions. The obtained data indicate a higher incidence of Schneider membrane damage during open sinus lift surgery in patients with individual anatomical features of the MS compared to patients with classic MS anatomy. The above-mentioned necessitates a more thorough preoperative planning of the invasive intervention, as well as a detailed analysis of 3D radiographs (CBCT) of the maxillary sinus.

1. Altındağ A., Yıldırım C. N. Location, Size, and Prevalence of the Maxillary Sinus Septa: Comparison of Panoramic Radiography and Cone-Beam Computerize Tomography – Harran Üniversitesi Tıp Fakültesi Dergisi. – 2023;420(3):605-611. doi: 10.35440/hutfd.1318797.

2. Amine K., Slaoui S., Kanice F. Z., Kissa J. Evaluation of maxillary sinus anatomical variations and lesions: a retrospective analysis using cone beam computed tomography – Journal of Stomatology, Oral and Maxillofacial Surgery. – 2020;121(5):С. 484-489. doi: 10.1016/j.jormas.2019.12.021.

3. Barros M. S., do Amaral R. C., Pedron I. G., Shinohara E. H., Gaujac C. New perspectives about maxillary sinus lifting : a literature review – ARCHIVES OF HEALTH INVESTIGATION. – 2023;12(1):26-32. doi: 10.21270/archi.v12i1.5930.

4. Bornstein M. M., Seiffert C., Maestre-Ferrín L., Fodich I., Jacobs R., Buser D., von Arx T. An analysis of frequency, morphology, and locations of maxillary sinus septa using cone beam computed tomography – Int J Oral Maxillofac Implants. – 2016;31(2):280-7. doi: 10.11607/jomi.4188.

5. Giuseppe Lizio D.D.S., Antonio Mingione M.D., Claudio Marchetti M.D. The Pre-Implant ”Window-Osteotomy” Technique for the Atrophic Posterior Mandible – The Journal of Oral Implantology. – 2016;42(2):195. doi: 10.1563/aaid-joi-d-14-00144.

6. Henriques I., Caramês J., Francisco H., Caramês G., Hernández-Alfaro F., & Marques D. Prevalence of maxillary sinus septa : systematic review and meta-analysis – International Journal of Oral and Maxillofacial Surgery. – 2022;51(6):823-831. doi: 10.1016/j.ijom.2021.10.008.

7. Ivanov SJ, Yamurkova NF, Muraev AA, Migura SA. Management of Schneider’s membrane defects occurring during sinus elevator surgery. – Stomatologia. – 2010;89(2):48–51. doi: 10.17116/stomat202410301131.

8. Ivanov SS, Muraev AA, Muhametshin RF, Ivanov SJ, Sudiev SA, Gahri D, Jamurkova NF. Elimination of defects in the Schneiderian membrane during sinus lift operations. – Stomatologiia. – 2024;103(1):31-4.

9. Ivanov SY, Muraev AA, Yamurkova NF, Migura SA. Surgical tactics in perforation of the mucous membrane of the maxillary sinus arising during sinus-lifting surgery. – Journal of Stomatology. – 2009;2:176-8.

10. Kobets K., Kazaryan A., Bopkhoev S. Tissue-engineered bone implants for the replacement of jawbone defects. Literature review. International journal of Innovative Medicine. 2022;(2):21-26. doi: 10.33667/2782-4101-2022-2-21-26.

11. Molina A., Sanz-Sánchez I., Sanz-Martín I., Ortiz-Vigón A., Sanz M. Complications in sinus lifting procedures: Classification and management – Periodontology 2000. – 2022; 88(1):103-115. doi: 10.1111/prd.12414.

12. Pommer B., Ulm C., Lorenzoni M., Palmer R., Watzek G., Zechner W. Prevalence, location and morphology of maxillary sinus septa : systematic review and meta-analysis – Journal of clinical periodontology. – 2012;39(8):769–773. doi: 10.1111/j.1600-051x.2012.01897.x.

13. Rogoleva Gjurovski S. Evaluation of the efficiency of sinus lifting techniques – MEDIS–International Journal of Medical Sciences and Research. – 2022;1(2):37–41.

14. Sigaroudi A. K., Kajan Z. D., Rastgar S., Asli H. N.Frequency of different maxillary sinus septal patterns found on cone-beam computed tomography and predicting the associated risk of sinus membrane perforation during sinus lifting – Imaging science in dentistry. – 2017;47(4):261-267. doi: 10.5624/isd.2017.47.4.261.

15. Yamurkova N., Ivanov S., Mukhametshin R., Trubushkina E., Kutsenko A. Sinus lifting surgery with simultaneous sanation of the lower sections of the maxillary sinus. International journal of Innovative Medicine. 2022;(1):23–27. doi: 10.33667/2782-4101-2022-1-23-27.

16. Yang B., Wang T., Wen Y., Liu X. Association between sinus septa and lateral wall thickness with risk of perforation during maxillary sinus lift surgery : A systematic review and meta-analysis – PloS one. – 2024;19(8):e0308166. doi: 10.1371/journal.pone.0308166.