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Incidence and Associated Factors of Schneiderian Membrane Perforation in Maxillary Sinus Floor Elevation: A
Yanmei Liu1, Qiuyu Zhou2, Enhong Li3
1Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China.
Introduction And Aims:
Schneiderian membrane perforation (SMP) is a common intraoperative event during maxillary sinus floor elevation (MSFE), yet contemporary estimates of its incidence and determinants remain inconsistent, leaving preoperative assessment, surgical planning, and perioperative counselling insufficiently informed. This systematic review and meta-analysis synthesized evidence on SMP incidence and prespecified anatomical, patient-related, and procedural factors associated with intraoperative perforation.
Methods:
Six databases were searched from inception to October 2025 for observational studies reporting intraoperative SMP incidence and/or associated factors during MSFE. Two reviewers independently performed study selection, data extraction, and quality appraisal (AHRQ for cross-sectional studies; Newcastle-Ottawa Scale for cohort studies). Random-effects meta-analyses pooled incidence (patient- and surgery-level) and odds ratios (ORs).
Results:
Twenty-six studies (4519 patients) were included. The pooled SMP incidence was 0.19 (95% confidence interval [CI] 0.14-0.24; I² = 91.4%) per patient and 0.19 (95% CI 0.15-0.23; I² = 91.9%) per surgery. Sinus septa (OR = 3.56, 95% CI = 1.82-6.96) and smoking (OR = 2.57, 95% CI = 1.47-4.47) were associated with higher odds of perforation, whereas other prespecified factors showed no significant pooled effects. Findings were robust across sensitivity analyses, and no marked small-study effects were detected for the main pooled outcomes.
Conclusions:
SMP occurs in approximately one in five MSFE procedures. Preoperative identification of septa and targeted counselling for smokers may improve preoperative assessment and contingency planning. Future studies should adopt standardized CBCT measurement landmarks and report perforation phenotype and management.
Clinical Relevance:
Findings support structured preoperative assessment and informed consent focused on septa and smoking.
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