Risk factors contributing to membrane perforation in lateral window maxillary sinus elevation: systematic review and meta-analysis

Objective: To scrutinize the risk factors related to membrane perforation during lateral window preparation for maxillary sinus elevation. Study design: The investigation was conducted across different electronic databases, followed by a critical evaluation of studies that matched the inclusion criteria. Results: The studies identified several risk factors contributing to sinus membrane perforation. Thin membranes (<1.5 mm) are at significant risk of perforation compared to thicker ones. Smoking significantly increased the likelihood of perforation by 1.6 times, with one perforation occurring in every seven smokers treated. The presence of septa increased the risk of perforation three times compared to the absence of septa. There was a marginal significance (P = .05) that piezosurgery reduced the risk of perforation compared to rotary instruments. Limited evidence, based on three studies, indicated that the lateral wall thickness and the residual ridge height are significant factors for membrane perforation. The number of missing teeth and the window size did not appear to affect the likelihood of SMP. Conclusions: Although most studies are retrospective, several factors are associated with membrane perforation during lateral window sinus preparation. Among all studied factors, membrane thickness, septa, and smoking appear to be the most prominent.