Background: After tooth loss, the posterior maxilla is usually characterized by limited bone height secondary to pneumatization of the maxillary sinus and/or collapse of the alveolar ridge that preclude in many instances the installation of dental implants. In order to compensate for the lack of bone height, several treatment options have been proposed. These treatment alternatives aimed at the installation of dental implants with or without the utilization of bone grafting materials avoiding the perforation of the Schneiderian membrane. Nevertheless, membrane perforations represent the most common complication among these procedures. Consequently, the present review aimed at the elucidation of the relevance of this phenomenon on implant survival and complications.
Material and methods: Electronic and manual literature searches were performed by two independent reviewers in several databases, including MEDLINE, EMBASE, and Cochrane Oral Health Group Trials Register, for articles up to January 2018 reporting outcome of implant placement perforating the sinus floor without regenerative procedure (lateral sinus lift or transalveolar technique) and graft material. The intrusion of the implants can occur during drilling or implant placement, with and without punch out Schneiderian. Only studies with at least 6 months of follow-up were included in the qualitative assessment.
Results: Eight studies provided information on the survival rate, with a global sample of 493 implants, being the weighted mean survival rate 95.6% (IC 95%), after 52.7 months of follow-up. The level of implant penetration (≤ 4 mm or > 4 mm) did not report statistically significant differences in survival rate (p = 0.403). Seven studies provided information on the rate of clinical complications, being the mean complication rate 3.4% (IC 95%). The most frequent clinical complication was epistaxis, without finding significant differences according to the level of penetration. Five studies provide information on the radiographic complication; the most common complication was thickening of the Schneiderian membrane. The weighted complication rate was 14.8% (IC 95%), and penetration level affects the rate of radiological complications, being these of 5.29% in implant penetrating ≤4 mm and 29.3% in implant penetrating > 4 mm, without reaching statistical significant difference (p = 0.301).
Conclusion: The overall survival rate of the implants into the sinus cavity was 95.6%, without statistical differences according to the level of penetration. The clinical and radiological complications were 3.4% and 14.8% respectively. The most frequent clinical complication was the epistaxis, and the radiological complication was thickening of the Schneiderian membrane, without reaching statistical significant difference according to the level of implant penetration inside the sinus.
Keywords: Bone grafting; Bone regeneration; Dental implant; Maxillary sinus; Maxillary sinusitis; Sinusitis.
Conflict of interest statement
Ethics approval and consent to participate
Consent for publication
Gian Maria Ragucci, Basel Elnayef, Fernando Suárez López del Amo, Hom-Lay Wang, Federico Hernández-Alfaro, and Jordi Gargallo-Albiol declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Effect of Maxillary Sinus Augmentation on the Survival of Endosseous Dental Implants. A Systematic ReviewSS Wallace et al. Ann Periodontol 8 (1), 328-43. PMID 14971260. - ReviewInsufficient data were present to statistically evaluate the effects of smoking, residual crestal bone height, screw versus press-fit implant design, or the effect of imp …
Effectiveness of Sinus Lift Procedures for Dental Implant Rehabilitation: A Cochrane Systematic ReviewM Esposito et al. Eur J Oral Implantol 3 (1), 7-26. PMID 20467595. - ReviewConclusions are based on few trials, usually underpowered, having short follow-ups, and often judged to be at high risk of bias, therefore they should be viewed as prelim …
Radiographic Analysis of a Transalveolar Sinus-Lift Technique: A Multipractice Retrospective Study With a Mean Follow-Up of 5 YearsE Soardi et al. J Periodontol 84 (8), 1039-47. PMID 21542733.The transalveolar sinus-lift technique was a safe, minimally invasive technique with an implant success rate comparable to traditional implantology. The implant success r …
Effect of Schneiderian Membrane Perforation on Posterior Maxillary Implant SurvivalN Nooh. J Int Oral Health 5 (3), 28-34. PMID 24155599.An intentional perforation of the Schneiderian membrane using a 2mm twist drill at the time of implant placement and protrusion of the implant up to 3mm beyond the sinus …
Outcome of Implant Therapy Involving Localised Lateral Alveolar Ridge and/or Sinus Floor Augmentation: A Clinical and Radiographic Retrospective 1-year StudyEJ Hansen et al. Eur J Oral Implantol 4 (3), 257-67. PMID 22043469.Localised lateral alveolar ridge and/or sinus floor augmentation performed before implant placement seems to be associated with few complications after 1 year. However, i …
- Roccuzzo M, Bonino L, Dalmasso P, Aglietta M. Long-term results of a three arms prospective cohort study on implants in periodontally compromised patients: 10-year data around sandblasted and acid-etched (SLA) surface. Clin Oral Implants Res. 2014;25(10):1105–1112. doi: 10.1111/clr.12227. - DOI - PubMed
- Esposito M, Grusovin MG, Rees J, Karasoulos D, Felice P, Alissa R, Worthington H, Coulthard P. Effectiveness of sinus lift procedures for dental implant rehabilitation: a Cochrane systematic review. Eur J Oral Implantol. 2010;3(1):7–26. - PubMed
- Felice P, Soardi E, Pellegrino G, Pistilli R, Marchetti C, Gessaroli M, Esposito M. Treatment of the atrophic edentulous maxilla: short implants versus bone augmentation for placing longer implants: five-month post-loading results of a pilot randomised controlled trial. Eur J Oral Implantol. 2011;4(3):191–202. - PubMed
- Esposito M, Cannizzaro G, Soardi E, Pistilli R, Piattelli M, Corvino V, Felice P. Posterior atrophic jaws rehabilitated with prostheses supported by 6 mm-long, 4 mm-wide implants or by longer implants in augmented bone. Preliminary results from a pilot randomised controlled trial. Eur J Oral Implantol. 2012;5(1):19–33. - PubMed
- Felice P, Pistilli R, Piattelli M, Soardi E, Corvino V, Esposito M. Posterior atrophic jaws rehabilitated with prostheses supported by 5×5 mm implants with a novel nanostructured calcium-incorporated titanium surface or by longer implants in augmented bone. Preliminary results from a randomised controlled trial. Eur J Oral Implantol. 2012;5(4):149–161. - PubMed