Patient-Reported Outcome Measures (PROMs) in Sinus Elevation Procedures: A Systematic Review and Meta-analysis
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Purpose:
To evaluate patient-reported outcome measures (PROMs) related to maxillary sinus augmentation and alternative options for rehabilitation of the atrophic posterior maxilla.
Materials And Methods:
An electronic search was conducted on PubMed, Scopus, and Cochrane CENTRAL up to January 31, 2025, to identify randomized clinical trials (RCTs) and comparative nonrandomized clinical trials (non-RCTs) involving at least one group treated with maxillary sinus floor elevation (SFE), with a minimum of five patients per group, in which PROMs were assessed. The focused question was: In patients requiring rehabilitation of the atrophic posterior maxilla, is there a protocol superior to others among SFE using the lateral or transcrestal approach with or without grafting, and implant placement without augmentation, in terms of PROMs? Pairwise meta-analysis was done to estimate the overall effect when at least two studies with similar treatment comparisons, reporting the same outcome, were found. The primary outcome was postoperative pain, measured using a visual analog scale in the first 7 days after surgery. Secondary outcomes were any other PROMs, such as postoperative symptoms or standard satisfaction questionnaires.
Results:
The electronic search initially identified 104 articles. After removing duplicates, 56 articles were screened, and 12 studies (11 RCTs and 1 non-RCT) were finally included. Ten studies were judged at moderate risk of bias, with one RCT at a high risk and the non-RCT study at a moderate risk. Meta-analysis could be performed only for the proportion of patients reporting pain at 1, 3, and 7 days postoperatively. The graftless approach resulted in less pain at 3 and 7 days postoperative compared to SFE with grafting. Transcrestal SFE also showed less postoperative discomfort than lateral SFE.
Conclusions:
The results indicated that patients may experience reduced discomfort and inflammation when graftless procedures and transcrestal approaches are used. Overall, there is a paucity of evidence regarding the assessment of PROMs in the rehabilitation of the atrophic posterior maxilla.
