Available online 26 April 2023, 101887

Author links open overlay panel, , SummarySelection Criteria

The most recent search was performed in February 2022 and included an electronic search of four databases: PubMed, Web of Science, Embase, and Cochrane. Studies were included if they included participants aged 18 and above with maxillary sinus floor elevation prior to dental implant insertion and if data on participants' smoking habits and perforations in the Schneiderian membrane were provided. On the other hand, animal studies, reviews, and case reports were excluded.

Separately, two reviewers evaluated the title and abstract, collected data, and assessed the likelihood of bias in relevant studies; any discrepancies were discussed with the third reviewer. The Newcastle-Ottawa scale was used to evaluate the possibility of bias in the included reports.

Key Study Factor

This review compared the occurrence of Schneiderian membrane perforation between smokers and non-smokers undergoing maxillary sinus floor elevation before dental implant insertion.

Main Outcome Measure

The occurrence of the Schneiderian membrane perforation during maxillary sinus augmentation (i.e., Yes/ No).

Main Results

A total of 9 articles were included in the review, with 1424 patients included. Eight studies were retrospective trials, and one was a prospective clinical trial. All articles reported that the lateral window technique was used to lift the maxillary sinus. Three articles reported using two different procedures for maxillary sinus floor elevation: simultaneous implant placement during maxillary sinus elevation and maxillary sinus elevation followed by delayed implant placement.

Eight articles were selected for meta-analysis and synthesis. A random-effects model was used to evaluate Schneiderian membrane perforation in smoking patients due to differences in the adopted methodologies of included studies (p = 0.39, I2 = 5%). The analysis resulted in odds ratios (ORs) of 1.58 (95% CI, 1.10–2.25) for patients with Schneiderian membrane perforation during maxillary sinus augmentation. All included studies were considered at low risk of bias (i.e., high quality) according to the Newcastle-Ottawa scale.

Conclusion

The occurrence of Schneiderian membrane perforation after maxillary sinus augmentation is higher in smokers than in non-smokers. Maxillary sinus elevation was associated with an increased incidence of membrane perforation among smokers.

Section snippetsCommentary and Analysis

Pneumatization of the maxillary sinus results in a lack of sufficient bone in the posterior maxilla to maintain the stability of dental implants.1 The placement of the short implant,2 zygomatic implants,3 or sinus augmentation had been suggested as a solution for such cases.4 Maxillary sinus augmentation is considered a predictable treatment for rehabilitating the atrophic maxilla and has been modified over the years, where the Schneiderian membrane must be elevated to place the grafting

TYPE OF STUDY/DESIGN

Systematic review and meta-analysis

SOURCE OF FUNDING

National Natural Science Foundation of China, Grant/Award Number: 81801021; Hunan Provincial Health Commission, Grant/Award Number: B202308056991.

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