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The impact of anatomic, patient and surgical factors on membrane perforation during lateral wall sinus floor
Andrea Pizzini1, Hussein S Basma1, Peng Li2
1Department of Periodontology, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA.
Objectives:
This retrospective study aimed to evaluate the influence of anatomical, patient and surgical factors on the occurrence of membrane perforation (MP) during lateral window sinus floor elevation (LWSFE).
Material And Methods:
A review of LWSFE patient records between 2014 and 2019 accounted for MP occurrence, window surface area (WSA), intravenous sedation use, osteotomy instrument type and clinician experience. Preoperative cone beam computed tomography (CBCT) scans were analyzed for lateral wall thickness (LWT), LFM and LAM angles formed between lateral and medial walls at the floor and anterior wall, respectively, sinus width at 5-, 10- and 15-mm (LM-5, LM-10 and LM-15) from the floor, residual bone height (RBH), sinus pathologies, septa and arterial anastomoses. The generalized estimating equation (GEE) approach with a sandwich variance-covariance estimator was used to evaluate the associations with MP.
Results:
MP occurred in 25.74% of 202 LWSFE procedures (166 patients). Mean 1.6 mm-LWT, 3.2 mm-RBH, 95°-LFM, 75.5°-LAM, 12 mm-LM-5, 20.79% septa, 16.83% arterial anastomosis, 37.62% sinus pathology and 29.21% intravenous sedations, 85.24% WSA ≥ 40 mm2 and 57% >10 procedures/clinician were reported. Greater MP rates were encountered as follows: 38.3% (LWT ≥ 1.5 mm), 38% (LFM < 90°), 59.6% (LAM < 70°), 45.4% (LM-5 < 10 mm) and 36.4% (WSA ranged > 80 mm2 ), with statistically significant associations with all these outcomes (p < .05). The presence of pathologies was also associated with MP (p = .013). Associations between MP and the presence of septa and arterial anastomoses, age/gender, right/left sinus, RBH, clinician's experience, instrument type and intravenous sedation use could not be demonstrated.
Conclusions:
MP is significantly associated with thicker lateral walls, narrower sinuses, larger windows and existing sinus pathology.
Insights
Membrane perforation (MP) during lateral window sinus floor elevation (LWSFE) is linked to thicker lateral walls, narrower sinuses, and larger surgical windows. Sinus pathology also increases the risk of MP.
Area of Science:
- Oral and Maxillofacial Surgery
- Dental Implantology
- Anatomical Studies
Background:
- Lateral window sinus floor elevation (LWSFE) is a common procedure to augment bone height for dental implants.
- Membrane perforation (MP) is a potential complication that can affect treatment outcomes.
- Understanding factors influencing MP is crucial for improving surgical success rates.
Purpose of the Study:
- To investigate the association between anatomical, patient, and surgical variables and the occurrence of membrane perforation (MP) during lateral window sinus floor elevation (LWSFE).
Main Methods:
- A retrospective review of 202 LWSFE procedures (2014-2019) was conducted.
- Data collected included MP occurrence, surgical factors (window size, sedation, instrument, experience), and preoperative CBCT analysis (lateral wall thickness, sinus dimensions, bone height, pathology, anatomy).
- Generalized estimating equation (GEE) was used for statistical analysis.
Main Results:
- Membrane perforation occurred in 25.74% of procedures.
- Significant associations were found between MP and thicker lateral walls (≥1.5 mm), narrower sinus width (<10 mm at 5 mm from floor), smaller lateral wall angles (<90° LFM, <70° LAM), larger window surface area (>80 mm²), and presence of sinus pathology.
- No significant association was found with septa, arterial anastomoses, patient demographics, or clinician experience.
Conclusions:
- Thicker lateral walls, narrower sinus dimensions, larger surgical windows, and sinus pathology are significant risk factors for membrane perforation during LWSFE.
- These findings can help clinicians anticipate and potentially mitigate MP during LWSFE procedures.
