Incidence of Maxillary Sinus Membrane Perforation During Crestal Sinus Elevation: A Comparison of Osteotomes and Osseodensification Drills in Human Cadavers

This study aims to compare the incidence of sinus membrane perforation between osseodensification and osteotome crestal sinus lift techniques when 5 mm of residual bone is present beneath the sinus floor. Additionally, it seeks to identify when the perforation most commonly occurs-during instrumentation, bone grafting, or implant insertion. A split-mouth design using 20 sinuses from 10 fresh human cadaver heads were employed. One side underwent a bone-added osteotome crestal sinus lift, while the other side received an osseodensification lift. Membrane perforation was recorded through video analysis. Statistical analysis was performed. Sinus membrane perforation occurred in 40% of the osteotome group and 50% of the osseodensification group, with no significant difference between the two (P = .564). Most perforations occurred during implant placement (20% in the control group and 40% in the test group), but this difference was not statistically significant (P = .480). Perforations during drilling were observed in 10% of test sinuses and 20% of the control group, but this difference was not statistically significant (P = .317). No perforations occurred during bone graft placement. There was no significant difference in the incidence of membrane perforation between the osseodensification and osteotome groups. However, a higher incidence during implant placement suggests potential limitations in the predictability of crestal sinus lift procedures with 5 mm of residual bone. Further research is needed to optimize outcomes and predictability in crestal sinus lift procedures.